Abdominal pain and irritable bowel syndrome in adolescents: A community-based study,☆☆,

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Abstract

OBJECTIVES: This study was undertaken to determine (1) the prevalence of gastrointestinal symptoms including abdominal pain in a community-based population of adolescents, (2) whether a subgroup of these subjects have symptoms resembling irritable bowel syndrome (IBS), and (3) whether anxiety and depression are more commonly found in adolescents with IBS-type symptoms compared with unaffected adolescents. METHODS: We collected data by administration of a gastrointestinal symptoms questionnaire, State-Trait Anxiety Inventory, and Children's Depression Inventory to middle school and high school students. RESULTS: A total of 507 subjects participated (mean age of middle school students 12.6 years; mean age of high school students 15.6 years). Abdominal pain was noted by 75% of all students. The pain occurred weekly in 13% to 17% of the subjects and was severe enough to affect activities in approximately 21%. Irritable bowel syndrome-type symptoms were noted by 17% of high school students and 8% of middle school students (p <0.01) who reported abdominal pain (n = 381), representing 14% and 6% of all high school and middle school students (p <0.005), respectively. Anxiety and depression scores were significantly higher for students with IBS-type symptoms compared with those without symptoms. Eight percent of all students had seen a physician for abdominal pain in the previous year. These visits were correlated with abdominal pain severity, frequency, duration, and disruption of normal activities but not with anxiety, depression, gender, family structure, or ethnicity. CONCLUSION: Recurrent abdominal pain and symptoms of IBS are commonly noted in a community-based adolescent population and frequently result in use of health care resources. Health care providers who work with this age group need to be able to recognize the symptom complex associated with IBS, as well as the possible relationship to anxiety and depression. (J PEDIATR 1996;129:220-6)

Section snippets

Subjects

Study subjects were recruited from the seventh grade (middle school) and tenth grade (high school) in a midsized town (population 60,000) in suburban Connecticut. Each student was asked to complete three questionnaires during the course of a health education class. A nurse research assistant explained the concept of the study and was available to answer any questions posed by the students. The purpose of the study had been previously explained to the students and their parents. All students had

Study subjects

More than 97% of the students present in school on the days the study was conducted completed the questionnaires (n = 507). Demographic characteristics of the study population are shown in Table I. The mean age of the middle school students was 12.6 years and that of the high school students 15.6 years. White students represented 74% of the study sample. Approximately 80% of the study subjects lived in two-parent households.

Abdominal pain

Data concerning abdominal pain are shown in Table II. Abdominal pain

DISCUSSION

Our study is unique in that it has characterized the nature and prevalence of gastrointestinal symptoms, anxiety, and depression in a community-based population of adolescents. We have determined that recurrent abdominal pain is a common problem for middle school and high school students, occurring weekly in 13% to 17% of this population and being severe enough to affect activity in approximately 21%.

An association between the onset of abdominal pain and looser or more frequent stools was noted

Acknowledgements

We thank the following individuals whose help was invaluable in the completion of this study: G. Amato, B. Davis, S. Curnias, M. Lefevre, D. Walkwitz, P. Moffo, E. Bessette, P. Berkel, N. Etienne, and M. Shoup.

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    From the Departments of Pediatrics, Psychiatry, and Psychology, Hartford Hospital, Connecticut Children's Medical Center, and University of Connecticut School of Medicine, Hartford, Connecticut

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    Reprint requests: Jeffrey S. Hyams, MD, Division of Pediatric Gastroenterology, Connecticut Children's Medical Center, 282 Washington St., Hartford, CT 06106.

    0022-3476/96/$5.00 + 0 9/21/73642

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