Study evaluating chronic abdominal pain and functional abdominal pain syndrome

Sangeeta Gupta; Gaurav Gupta; Prateek Sharda; Karan Mittal

doi:10.18203/2320-6012.ijrms20150619

Authors

Sangeeta Gupta Department of Physiology, M.M.I.M.S.R., Mullana-Ambala, Haryana
Gaurav Gupta Department of Surgery, M.M.I.M.S.R., Mullana-Ambala, Haryana
Prateek Sharda Department of Surgery, M.M.I.M.S.R., Mullana-Ambala, Haryana
Karan Mittal Department of Surgery, M.M.I.M.S.R., Mullana-Ambala, Haryana

DOI:

https://doi.org/10.18203/2320-6012.ijrms20150619

Keywords:

Chronic abdominal pain, Functional abdominal pain syndrome

Abstract

Background: Chronic abdominal pain (CAP) is a prevalent condition with a wide etiology and is often associated with significant health care utilization. A functional diagnosis, particularly, Functional abdominal pain syndrome (FAPS) is more challenging and has been a less extensively studied condition in adults as compared to other common functional gastrointestinal disorders. Hence, this study attempts to formulate a definite line of investigations, study various causes of chronic abdominal pain and to evaluate FAPS, in a population from Central India.

Methods: 100 patients in the age-group of 10-60 years with chronic abdominal pain were selected. A careful history, clinical examination and investigations were performed and final diagnosis was made on the basis of the available data.

Results: Eighty-nine out of hundred patients were found to be having some organic disorder causing CAP while eleven had functional gastrointestinal disorders. FAPS was diagnosed in three patients on the basis of Rome III diagnostic criteria while one had unspecified functional abdominal pain.

Conclusions: CAP is a multifactorial condition yet, a thorough history coupled with a complete physical examination and investigative profile help to a great extent in diagnosing the cause. FAPS should be diagnosed on the basis of a careful clinical history and characteristic pain behaviour during physical examination. A cost-effective and conservative approach should be adopted for investigations. Unlike the organic causes, FAPS should be treated with a biopsychosocial approach with a variable combination of pharmacological, cognitive-behavioural and psychological interventions.

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References

Apley J, Naish N. Recurrent abdominal pains: a field survey of 1,000 school children. Arch Dis Child. 1958;33(168):165-70.

Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Müller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut. 1999;45:S43-S47.

Wallander MA, Johansson S, Ruigomez A, Garcia Rodriguez LA. Unspecified abdominal pain in primary care: the role of gastrointestinal morbidity. Int J Clin Pract. 2007;61(10):1663–70.

Penston JG, Pounder RE. A survey of dyspepsia in Great Britain. Aliment Pharmacol Ther. 1996;10(1):83–9.

Sandler RS, Stewart WF, Liberman JN, Ricci JA, Zorich NL. Abdominal pain, bloating, and diarrhoea in the United States: prevalence and impact. Dig Dis Sci. 2000;45(6):1166–71.

Heading RC. Prevalence of upper gastrointestinal symptoms in the general population: a systematic review. Scand J Gastroenterol Suppl. 1999;231:3–8.

Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Thompson WG, et al. U.S. Householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci. 1993;38(9):1569–80.

Sandler RS, Stewart WF, Liberman JN, Ricci JA, Zorich NL. Abdominal pain, bloating, and diarrhoea in the United States: prevalence and impact. Dig Dis Sci. 2000;45(6):1166–71.

Wallander MA, Johansson S, Ruigomez A, et al. Unspecified abdominal pain in primary care: The role of gastrointestinal morbidity. Int J Clin Pract. 2007; 61:1663-70.

Penston JG, Pounder RE. A survey of dyspepsia in Great Britain. Aliment Pharmacol Ther. 1996;10:83-9.

Sandler RS, Stewart WF, Liberman JN, et al. Abdominal pain, bloating, and diarrhoea in the United States: prevalence and impact. Dig Dis Sci. 2000;45:1166-71.

Heading RC. Prevalence of upper gastrointestinal symptoms in the general population: a systematic review. Scand J Gastroenterol Suppl. 1999;231:3-8.

Halder SL, McBeth J, Silman AJ, et al. Psychosocial risk factors for the onset of abdominal pain. Results from a large prospective population-based study. Int J Epidemiol. 2002;31:1219-25.

Mayer EA, Tillisch K. The brain-gut axis in abdominal pain syndromes. Annu Rev Med. 2011;62:381-96.

Clouse RE, Mayer EA, Aziz Q, Drossman DA, Dumitrascu DL, Mönnikes H, Naliboff BD Functional Abdominal Pain Syndrome. Gastroenterology 2006;130(5):1492–7.

Functional Gastroduodenal Disorders Tack J, Talley NJ, Camilleri M, Holtmann G, Hu P, Malagelada JR, Stanghellini V. Gastroenterology. 2006;130(5):1466 –79.

Talley NJ, Zinsmeister AR, Schleck CD, et al. Dyspepsia and dyspepsia subgroups: a population based study. Gastroenterology. 1992;102:1259–68.

Agreus L, Svardsudd K, Nyren O, et al. Irritable bowel syndrome and dyspepsia in the general population: overlap and lack of stability over time. Gastroenterology. 1995;109:671-80.

Behar J, Corraziari E, Guelrud M, Hogan W, Sherman S, Toouli J. Functional gall bladder and sphincter of oddi disorders. Gastroenterology. 2006;130(5):1498-509.

Tolba R, Shroll J, Kanu A, Rizk MK. Chronic Abdominal Pain: An Evidence-Based, Comprehensive Guide to Clinical Management. Kapural L, editor. New York: Springer Science + Business Media; c2015. Chapter 2, The Epidemiology of Chronic Abdominal Pain; p.13-24. DOI 10.1007/978-1-4939-1992-5_2.

Gray DW, Dixon JM, Collin J. The closed eye sign: an aid to diagnosing non-specific abdominal pain. BMJ. 1988;297:837.

Carnett J. Intercostal neuralgia as a cause of abdominal pain and tenderness. Surg Gynaecol Obstet. 1926;42:625-32.

Kapural L, editor. Chronic abdominal pain: An Evidence-Based, Comprehensive Guide to Clinical Management. 2nd Ed: Springer; c2014. Chapter 11, Paediatric chronic abdominal pain; p.115-124.

Ammoury RF, Pfefferkorn Model R, and Croffie JM: Functional gastrointestinal disorders: past and present, World J Pediatr. 200;5(2):103-12.

Lake AM: Chronic Abdominal Pain in Childhood: Diagnosis and Management. Am FAM Physician. 1999;59(7):1823-30.

Svendsen JH, Munck LK, Andersen JR. Irritable bowel syndrome-prognosis and diagnostic safety. A 5-year follow-up study. Scand J Gastroenterol. 1985;20(4):415-8.

Mayer EA, Tillisch K. The brain-gut axis in abdominal pain syndromes. Annu Rev Med. 2011;62:381-96.

Sperber AD, Morris CB, Greemberg L, Bangdiwala SI, Goldstein D, Sheiner E, Rusabrov Y, Hu Y, Katz M, Freud T, Neville A, Drossman DA. Development of abdominal pain and IBS following gynecological surgery: a prospective, controlled study. Gastroenterology. 2008;134(1):75-84.

Nozu T, Kudaira M. Altered rectal sensory response induced by balloon distention in patients with functional abdominal pain syndrome. Biopsychosoc Med. 2009;3:13.

Walker LS, Sherman AL, Bruehl S, Garber J, Smith CA. Functional abdominal pain patient subtypes in childhood predict functional gastrointestinal disorders with chronic pain and psychiatric comorbidities in adolescence and adulthood. Pain. 2012;153(9):1798-806.

Sarkar S, Aziz Q, Woolf CJ, Hobson AR, Thompson DG. Contribution of central sensitisation to the development of non-cardiac chest pain. Lancet 2000;356(9236):1154-9.

Ballantyne JC. Functional Abdominal Pain. Pain: Clinical Updates 2013;21(2):1-6.

Leonard BE. The HPA and immune axes in stress: the involvement of the serotonergic system. Eur Psychiatry 2005;20 Suppl 3:S302-6.

Welgan P, Meshkinpour H, Beeler M. Effect of anger on colon motor and myoelectric activity in irritable bowel syndrome. Gastroenterology. 1988;94(5 Pt 1):1150-6.

Moloney RD, O'Mahony SM, Dinan TG, Cryan JF. Stress-induced visceral pain: toward animal models of irritable-bowel syndrome and associated comorbidities. Front Psychiatry. 2015;6:15.