Abdominal pain impacts many kids and teenagers and is one of the most common reasons for referral to pediatric gastroenterology – accounting for almost 50% of all referrals. Up to 25% of youth experience chronic abdominal pain – defined as persistent or recurrent abdominal pain lasting more than two months – and finding relief can be both frustrating and challenging.
Kids and teens with a variety diseases and conditions – such as musculoskeletal conditions, inflammatory digestive diseases, or other disorders – may experience chronic abdominal pain related to an active flare, as a side effect of medications or from ongoing injury or use.
In most cases, however, chronic abdominal pain itself is the primary condition and is diagnosed as a disorder of gut-brain interaction (DGBI), previously known as functional gastrointestinal disorders (FGIDs). DGBIs are a group of conditions characterized by a variety of gastrointestinal symptoms (e.g., pain, nausea) and defined by the symptom-based Rome criteria (now in the 4th edition, Childhood Functional GI Disorders: Child/Adolescent).
In DGBIs, abdominal pain and other symptoms persist without any specific or consistent structural, anatomic, biochemical, or endoscopic abnormalities. Standard testing, such as bloodwork, stool studies, endoscopy or radiology studies are typically within normal ranges in DGBIs. For patients and families looking for answers as to why these symptoms continue, it can be incredibly frustrating, and sometimes seem invalidating, that kids are having such long-lasting, intense pain while many tests are reassuring their bodies are healthy in many ways.
While there is no specific test for DGBIs, we do know that these conditions can stem from an interplay of factors, including but not limited to:
- Increased sensitivity of the GI tract (a concept known as “visceral hyperalgesia”)
- Alterations in the gut microbiota and immune function
- Changes in GI tract motility
- Impact of diet and previous infections
- Psychological and cognitive and affective factors
- Health behavior patterns
Why Choose Lurie Children's?
We understand that chronic abdominal pain and other symptoms, and their implications are very real. Chronic abdominal pain is complex, and an effective treatment plan almost always includes a combination of treatment methods to address the range of biopsychosocial factors related to persistent abdominal pain.
Our interdisciplinary team takes an integrative approach from the very first visit. We aim to provide a comprehensive assessment of our patients and to develop an individualized treatment plan for patients and families. Our pediatric specialists are leading clinicians, researchers, and educators in their respective areas of healthcare, and all have unique expertise in pediatric abdominal pain.
Conditions We Treat
Our team treats chronic abdominal pain of all forms, with a special focus on pain predominant DGBIs (PP-DGBIs) and abdominal pain. PP-DGBIs and their major symptoms include:
- Irritable bowel syndrome – abdominal pain with changes in stools such as diarrhea or constipation
- Functional dyspepsia – fullness after eating, feeling full even with very little food, and pain or burning sensation in the upper abdomen area
- Abdominal migraine – repeated episodes of intense pain around the middle of the abdomen that involve other symptoms such as nausea, vomiting, headache, or difficulty eating or weight loss
- Functional abdominal pain, not otherwise specified – chronic abdominal pain that is continuous or episodic and does not clearly fit other conditions or diseases
Through our comprehensive, interdisciplinary assessment, our team may provide new diagnoses, confirm existing diagnoses, or help patients and families understand diagnoses and appropriate treatments.
Most patients with chronic abdominal pain also experience challenges in many areas of their life including:
- Sleep difficulties
- Decreased physical endurance and physical functioning
- Fatigue
- Anxiety and depressive mood
- Challenges attending school or keeping up with schoolwork, grades, and other things they enjoy with peers, friends, and family
Our team provides comprehensive treatment for the range of symptoms and changes in daily functioning that often come with chronic abdominal pain. We also work closely with colleagues in the following areas:
Our Specialists
Interdisciplinary care is a foundational feature of our program. Your child or teenager will be seen by a physician and clinical health psychologist during the initial office visit and throughout their course of treatment. Other clinicians who are often involved in our patients’ care may include dietitians, physical therapists, or social workers.
The current Chronic Abdominal Pain Program team includes:
Maria E. Perez, DO
Attending Physician, Gastroenterology, Hepatology & Nutrition
Bonnie S. Essner, PhD
Pediatric Psychologist, The Pritzker Department of Psychiatry and Behavioral Health
Peter T. Osgood, MD
Attending Physician, Gastroenterology, Hepatology & Nutrition
What to Expect
At the time of referral to our program, our team reviews patient clinical information, treatment history, and patient and family goals for their care to ensure patients and families are set up for success from the initial visit. Our team meets frequently to review patient cases to ensure care is collaborative and patients have a strong treatment plan.
New patients are seen by a pediatric gastroenterologist and a clinical health psychologist during the same visit to provide a truly integrated “whole person” assessment. As part of a thorough history, physical exam, and review of patient and parent responses on clinical forms, we evaluate:
- Health history – current and past diagnoses and treatments
- Symptom history and severity
- Health behaviors – sleep, eating, physical activity
- Daily functioning – how chronic abdominal pain relates to how patients are doing in school, activities, and with peers and family; patients’ interests and strengths
- Psychological functioning – patterns of thoughts, emotions, and behaviors
The goal of this initial visit is to address patient and family concerns about the ongoing symptoms, determine the need for additional testing, and make a treatment plan.
At the end of the visit, patients and families are provided with a comprehensive individualized treatment plan addressing the range of factors contributing to chronic abdominal pain, including:
- Diagnostic tests and/ or procedures that may be needed to assess symptoms
- Medication management, including prescription and over the counter treatments, and other integrative health strategies, such as guidance for dietary supplements
- Neuromodulation via IB-Stim®
- Health behaviors – e.g., sleep, diet, physical activity
- Evidence-based psychological strategies, including mindfulness interventions, hypnosis, other mind-body treatments, and cognitive and behavioral strategies to enhance health behaviors, emotional functioning, and daily activity
- Recommendations for school functioning – e.g., temporary accommodations, managing school attendance and schoolwork
- Referrals to clinicians closely associated with our program, such as physical therapists or registered dieticians
- Referral to additional specialists to address the many comorbidities often experienced by patients with DGBIs
Interdisciplinary appointments with the team are expected to occur on a regular basis. A typical course in our program generally includes 3-4 total outpatient visits with the physician and psychologist together, which allows for testing, holistic treatment, modifications to the treatment plan, and monitoring of progress.
Health & Behavior Treatment Course
Patients may also participate in a course of brief health and behavior treatment with the GI pain psychologist. The goals of this 6 – 8 appointment brief treatment course is to:
- Integrate mind and body practices (e.g., mindfulness) into patients’ treatment plans,
- Set goals for improving health behaviors that are related to GI symptoms (e.g., sleep, physical activity)
- Improve daily functioning (e.g., school attendance).
Many of our patients continue to see established mental health providers (e.g., psychologists, licensed social workers, psychiatrists) for conditions such as anxiety and depression while they participate in our program’s care and after completing this brief course of GI pain psychology treatment.
We aim to provide patients and families with treatment and resources to help improve symptoms and return to daily function.
Make an Appointment
Call to make an appointment with one of our specialists.
Our Location
Ann & Robert H. Lurie Children's Hospital of Chicago
225 E. Chicago Ave.Chicago, Illinois 60611
312.227.4000
Research
Members of the Chronic Abdominal Pain Program, and colleagues within Lurie Children’s and other research institutions, have an active research agenda with ongoing studies that include, but are not limited to:
- Evaluating a digital mindfulness-based intervention designed for adolescents and young adults with chronic health conditions
- Examining how differences in teenagers’ cognitive and affective patterns affect the abdominal pain and other body sensations that they experience
- Understanding the range of stressors experienced by teenagers with chronic abdominal pain conditions
- Exploring patient factors that affect pediatric primary care providers’ decisions for management of chronic abdominal pain
- Exploring the complex relations between the autonomic nervous system, and GI symptoms and motility, and the range of other symptoms that affect many kids and teenagers with DGBIs
Resources & Support
- Vernon-Roberts A, Alexander I, Day AS. Systematic Review of Pediatric Functional Gastrointestinal Disorders (Rome IV Criteria). J Clin Med. 2021 Oct 29;10(21):5087. doi: 10.3390/jcm10215087. PMID: 34768604; PMCID: PMC8585107.
- Childhood Functional Gastrointestinal Disorders: Child/Adolescent (theromefoundation.org)
- GIKids.org – Educational materials about sponsored by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition