Diagnostic Approach to Abdominal Pain in School-Age Children

Abdominal pain is probably the most common cause of addressing a doctor or of school absenteeism. The family doctor, the pediatrician, and the school doctor must identify the red fl ags that can direct the diagnosis towards an organic cause (acute, chronic, or even a surgical emergency). They also have to be aware of functional causes of abdominal pain in school-age children and adolescents. The pathogenesis of functional abdominal pain is multifactorial, based on the interrelationship between visceral hypersensitivity and the alteration of gastrointestinal motility. The Roma IV criteria help a proactive diagnosis of functional gastrointestinal disorders: functional dyspepsia, irritable bowel syndrome, abdominal migraine, and functional abdominal pain. In functional abdominal pain, there are no biochemical markers or structural changes that allow an objective diagnosis or the monitoring of these disorders. The decision to use diagnostic tests is left to the physician. Functional abdominal pain can infl uence a child's school performance and social relationships and may associate anxiety, depression, and extra-intestinal manifestations, with poor quality of life. Thus a correct diagnosis and management of abdominal pain are essential for these children.