A recent editorial (MK Farrell. J Pediatr 2016; 177: 16-17) provides many useful pointers from a master clinician along with commentary on an epidemiology study of recurrent abdominal pain (ML Lewis et al. J Pediatr 2016; 177: 39-43).
The main finding of the study which used an internet survey of mothers (children 4-18) was that 23% of US children met the Rome III criteria for a functional GI disorder. Constipation was the most common.
Key points in commentary:
- John Apley’s monograph The Child with Abdominal Pains “should be read by all who care for children.”
- Worldwide prevalence of functional GI disorders has been estimated to be 13%. Peak ages were 4-6 years and early adolescence with a greater prevalence in females
- “A variety of phamacologic and nonpharmacologic treatments have been proposed, but none have been consistently effective except perhaps cognitive behavioral therapy and hypnotherapy.”
- “Negative studies are not reassuring” [to families]
Pithy observations from Apley:
- “The more time the doctor spends on the history, the less time he is likely to spend on treatment.”
- “Doctors who treat the symptoms tend to file a prescription. Doctors who treat the patient are more likely to offer guidance.”
- “It is a fallacy that a physical symptoms always has a physical cause and needs a physical treatment.”
- “Anxiety like courage is contagious.”
My take: Dr. Farrell urges more research focus on interventions (diet, behavioral, alternative therapies, medical treatments) to improve outcomes and less focus on epidemiology.
Related blog posts:
- Anxiety and Functional Abdominal Pain | gutsandgrowth
- Brave New World: Psychotropic Manipulation … – gutsandgrowth
- Acupuncture for irritable bowel syndrome | gutsandgrowth
- Pain changes brain | gutsandgrowth
- Cognitive Behavioral Therapy for Childhood … – gutsandgrowth
- Dreaded Nausea | gutsandgrowth
- Disaccharidase Deficiencies in Recurrent Abdominal Pain …
- Unexplained chest pain | gutsandgrowth
- Does negative testing reassure patients? | gutsandgrowth
- Understanding Idiopathic Nausea | gutsandgrowth
- Does buspirone help functional dyspepsia? | gutsandgrowth
Disclaimer: These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician. This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.