title: Recurrent abdominal pain in children: underlying pathologies in the absence of "alarm" symptoms.
abstract: BACKGROUND
  Recurrent abdominal pain (RAP) is a common disorder in childhood. However, it is not clear what the incidence of organic disease is, in the absence of "alarm" symptoms or signs. The aim of this study was to clarify if the performance of diagnostic tests can be useful in revealing underlying organic disorders.
  
  
  METHODS
  The participants were 4- to 16-year-old children, who had been referred to our tertiary care pediatric center. A total of 98 children (48 males, 50 females) with RAP but without any alarm symptoms or signs were selected. In the 98 selected children, the performance of diagnostic tests for suspected organic diseases was recommended.
  
  
  RESULTS
  Fourteen children refused diagnostic tests. Forty-eight out of 84 children with RAP without any alarm symptoms and signs received a diagnosis of organic disease. Nineteen (22.6%) patients resulted positive for lactose intolerance. Seventeen patients (20.2%) were affected by celiac disease. Two (2.4%) patients were positive for cow milk allergy. Nine (10.7%) patients resulted positive for ureteral calculosis. One (1.2%) was affected by teniasis. Thirty-three children of the 38 children tested positive for lactose intolerance, celiac disease or cow-milk allergy were completely symptom-free at the 6 months follow-up and the remaining five patients reported a significant lower mean level of pain severity overall. Seven of 9 children with calculosis improved symptomatology. At the next follow-up six children were again suffering from RAP.
  
  
  CONCLUSIONS
  Children with RAP should be referred to pediatric gastroenterologists if symptoms persist; testing should be performed even in the absence of alarm signs because of the high prevalence of underlying organic pathologies.
authors.affiliation: Department of Pediatrics, Second University of Naples, Naples, Italy - carlo.tolone@unina2.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Tolone
authors.affiliation: Department of Pediatrics, Second University of Naples, Naples, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Pellino
authors.affiliation: Department of Pediatrics, Second University of Naples, Naples, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Piccirillo
authors.affiliation: Department of Pediatrics, Second University of Naples, Naples, Italy.
authors.forename: Mariarosaria
authors.initials: M
authors.lastname: Letizia
authors.affiliation: Department of Pediatrics, Second University of Naples, Naples, Italy.
authors.forename: Ivano
authors.initials: I
authors.lastname: Belfiore
authors.affiliation: Department of General Surgery, Second University of Naples, Naples, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Tolone
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D000293:Adolescent; D002446:Celiac Disease / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007787:Lactose Intolerance / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D016269:Milk Hypersensitivity / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D012008:Recurrence; D012720:Severity of Illness Index; D062606:Tertiary Care Centers