Recurrent abdominal pain- abdo migraine, peptic ulceration, IBS

Recurrent abdominal pain- abdo migraine, peptic ulceration, IBS

1. abdominal migraine

   • often associated with abdominal pain in addition to headaches
   • in some kids, the abdo pain predominates
   • attacks of abdo pain
     • midline
     • associated with vomiting
     • associated with facial pallor
   • usually a personal or family hx of migraine

2. irritable bowel syndrome

   • also common in adults
   • associated w/ altered GI motility & abnormal sensation of GI events
   • Sx may occur ff a GI infection
   • abnormally forceful contractions thought to occur
     • modulated by stress and anxiety
   • pain experienced at lower volumes of inflation of bowel than normal
     • modulated by stress and anxiety
   • often a +ve fam hx present
   • characteristic set of sx
     • not all pts have every sx
     • abdo pain
       • often worse before, or relieved by defecation
     • explosive, loose or mucousy stools
     • feeling of incomplete defecation
     • contsipation
       • often alternating w/ normal or loose stools

3. peptic ulceration, gastritis & functional dyspepsia

   • duodenal ulcers uncommon in children
     • but consider if epigastric pain
       • especially if it wakes child at night
     • consider if hx of peptic ulceration in 1st degree relative
   • assocn btw H. pylori and duodenal ulcer in kids is not as strong as in adults
   • nodular antral gastritis
     • caused by H. pylori
       • usually IDed in antral gastric biopsies
       • make urease
         • C13 breath test
           • ff admin of 13 C labelled urea by mouth
           • detect presence
       • stool antigen for H. pylori
         • may be +ve in infected kids
       • serological tests unreliable in kids
     • assoc w/
       • abdo pain
       • nausea
   • Rx
     • if peptic ulceration suspected
       • proton pump inhibitors
         • e.g. omeprazole
       • and if H. pylori infection suggested by ix
         • eradication therapy
           • amoxicillin + metronidazole/clarithromycin
         • failure to respond to Rx or symptoms recur on stopping Rx
           • upper GI endoscopy
             • if normal
               • functional dyspepsia diagnosed
   • functional dyspepsia
     • sx of peptic ulceration
     • non-specific sx
       • early satiety
       • bloating
       • postprandial vomiting
       • delayed gastric emptying
     • Rx
       • hypoallergenic diet
         • some kids respond
       • difficult