Prognosis of chronic or recurrent abdominal pain in children.
BACKGROUND
Chronic abdominal pain (CAP) or recurrent abdominal pain is common in childhood and is rarely associated with organic disease. With modern diagnostic technology, new organic abnormalities are found in children with CAP. Thus far a causal relation between these abnormalities and CAP has not been established. The additional prognostic value of extensive testing of children with CAP is a subject of debate.


OBJECTIVE
To investigate how often abdominal pain persists in children with CAP and to investigate whether medical tests such as laboratory tests, imaging, and endoscopy have additional prognostic value to history taking and clinical examination.


METHODS
A systematic search was conducted in MEDLINE, EMBASE, and PsycINFO for prospective cohort studies published from 1960 until October 2005. The most common medical key words for CAP were used in our search strategy. The methodological quality of studies was determined. Clinical heterogeneity between studies was analyzed. The percentages of children with abdominal pain after follow-up were pooled.


RESULTS
The search yielded 2620 citations, of which 18 studies met the inclusion criteria. In total, 1331 children were followed up for 5 years (median, range 1-29 years). In total, 29.1% (95% CI 28.1-30.2) of patients with CAP had abdominal pain after follow-up. The prognosis of CAP diagnosed clinically was similar to that diagnosed after additional medical testing.


CONCLUSIONS
CAP persisted in 29.1% (95% CI 28.1-30.2) of children. In the absence of alarming symptoms, additional diagnostic testing did not influence the prognosis of CAP.
Gieteling
Marieke J
MJ
Department of General Practice, Erasmus Medical Centre, Rotterdam, The Netherlands. m.gieteling@erasmusmc.nl
Bierma-Zeinstra
Sita M A
SM
Passchier
Jan
J
Berger
Marjolein Y
MY
D015746:Abdominal Pain / Q000175:diagnosis* / Q000473:pathology / Q000523:psychology; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D003937:Diagnosis, Differential; D003955:Diagnostic Tests, Routine / Q000379:methods* / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D015201:Meta-Analysis as Topic; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012720:Severity of Illness Index; D055815:Young Adult