Research ArticleOriginal ResearchA

Prognosis of Abdominal Pain in Children in Primary Care—A Prospective Cohort Study

Yvonne Lisman-van Leeuwen, Leo A. A. Spee, Marc A. Benninga, Sita M. A. Bierma-Zeinstra and Marjolein Y. Berger
The Annals of Family Medicine May 2013, 11 (3) 238-244; DOI: https://doi.org/10.1370/afm.1490

Article Figures & Data

Figures

Tables

  • Table 1

    Baseline Characteristics of the 305 Participating Children

    CharacteristicBaseline
    Age, median (IQR), years7.8 (5.7–10.5)
    Age category, No. (%)
     4–5 years88 (28.9)
     6–9 years126 (41.3)
     ≥10 years91 (29.8)
    Sex, No. (%)
     Boys116 (38.0)
     Girls189 (62.0)
    Diagnosis of physician, No. (%)
     Generalized abdominal pain174 (57.0)
     Localized abdominal pain57 (18.7)
     Constipation31 (10.2)
     Gastroenteritis17 (5.6)
     Urinary tract infection/cystitis5 (1.6)
     Stomach pain2 (0.7)
     Appendicitis1 (0.3)
     Othera10 (3.3)
     No diagnosis available8 (2.6)
    Symptom classification, No. (%)
     Functional dyspepsia24 (7.9)
     Irritable bowel syndrome114 (37.4)
     Functional abdominal pain152 (49.8)
     Missing classification15 (4.9)

    • ICPC=International Classification of Primary Care.

    • ↵a Other diagnoses were acute upper respiratory tract infection (ICPC code R74, n = 3), otitis media (H71, n = 1), hernia inguinalis sinistra (D89, n = 1), pneumonia (R81, n = 1), mononucleosis infection (A75, n = 1), other viral disease with exanthema (A76, n = 1), lymphadenitis mesenterica (n = 1), fatigue/ malaise (A04, n = 1).

  • Table 2

    Prevalence of Chronic Abdominal Pain Among 305 Children With Abdominal Pain in General Practice, According to Sex and Age Categories

    Children With Chronic Abdominal Pain, No. (%)
    ParticipantsBaseline (n=305)3 Months (n=266)6 Months (n=256)9 Months (n=246)12 Months (n=283)
    Boys
     4–5 years13 (37.1)13 (41.9)10 (34.5)10 (34.5)8 (26.7)
     6–9 years24 (50.0)20 (42.6)14 (33.3)17 (42.5)13 (27.7)
     10–17 years11 (33.3)17 (58.6)12 (42.9)9 (36.0)11 (37.9)
     All48 (41.4)50 (46.7)36 (36.4)36 (38.3)32 (30.2)
    Girls
     4–5 years30 (56.6)27 (60.0)18 (40.0)16 (37.2)19 (38.0)
     6–9 years37 (47.4)40 (61.5)35 (53.0)30 (48.4)27 (36.5)
     10–17 years27 (46.6)34 (69.4)32 (69.6)31 (66.0)27 (50.9)
    All94 (49.7)101 (63.5)85 (54.1)77 (50.7)73 (41.2)
     Total group142 (46.7)151 (56.7)121 (47.3)113 (45.9)105 (37.1)
  • Table 3

    Prevalence of Chronic Abdominal Pain Among 305 Children With Abdominal Pain in General Practice, by Classification of Symptoms Resembling Functional Gastrointestinal Disorders

    Children With Chronic Abdominal Pain, No. (%)
    Symptom CategoryBaseline3 Months6 Months9 Months12 Months
    Functional dyspepsia11 (45.8)12 (54.5)9 (45.0)6 (28.6)6 (26.1)
    Irritable bowel syndrome48 (42.1)54 (54.0)46 (46.5)50 (52.6)45 (41.3)
    Functional abdominal pain75 (49.3)77 (58.8)60 (48.8)51 (44.0)51 (37.2)
    Missing8 (53.3)8 (61.5)6 (42.9)6 (42.9)3 (21.4)
  • Table 4

    The 3 Components of Impact at Each Follow-up Point

    ComponentBaseline No. (%)3 Months No. (%)6 Months No. (%)9 Months No. (%)12 Months No. (%)
    No impact22 (7.2)93 (33.8)105 (40.6)110 (43.3)142 (50.2)
    Impacta283 (92.8)176 (66.2)152 (59.4)137 (56.9)141 (49.8)
    Pain intensity277 (97.9)152 (86.4)135 (88.8)124 (90.5)120 (85.1)
    Absence137 (48.4)55 (31.3)40 (26.3)36 (26.3)51 (36.2)
    Medication81 (28.6)38 (21.6)29 (19.1)31 (22.6)34 (24.1)

    • ↵a Pain intensity = rating the pain as moderate to severe; absence = staying home from school or terminating or avoiding to play; medication = taking medication for the pain.

Additional Files

  • Supplemental Appendix

    Supplemental Appendix I. Assessment of the Pediatric Rome III Criteria (PRCIII) Adapted With Time Criterion as Proposed by von Baeyer

    Files in this Data Supplement:

  • The Article in Brief

    Prognosis of Abdominal Pain in Children in Primary Care-A Prospective Cohort Study

    Yvonne Lisman-van Leeuwen , and colleagues

    Background Chronic abdominal pain (pain at least once a month during at least 3 consecutive months, with an impact on daily activities) has major implications for a child's well-being and use of the health care system. This study describes the prognosis for children with abdominal pain in primary care.

    What This Study Found Chronic abdominal pain is highly prevalent and long lasting among children seen in primary care. In children ages 4 to 17 years with abdominal pain, most had or developed chronic abdominal pain. Chronic abdominal pain was present in 47 percent of children at the initial visit, and 79 percent at one or more follow-up points (3, 6, 9, and 12 months). The median duration of abdominal pain was 8.3 months, with children aged 10 to 17 years having the longest duration (median = 9 months). Girls had chronic abdominal pain more frequently during follow-up and with longer duration than boys.

    Implications

    • Given this poor prognosis, the authors call for follow-up of children with chronic abdominal pain.

  • Annals Journal Club

    May/Jun 2013: The Surprising Chronicity of Abdominal Pain in Children


    The Annals of Family Medicine encourages readers to develop a learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club and sharing the results of your discussions in the Annals online discussion for the featured articles. RADICAL is an acronym for Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care and then acting on those discussions.1

    HOW IT WORKS

    In each issue, the Annals selects an article or articles and provides discussion tips and questions. We encourage you to take a RADICAL approach to these materials and to post a summary of your conversation in our online discussion. (Open the article online and click on "TRACK Comments: Submit a response.") You can find discussion questions and more information online at: http://www.AnnFamMed.org/site/AJC/.

    CURRENT SELECTION

    Article for Discussion

    • Lisman-van Leeuwen Y, Spee LAA, Benninga MA, Bierma-Zeinstra SMA, Berger MY. Prognosis of abdominal pain in children in primary care--a prospective cohort study. Ann Fam Med. 2013;11(3):238-244.

    Discussion Tips

    This cohort study gives us a chance to see the big picture about abdominal pain in children that otherwise would become apparent only across a professional lifetime and then only with great attention.

    Discussion Questions

    • What are the study's research questions and hypotheses, and why do they matter?
    • How does this study advance beyond previous research and clinical practice on this topic?
    • How strong is the study design for answering the question?
    • To what degree can the findings be accounted for by:
      1. How patients were selected, excluded, or lost to follow-up over multiple time points?
      2. How the main variables were measured?
      3. Confounding (false attribution of causality because 2 variables discovered to be associated actually are associated with a 3rd factor)?
      4. Chance?
      5. How the findings were interpreted?
    • How were possible biases controlled for in analyses?
    • How do the sensitivity analyses affect your confidence in the findings?
    • What are the main study findings?
    • Does it surprise you how often pain is chronic among children complaining of abdominal pain?
    • How comparable is the study sample to similar patients in your practice? What is your judgment about the transportability of the findings?
    • How might the findings of this study affect your diagnostic approach to children complaining of abdominal pain?
    • How might the findings of this study influence how you talk with parents and children complaining of abdominal pain?
    • How might this study change your practice?
    • What researchable questions remain?

    References

    1. Stange KC, Miller WL, McLellan LA, et al. Annals Journal Club: It's time to get RADICAL. Ann Fam Med. 2006;4(3):196-197.

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