Functional gastrointestinal disorders are common in children and adolescents with complaints of abdominal pain. Our brains and our GI tracts are closely connected (the “mind-body connection”). Functional GI conditions are due to a combination of extra sensitivity of the GI tract, with changes in the motility or movement of the digestive system. Our stomachs and intestines are moving food all the time, and some people feel this more intensely than other people. It’s as if the “volume” has been turned up from their GI tract. When their brains receive these sensations, its reaction can change the motion of the GI tract. These conditions are common, sometimes run in families, and are usually found in individuals who are otherwise healthy. In children, that means they are growing well, have normal lab and x-ray results, and don’t have “alarm symptoms” like blood in the stool, weight loss or fevers.
The most common pediatric functional GI condition is functional abdominal pain. Children with this disorder usually experience recurrent pain in the middle of the abdomen. The pain may be severe, and commonly results in the child missing school and other activities. After taking a detailed history and performing a physical exam to see if the picture fits with functional abdominal pain and does not point in another direction, the doctor may recommend screening tests. Depending on the situation, these may include basic tests on blood, urine and stool, and imaging of the abdomen (e.g. ultrasound or x-rays). If those tests are normal (as expected in functional pain) health care providers may concentrate on making the pain better and returning the child to his/her normal activities. We search for common things that can worsen functional pain, like constipation, stress and various foods or additives in the diet. Having the patient keep a symptom diary also noting what they ate and drank, what they did each day and how their stools were can be really helpful, and helps the child feel like a part of the team along with his/her parents and the doctor. There are many different things that can be done to help the child feel better, and the process starts with the child and parents understanding the diagnosis, and knowing that although the pain is real and often intense, it is a “safe” condition to have.
When the abdominal pain or discomfort is relieved by stooling or is connected with a change in the frequency or consistency of the stool, we call that irritable bowel syndrome (IBS). Patients with this condition can have mucus (but not blood) in the stool and feel and look bloated. Sometimes they get the urgent need to stool when stressed, such as before a performance or test. When there is diarrhea involved we usually want to be sure there is no infection in the stool, and no large intake of sweetened clear liquids that may be causing or worsening the symptoms.
When the pain is in the upper abdomen and not related to stool changes, the term “functional dyspepsia” is used. If the child is taking medications called “NSAIDs” also known as nonsteroidal anti-inflammatory medications (like ibuprofen, Motrin™, Aleve™ and Advil™), it may be helpful to stop or reduce them as they may be contributing to the pain. Sometimes children with dyspepsia are given a course of acid-reducing medication, but if the problem continues, the doctor may do a scope test (“upper endoscopy” or “EGD”) to look for ulcers, acid reflux and stomach infections.
Treatments for functional gastrointestinal disorders differ based on what symptom is affecting the patient the most. These may include medications to decrease or increase movement of stool through the intestinal tract, decrease stomach acid, decrease intestinal spasm, change the mix of bacteria in the intestine, or decrease the amount of GI tract sensations that are reaching the brain. There are also important non-medicine treatments such as relaxation techniques, biofeedback, self hypnosis and specialized diets. As more research is done, the treatment options change. This, plus the fact that each patient is an individual means that it is best to discuss these choices with your child’s doctor.
If you think your child may have one of these conditions, talk to your doctor. You may also get more information at www.gikids.org.
Claire M. Wilson, MD, Providence Alaska Medical Center, Anchorage, AK, Jonathan S. Evans, MD, FACG, Nemours Children's Clinic, Jacksonville, FL, and Marsha H. Kay, MD, FACG, Cleveland Clinic, Cleveland, OH – Published July 2013.