British secondary school students report frequent abdominal pain with associated physical and emotional symptoms
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Correspondence to: Dr Miguel Saps
Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E Chicago Avenue, Box 65, Chicago, IL 60611, USA;
Commentary on: Vila M, Kramer T, Obiols JE, et al. Abdominal pain in British young people: associations, impairment and health care use. J Psychosom Res 2012;73:437–42.
Implications for practice and research
Abdominal pain is common in children, and frequently associated with anxiety, depression, school absenteeism and physical complaints such as headache and limb pain.
Assessment and treatment of children with abdominal pain should be underpinned by a biopsychosocial approach.
Functional abdominal pain research should use standardised research tools and definitions such as the Rome III criteria.
Between 20% and 40% of school children have weekly abdominal pain accounting for 2–4% of childhood medical consultations in the USA.1 ,2 Most abdominal pain is functional; no anatomical, biochemical or structural abnormalities are found. The health system burden and impairment of affected children remains poorly understood. Studies cannot be accurately extrapolated across countries, cultures and health systems, necessitating ongoing research in specific populations. Little is known about adolescent abdominal pain in the UK. Vila and colleagues aimed to investigate abdominal pain prevalence, characteristics and associated healthcare utilisation in a British adolescent cohort.
The study was conducted in March 2004 in a metropolitan co-educational school in England. Data were collected from 1251 school children 11–17 years of age. Data included demographic details, general health status and medical consultation for abdominal pain in the previous 3 months. Abdominal pain prevalence was assessed using a question adapted from The Child and Adolescent Psychiatric Assessment. Associated functional impairment was scored using a modified questionnaire based on the Children's Global Assessment Scale. The authors assessed physical (Children's Somatisation Inventory) and depressive (Moods and Feelings Questionnaire) symptoms from the previous 2 weeks. Behavioural problems over the prior 6 months were assessed using the Strengths and Difficulties Questionnaire. Data were analysed for internal reliability and group associations. Regression analysis was used to identify independent predictors of functional impairment and abdominal pain-related healthcare consultation.
Fifty-three per cent (n = 598) of children reported ‘stomach ache’ lasting longer than 1 h in the past 3 months. Within this group, 29% had pain at least once weekly. Students with abdominal pain were more likely to be female (63%), had more depressive symptoms, school absenteeism, and physical, emotional and behavioural problems than children who did not report a history of abdominal pain. Abdominal pain frequency, physical symptoms and somatic sensitivity to stress were independently associated with functional impairment. Medical and mental health consultations were more common in children with abdominal pain. Eighteen per cent of children consulted a doctor in the last 3 months for their pain.
The abdominal pain prevalence, characteristics and impact found by Vila and colleagues were similar to other school-based studies.1 ,3 The authors’ use of standardised research instruments and high survey completion rate in a focused population is strength of the study. The design accounted for the integrated nature of physical symptoms with emotion, behaviour and environment, and the biopsychosocial model, which is the cornerstone in management of functional abdominal pain. The authors identify the limitations of their study, which included a retrospective design and an inability to assess the role of menstruation and organic disease in relation to pain prevalence. Although retrospective studies may be affected by recall bias, they allow for collection of large data sets when prospective studies may not be possible.
The use of standardised questionnaires such as the Questionnaire on Paediatric Gastrointestinal Symptoms (QPGS) is desirable to help improve accuracy and specificity of diagnosis. The QPGS uses the Rome III diagnostic criteria which were developed by international experts in functional gastrointestinal disorders.4 Diagnosis of functional abdominal pain disorders by the Rome III criteria requires more than 2 months of weekly abdominal pain and no evidence of an organic disorder. Use of standardised survey instruments, including the QPGS and the Pediatric Functional Disability Inventory5 could assist in making comparisons between different cohorts of patients.
Future studies of paediatric functional abdominal pain prevalence and aetiology are needed. Identification of factors contributing to pain, associated disability and healthcare utilisation may lead to improved medical care and patient outcomes. There is a need for international studies of children with abdominal pain. Studying children of different cultures and background could help identify the relative impact of socioeconomics, health beliefs, healthcare access, language, climate, infections and other cultural phenomena6 in children with functional pain.