title: Recurrent abdominal pain in 200 children: somatic causes and diagnostic criteria.
abstract: OBJECTIVE
  To establish to what extent somatic causes can be found in children referred to secondary care with recurrent abdominal pain.
  
  
  METHODS
  For 2 years, all consecutive patients (age 4-16 years) fulfilling Apley criteria, referred to secondary care, were included. After a diagnostic work-up, stepwise therapeutic interventions were performed. A diagnosis was considered to be the cause of the pain when the patient became pain free following therapeutic intervention and remained so for at least 6 months.
  
  
  RESULTS
  Two hundred and twenty children (128 F, 92 M; mean age 8.8 years) were enrolled, of which 20 were lost to follow-up. Spontaneous recovery was seen in 54 patients, (occult) constipation in 92 patients (of whom 18 also had a somatic cause), gastrointestinal infections in 40, food allergy in five, miscellaneous disorders in seven and uncertain diagnosis in 13. In five patients, stress most likely caused the pain. A total of 198 patients became pain free and remained so during follow-up (mean 18, range 6-60 months).
  
  
  CONCLUSIONS
  In 200 children with recurrent abdominal pain, somatic causes were found in 26%. Laxative therapy was successful in 46%, resulting in nearly all patients with functional abdominal pain to become pain free. Eventually, 99% became pain free using a therapeutic intervention protocol.
authors.affiliation: Department of Paediatric Gastroenterology, Juliana Children's Hospital/Haga Teaching Hospital, The Hague, The Netherlands. cfm.gijsbers@planet.nl
authors.forename: C F M
authors.initials: CF
authors.lastname: Gijsbers
authors.forename: C M F
authors.initials: CM
authors.lastname: Kneepkens
authors.forename: J J
authors.initials: JJ
authors.lastname: Schweizer
authors.forename: M A
authors.initials: MA
authors.lastname: Benninga
authors.forename: H A
authors.initials: HA
authors.lastname: Büller
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D004035:Diet Therapy; D005260:Female; D005512:Food Hypersensitivity / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D005767:Gastrointestinal Diseases / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use; D008297:Male; D012008:Recurrence
chemical_list: D054368:Laxatives