Functional gastrointestinal disorders and visceral hypersensitivity in children and adolescents suffering from Crohn's disease.
BACKGROUND
Symptoms of abdominal pain are reported by children with active Crohn's disease (CD). During remissions abdominal pain improves in most children but some of them continue to experience pain. We hypothesized that these patients may suffer from protracted abdominal pain related to functional gastrointestinal disorders (FGID) and visceral hypersensitivity. The objective was to characterize the symptoms and to measure the rectal sensory threshold for pain (RSTP) by barostat in CD children and adolescents suffering from abdominal pain despite remission.


METHODS
Eight patients (median age 14.5 years; range 9.8-17) with quiescent CD but suffering from chronic abdominal pain were studied by rectal barostat. At the same time they completed validated questionnaires to assess FGID, anxiety, and depression. They were compared to 10 control children and 8 children with FGID also investigated in our laboratory.


RESULTS
All patients fulfilled Rome II criteria for irritable bowel syndrome (n = 5), functional abdominal pain (n = 2), and functional dyspepsia (n = 1). RSTP was significantly lower in CD patients compared to the normal controls: median (range) 25 mmHg (15-29) versus 40 mmHg (30-48) (P < 0.01). RSTP was similar in patients and children with FGID. Rectal compliance was similar in patients, children with FGID, and controls. Seven of the 8 patients had scores indicating an anxiety problem.


CONCLUSIONS
Protracted abdominal pain that affects children and adolescents with quiescent CD is related to FGID associated with visceral hypersensitivity and anxiety. The incidence of FGID in children suffering from CD requires further investigation.
Department of Pediatrics, Division of Pediatric Gastroenterology, Hôpital Sainte-Justine, Université de Montréal, Montréal, Québec, Canada. christophe.faure@umontreal.ca
Christophe
C
Faure
Lyse
L
Giguère
D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D000293:Adolescent; D000367:Age Factors; D016022:Case-Control Studies; D002648:Child; D002908:Chronic Disease; D015331:Cohort Studies; D003424:Crohn Disease / Q000150:complications* / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D008297:Male; D008365:Manometry; D010147:Pain Measurement; D017288:Pain Threshold; D011336:Probability; D012007:Rectum / Q000294:innervation / Q000473:pathology; D012016:Reference Values; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012684:Sensory Thresholds; D014781:Viscera / Q000294:innervation* / Q000473:pathology