Chronic recurrent abdominal pain is a common problem in children, occurring on average in 10-15% of school-age children (some authors report values up to 40%). Abdominal pain is a subjective finding that occurs due to many reasons. In a study he conducted in the 1950s, a researcher named Apley could not find an organic cause in more than 90% of children with abdominal pain and suggested that psychological factors played a very important role in the development of abdominal pain.
From the discovery of Helicobacter pylori. Later, various studies were conducted investigating the role of this bacterium in children with recurrent abdominal pain, and the frequency of this infection in these children was found to be between 7% and 44.4% in different countries. In a study we conducted at Cerrahpaşa Faculty of Medicine, Department of Pediatric Gastroenterology, Helicobacter pylori infection was detected in 65% of children who were brought to us with unexplained recurrent abdominal pain and underwent endoscopy (viewing the stomach and intestines with a special camera).
Helicobacter pylori can cause recurrent abdominal pain in children through gastritis, duodenitis (inflammation of the duodenum) and ulcers. Gastritis manifests itself with symptoms such as nausea and vomiting, as well as recurrent abdominal pain. Abdominal pain may occur mostly after eating, and in some cases, it may be a pain that wakes you up at night and can be confused with an ulcer. In some children, although Helicobacter pylori and gastritis accompanying this infection are detected incidentally, there may be no symptoms. These children may one day be brought to the emergency room with bleeding ulcers. Helicobacter pylori infection was detected in 55% of the children brought to our Department of Pediatric Gastroenterology with upper digestive system bleeding, and no cause of bleeding other than the presence of Helicobacter pylori could be detected in 33% of the cases. For this reason, when Helicobacter pylori infection is detected, at least in children who have a family history of ulcer disease, a risky disease such as kidney failure, or who use non-steroidal anti-inflammatory drugs due to a rheumatic disease, they should be treated to prevent possible complications.
A ulcer in the stomach or duodenum Ceres and esophagitis (inflammation of the esophagus) can also cause recurrent abdominal pain. Pain after eating is more in favor of gastritis, hunger pain and pain that wakes you up at night are more in favor of an ulcer. The presence of ulcers in other members of the family should alert the physician. In children with esophagitis, abdominal pain may be accompanied by chest pain, burning, and bitter water coming into the mouth.
Non-ulcer dyspepsia (indigestion) or functional dyspepsia is a condition in which complaints such as recurrent abdominal pain, gas, bloating, fullness, nausea, and vomiting occur. It is a situation in which no organic lesion can be detected in the examinations. In recent years, it has been shown that Helicobacter pylori infection is detected in some of these cases and that patients can experience significant improvement after treatment.
Endoscopy is required to demonstrate the presence of Helicobacter pylori infection and associated lesions. Thanks to endoscopy, gastritis, doduodenitis and ulcers accompanying Helicobacter pylori infection can be detected, and the tests necessary for the diagnosis of Helicobacter pylori can also be performed. Additionally, if present, esophagitis can be diagnosed.
Abdominal pain may also occur in other diseases arising from the digestive system. Constipation is a rather neglected disease in our country. Recurrent abdominal pain is common in children with constipation. Colitis (inflammation of the large intestine) is a disease that is occasionally seen in children and can cause abdominal pain as well as retardation in growth and weight gain. It may take years to be diagnosed.
Lactose intolerance (intolerance to milk sugar) is a disease that occurs after a certain age and can cause excessive gas and abdominal pain when milk is consumed, and diarrhea when the amount of milk increases. It is thought to be quite common in countries bordering the Mediterranean.
Diseases such as gallbladder stones or gallbladder inflammation can cause fever and jaundice as well as abdominal pain. Pancreatitis (inflammation of the pancreas gland) is another disease that can cause recurrent abdominal pain and digestive disorders and can be seen, although rarely, in children.
Apart from these, intestinal parasites cause conditions that are frequently seen in children in developing regions such as our country and can be confused with all kinds of diseases. may cause. Teeth grinding, drooling, recurring A child with symptoms such as abdominal pain, nausea, vomiting and diarrhea must be investigated for parasites.
Respiratory tract infections, sinusitis, pneumonia, kidney diseases (hydronephrosis, nephritis, urinary tract infection, stones..), Diseases related to the spine and spinal cord, some rheumatic diseases (familial Mediterranean fever, PAN..), some blood diseases, and some metabolic diseases are non-digestive causes that frequently cause abdominal pain in children.
As a result, abdominal pain is very common. In addition to accompanying many digestive system diseases, it can also be a presenting complaint of many diseases outside the digestive system. Therefore, before characterizing abdominal pain as psychological, the causes of abdominal pain should be investigated in the light of other complaints accompanying abdominal pain and physical and laboratory findings.
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