Functional Abdominal Pain

Pt with h/o physical/sexual abuse presents with acute on chronic abdominal pain. Denies fever, weight loss, vomiting, bloody stools. Reports anxiety, bullying at school. Appropriate progression along growth curve; no fever, CVA tenderness, HSM, abdominal mass, jaundice on exam.

• Consider CBC, CRP, ESR, U/A, beta-hCG, total IgA, anti-tissue transglutaminase IgA, FOBT, and/or fecal ova/parasite testing

• Consider abdominal x-ray to r/o fecal retention

• Treatment

  • Start cognitive behavioral therapy

  • Start lactobacillus, lactol with pH-dependent peppermint oil

  • Child/adolescent > 40 kg: Consider trial of famotidine 20 mg BID

  • Consider trial of cyproheptadine

    • 2-6 y/o: 2 mg q8h

    • 7+ y/o: 4 mg q8h

  • If symptoms do not improve, consider referral to GI

  • Reassurance provided to family

Notes

• Responsible for 90-95% of chronic abdominal pain in children

• No evidence for fiber, amitriptyline, citalopram when treating pain