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