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Standard of care for pediatric chronic abdominal pain needed
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Recent data suggest clinical practice guidelines are needed regarding treatment of pediatric chronic abdominal pain, as perceptions and practices vary widely among primary care physicians.
Jennifer Verrill Schurman, PhD, of Children’s Mercy Kansas City in Kansas City, Mo., and colleagues surveyed 470 office-based pediatrician members of the American Medical Association using the Pediatrician’s Gastroenterology Practice Survey. Half of study participants practiced in suburban settings; 26% practiced in urban settings; and 17% in rural settings.
More than half of pediatricians reported at least 10% of all patients presented with abdominal pain. The most common responses for causes of chronic abdominal pain were constipation, functional, and stress or anxiety.
More than 70% of pediatricians reported using blood and urine tests routinely to diagnose abdominal pain. A smaller percentage reported routine use of stool cultures, abdominal ultrasounds and psychological assessment.
Eighty-two percent of pediatricians reported using both behavioral/coping and medical/physiological methods in their routine treatment of children with abdominal pain. Referral to gastrointestinal specialists and fiber supplements were commonly reported medical treatment techniques. Prescription and over-the-counter acid suppression agents and probiotics were used by a smaller percentage of pediatricians. The majority of study participants reported using behavioral treatments such as lifestyle changes, patient/family reassurance, encouraging positive coping and referral to mental health professionals.
Study participants’ definitions of functional gastrointestinal disorders varied widely, although 73% included a lack of organic etiology as a defining feature. Sixteen percent of definitions included frequency or duration of pain, but specification of time frame varied. All other symptoms or features used to define functional gastrointestinal disorders were included in less than 10% of definitions. These included functional impairment, psychological factors and normal growth and weight. Eighteen percent of study participants did not provide a definition at all. Most pediatricians reported they had heard of the Rome Criteria for diagnosing functional gastrointestinal disorders, but 58% did not consider themselves knowledgeable about the criteria. Seven percent of pediatricians reported consistently using Rome Criteria in practice.
“Results from this survey of primary care physicians indicate significant variability in techniques used to assess and treat children with [chronic abdominal pain]… This variability demonstrates the fact that no current standard of care exists at the primary care level on which to base the initial development of such practice guidelines. A coordinated effort is needed to systematically evaluate assessment and treatment practices currently in use with regard to patient outcomes for children with [chronic abdominal pain],” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
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