or interpersonal psychotherapy and stress management. In a review of published psychological trials, Talley et al found methodological problems in all the studies, concluding that the efficacy of psychological treatment for IBS could not yet be established (171) .Despite the fact that alterations of enteric flora may play a role in IBS, convincing evidence for a pathogenic role of bacterial overgrowth or for a beneficial effect of probiotic therapy is still scant. A review of the therapeutic role of probiotics concluded that further studies are needed to identify particular subgroups of patients with IBS who could benefit from their use (172) . More recently, however, a very encouraging randomized, doubleblind and placebo-controlled study in adults with diarrhea-predominant IBS showed efficacy for the probiotic preparation „VSL3‟ (173) . These findings will of course have to be reproduced in children. In chronic cases of refractory pain, referral to specialized treatment centers for an interdisciplinary pain management approach may be the most efficient method of treating disability. Natural history Functional abdominalpain is not always a benign condition with a satisfactory outcome. Long-term psychiatric disorders have been identified in patients suffering from functional abdominalpain in childhood (174) . Children with abdominalpain do not necessarily continue to experience physical symptoms in adulthood but may have an increased risk of adult psychiatric disorders (175) .
Chronicabdominalpain (long-standing intermit- tent or constant abdominalpain) is common in chil- dren and adolescents. In most children, chronic ab- dominal pain is functional, that is, without objective evidence of an underlying organic disorder. Yet, an important part of the physician’s job is to determine which children have an organic disorder. A review of the current evidence, however, indicates that there are no studies showing that pain frequency, severity, location, or effects on lifestyle help to discriminate between functional and organic disorders. Children with chronicabdominalpain are more likely than children without chronicabdominalpain to have headache, joint pain, anorexia, vomiting, nausea, ex- cessive gas, and altered bowel symptoms, but there is insufficient evidence that the presence of the asso- ciated symptoms can help the physician discriminate between functional and organic disorders. Although children with chronicabdominalpain and their par- ents are more often anxious or depressed, the pres- ence of anxiety, depression, behavior problems, or recent negative life events does not seem to be useful in distinguishing between functional and organic ab- dominal pain.
All children aged 5 to 12 years with chronicabdominalpain as per the above criteria attending the pediatric medicine and pediatric surgery outpatient departments were enrolled in pediatric gastroenterology out-children department after parental consent. Following a detailed history and physical examination, children were subjected to baseline investigations like complete blood count, urine routine and culture examination, stool routine examination, ultra sound abdomen and pelvis, X-ray chest, mantoux, liver function test, serum amylase. Upper oesophagogastroduoduenal endoscopy was done in all the children and barium study was done when required.
ABSTRACT. Children and adolescents with chronicabdominalpain pose unique challenges to their caregiv- ers. Affected children and their families experience dis- tress and anxiety that can interfere with their ability to perform regular daily activities. Although chronic ab- dominal pain in children is usually attributable to a functional disorder rather than organic disease, numer- ous misconceptions, insufficient knowledge among health care professionals, and inadequate application of knowledge may contribute to a lack of effective manage- ment. This clinical report accompanies a technical report (see page e370 in this issue) on childhood chronic abdom- inal pain and provides guidance for the clinician in the evaluation and treatment of children with chronic ab- dominal pain. The recommendations are based on the evidence reviewed in the technical report and on consen- sus achieved among subcommittee members. Pediatrics 2005;115:812–815; abdominalpain, irritable bowel syn- drome, functional bowel disorders.
Recent advances on the role of 5-HT in the enteric ner- vous systems and its relationship to intestinal visceral hyperalgesia have contributed significantly to the under- standing of abdominalpain and IBS in adults. This increased knowledge has helped shift the paradigm that these disorders are exclusively behavioral in nature and that pathophysiologic disturbances at the cellular level exist. To date, the consideration of inflammation and intestinal pain has been traditionally reserved for condi- tions such as Crohn ’ s disease and ulcerative colitis. The preliminary findings presented in this manuscript indi- cate that similar relationships may exist in the pediatric population with chronicabdominalpain of unknown origin. Future research is needed in order to uncover the associated causes of abdominalpain without inflam- matory pathology in pediatric patients. Novel medical treatments can arise by unveiling the role of mast cells and 5-HT in the pathophysiology of chronicabdominalpain of unknown origin in children.
The outcome of children with pain is shown in table 3. Persistent abdominalpain in childhood was associated with psychiatric disorder, and this associ- ation remained after correction for potential con- founders in an ordinal regression model. Childhood pain was only very weakly associated with abdominalpain and headache at 36 years but was associated with increasing numbers of physical symptoms at this age. Because there is a strong association between psychiat- ric disorder and physical symptoms, psychiatric disorder was added to the model, and this led to the association between persistent abdominalpain and physical symptoms in adulthood failing to reach significance. None of the children with persistent abdominalpain developed inflammatory bowel dis- ease during the period of follow up. Only one subject with abdominalpain in childhood died over the follow up period, and this was lower than the rate for the rest of the cohort (hazard ratio (controlled for sex and social class) 0.15; 0.02 to 1.06).
Ultrasonogram of abdomen and pelvis is a painless, noninvasive and inexpensive test that can detect abnormalities of the kidneys, gallbladder, liver, pancreas, appendix, intestines, ovaries and uterus. Yield of this investigation in published literature is about 10% in evaluating chronicabdominalpain 24 . But in our study it has a very good yield of 43% and was
Many children seek medical advice for Recurrent AbdominalPain. Recurrent AbdominalPain hinders the daily activities of 4% to 25% of school going children. It seems to be a benign problem, but morbidities associated with RAP include poor school attendance, hospital admission and laparotomies, symptoms sometimes continue to adulthood. [1,2] Social withdrawal, poor physical abilities, school absentees occur in 10% to 15% of school children due to recurrent abdominalpain on regular basis that result in increased health care visits and has poor effect on child's well being. [3,4] The burden of disease is under scored as 1 out of 3 experience chronicabdominalpain for minimum of 5 years.  Irritable bowel syndrome, a functional gastro-intestinal disorder is one of adulthood complication of childhood RAP.  Acidic environment of stomach is site for growth of H.Pylori, a pathogenic Gram-negative spiral bacillus. It is a leading cause of chronic gastritis, peptic ulcers, non-ulcer dyspepsia, gastric adenocarcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma. 50% of the total world population is infected with H. pylori according one estimate. Developing World currently is on hit list of H.pylori.  Longstanding exposure to H. pylori is usually asymptomatic but can lead to chronic gastritis in children and sometimes peptic
Given their safety proﬁle, probiotics seem to be an attractive therapeutic option for chronicabdominalpain. However, few data are available from children with this condition, and differ- ences in study design and the use of nonvalidated and differing end points complicate the interpretation of the re- sults. LGG was evaluated in 2 different randomized, placebo-controlled trials. In 1 trial, LGG was administered for 6 weeks to 50 children with IBS. The au- thors did not ﬁnd an increased beneﬁt of the probiotic over the placebo, prob- ably because of a high response rate in the latter group. 15 LGG was subse-
Interestingly, we found that age, gender, body mass index, and gastrointestinal symptoms at the time of the initial consultation did not predict whether celiac sero- logic testing was completed. However, being Caucasian did increase the likelihood of serologic testing. We hypothesize that this may be due to the fact that providers recognize that certain high risk human leukocyte antigen alleles are found more commonly in the Caucasian popu- lation, with studies suggesting minority populations such as African Americans comprise only a small percentage of the celiac disease population in the United States [7,8]. Nevertheless, future investigation into whether race and/ or ethnicity clearly impact the yield of celiac testing in children with chronicabdominalpain is needed to help guide providers caring for these patients.
Chronicpain frequently persists into adolescence and adulthood and also can lead to psychopathology. In a follow-up study of clinically referred youth aged 8 to 17 years with chronicpain, it was found that after 6 years, 75% of the participants still experienced chronicpain and 15% were in complete remission of both chronicpain and psychiatric disorder; comorbid psychiatric disorder at study entry was a predictor of psychiatric disorder, but not of persistent chronicpain, in adolescence and young adulthood . In an earlier follow-up study , chronic benign pain in childhood seemed to persist in a considerable proportion (30-45%), although it didn’t generally deteriorate over time. Children with persistent pain (9.4%) differed from those with non-persistent pain in frequency, history and location of the pain, emotional problems and their mother's health . The follow-up of a clinical sample of children with abdominalpain revealed that patient's older age and peer problems at baseline were significantly associated with more abdominalpain at follow-up whereas patient's older age, emotional symptoms, prosocial behaviour and maternal somatic symptoms were associated with disability . In a prospective cohort study in primary care, the risk of having chronicabdominalpain at 1 year of follow-up was 37.1% overall; although the risk of this outcome increased with number of predictors, these predictors (e.g. increasing age, waking up at night with pain, high levels of other somatic complaints, and chronicabdominalpain at baseline) were of limited value in identifying children in whom pain will become chronic,
liver parenchyma deep to the surface can be felt by blunt instrument palpation . Biopsy must be performed using a cutting needle, cupped forceps or scissors with a cautery or a needle aspiration should be performed for a solid lesion to ascertain histology and cytology. Hemangiomas shall appear like a bluish cystic lesions ; a biopsy is generally avoided because of severe bleeding that may follow . Hepatic, pancreatic and other lesions can be evaluated in detail by the use of laparoscopic ultrasound probe . The gallbladder is situated on the under surface of the liver seen projecting beyond the liver margin ; However , lifting of the liver and adhesiolysis of the fibrous band may be required if gall bladder is not seen. In acute inflammation of the gallbladder, it will be tense, edematous ,with pericystic fluid collections and it ‘s wall is covered by fibrino suppurative exudates .In chronic cholcystitis there are characteristics of presence of adhesions with thick ,tough and gray white gall bladder . Distended gallbladder may be seen in distal extra hepatic obstruction. A pale GB is seen either in
Appropriately, you picked up the phone and called me saying, “There is something funny about this kid. He has abdominal tenderness of some etiology.” This speaks volumes to me. If you are worried, communicate your concerns directly to the radiologist. Infants can have significant amounts of bowel gas that can limit the utility of the ultrasound. Their anatomy is small, but usually the ultrasound is an excellent adjunct to the physical examination, if the abdominal radiograph has been unrevealing. After speaking to the clinical team, my differential diagnosis still included NEC and intussusception. I have definitely seen both in term infants. Gastroenteritis is common. Anatomic abnormalities such as the malrotation spectrum can also present this way. I think in an infant that young without fat planes that a commuted tomography scan of the abdomen without oral contrast is significantly limited. The ultrasound is a better imaging
For data extraction, the included articles were randomly assigned to 3 teams of 2 reviewers (TH, BZ; MK, RW; AH, LS). The 2 reviewers then conducted data extraction for the respective articles. Discrepancies were resolved by discussion. Two reviewers veriﬁed the entire data extraction of all studies. For the included articles, information regarding the design of the study, the child’s pain condition, demographics, characteristics of the IIPT and treatment components, and outcome measurement tools were extracted. Raw data for the 5 outcome domains from each study was used to conduct a meta-analysis of treatment effects at each relevant time point (baseline, immediately posttreatment, and follow-up).
study shows that there is a significant improvement in all the step length, time on each foot, step cycle, co-efficient of variance and the ambulation index. As all these parameters are interconnected during abdominal drawing in maneu- ver it activates the transverse abdominis and by stimulating the multifidus it maintains the normal lordotic curve or the neutral spine, thereby it reduces the low back pain. The re- duction in pain reduces the immobility and improves the individual’s performance level. When the muscular perfor- mance is improved, it influences on the gait cycles. When the step length is increased , the number of movements taken place in a particular time interval is reduced (step cycle) and thereby the time taken on each foot is increased to maintain the symmetry, which in turn reduces the ener- gy expenditure and improve core stability with better am- bulation of participants in the study.
Gene expression studies by microarray showed majority of differentially expressed genes comparing poor sleep quality to good sleep quality group were down-regulated (by a two-fold magnitude, Table 5). Interestingly, for the pain group, the CAP had increased gene expression (>2.0 fold) compared to healthy controls (Table 6). Three specific named genes overlap in the sleep quality (poor sleep versus good sleep) and pain (CAP versus healthy control) groups: insulin-like growth factor 1 (IGF1), spermatogenesis asso- ciated, serine-rich 2-like (SPATS2L), and immunoglobulin heavy constant gamma 1 or mu (IGHG1//IGHM). Also, two unnamed genes (probesets 230537_at and 233398_at) overlap between sleep quality and pain groups (Figure 1).