Epidemiology, diagnosis and management of functional abdominal pain in children: A look beyond the belly

Chronic abdominal pain represents a common problem in children. In almost 90% of children presenting with chronic abdominal pain, no organic cause is found and a diagnosis of functional abdominal pain is made. Initially this condition was referred to as ‘recurrent abdominal pain’ by Apley and Naish and it is currently defined as abdominal pain-related functional gastrointestinal disorders (AP-FGIDs); divided into functional dyspepsia (FD), irritable bowel syndrome (IBS), abdominal migraine (AM), functional abdominal pain (FAP) and functional abdominal pain syndrome (FAPS) according to the Rome III criteria. Children with AP-FGIDs report impaired health-related quality of life in relation to physical complaints and AP-FGIDs are ranked as second in causing school absence. The underlying pathophysiology of AP-FGIDs is considered to be multifactorial, but needs further elucidation. This lack of understanding often leads to extensive investigations, non-effective therapeutic modalities and staggering healthcare costs. This thesis elucidates current and new knowledge regarding epidemiology, pathophysiology, diagnostic workup and treatment of functional abdominal pain to improve the understanding and to maximize the quality of care for children suffering from this condition. The focus of this thesis is to identify risk factors for developing pediatric AP-FGIDs and to evaluate diagnostic and therapeutic strategies. This thesis ends with the evaluation of a new complementary treatment option