Unexplained gastrointestinal symptoms after abuse in a prospective study of children at risk for abuse and neglect.
OBJECTIVE
Unexplained gastrointestinal symptoms are more common in adults who recall abuse as a child; however, data available on children are limited. The aim of this study was to investigate the association of childhood maltreatment and early development of gastrointestinal symptoms and whether this relation was mediated by psychological distress.


METHODS
Data were obtained from the Longitudinal Studies of Child Abuse and Neglect, a consortium of 5 prospective studies of child maltreatment. The 845 children who were observed from the age of 4 through 12 years were the subjects of this study. Every 2 years information on gastrointestinal symptoms was obtained from parents, and maltreatment allegations were obtained from Child Protective Services (CPS). At the age of 12 years children reported gastrointestinal symptoms, life-time maltreatment, and psychological distress. Data were analyzed by logistic regression.


RESULTS
Lifetime CPS allegations of sexual abuse were associated with abdominal pain at age 12 years (odds ratio [OR] = 1.75; 95% confidence interval [CI] = 1.1-2.47). Sexual abuse preceded or coincided with abdominal pain in 91% of cases. Youth recall of ever having been psychologically, physically, or sexually abused was significantly associated with both abdominal pain and nausea/vomiting (range, OR = 1.5 [95% CI, 1.1-2.0] to 2.1 [95% CI, 1.5-2.9]). When adjusting for psychological distress, most effects became insignificant except for the relation between physical abuse and nausea/vomiting (OR = 1.5; 95% CI, 1.1-2.2).


CONCLUSIONS
Youth who have been maltreated are at increased risk for unexplained gastrointestinal symptoms, and this relation is partially mediated by psychological distress. These findings are relevant to the clinical care for children who complain of unexplained gastrointestinal symptoms.
van Tilburg
Miranda A L
MA
Division of Gastroenterology and Hepatology, Center for Functional GI & Motility Disorders, School of Medicine, University of North Carolina, Chapel Hill, North Carolina 27599-7080, USA. tilburg@med.unc.edu
Runyan
Desmond K
DK
Zolotor
Adam J
AJ
Graham
J Christopher
JC
Dubowitz
Howard
H
Litrownik
Alan J
AJ
Flaherty
Emalee
E
Chitkara
Denesh K
DK
Whitehead
William E
WE
D015746:Abdominal Pain / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D002648:Child; D002649:Child Abuse / Q000523:psychology*; D002675:Child, Preschool; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology*; D014481:United States / Q000453:epidemiology