Recurrent Abdominal Pain in Children

描述：(申请人提供)10%至17%的儿童 4岁和16岁符合复发性腹痛的标准a 至少占所有儿科诊所就诊次数5%的情况 并经常导致严重残疾(例如，缺课)。从30岁到60岁 患有RAP的儿童中有1%会继续经历与成人类似的疼痛 这导致了说唱和肠易激综合征(IBS)可能 同一综合征在不同的发育阶段。与IBS相似，20-68岁 报告腹痛的儿童中有%的人也经历了 肠道模式(便秘和/或腹泻)。虽然说唱事业(S)(AS) 以及IBS)是未知的，影响症状体验的因素， 包括寻求医疗保健，可能包括生理和 心理社会。生理异常与心理异常的关系 RAP中的化妆和父母的反应/行为在很大程度上是未被探索的 (未定义)。来研究这些因素的贡献和它们的 潜在的相互作用，我们建议比较三组儿童：那些有 被转介到三级医疗护理(RAP-GI)的RAP；有RAP但 不要寻求儿科医生以外的医疗服务(RAP-Ped)； 没有说唱症状的患者(对照)。我们的具体目标是描述和 在这些儿童(7-10岁)中进行比较：1)胃肠道症状(腹痛和 大便模式)和功能障碍(疼痛干扰活动， 缺课)使用回顾和前瞻性症状测量；2) 自主神经系统功能(心脏的光谱和非光谱分析 心率变异性和尿儿茶酚胺)；3)儿童和父母的疼痛应对 技能、家长建模和疾病行为强化；以及4) 心理困扰(焦虑、抑郁和躯体化)。孩子们会 从休斯顿的儿科诊所招募。这项建议 跨学科研究将是第一个在儿童中同时检查的研究 与RAP相关的生理和心理社会因素及其功能 结果，并将这些结果与患有RAP的儿童样本进行比较 寻求三级医疗服务。因为太多有说唱的孩子 这项研究可能会在他们成年后被确认为患有IBS 洞察这种疾病的发展进程。这些数据可能 用于制定指导方针，供卫生保健提供者使用以进行干预 及早与有这种常见症状的儿童接触，以防止健康 护理寻求行为及其伴随的经济和情感成本。

DESCRIPTION: (provided by applicant) Ten to 17 percent of children between the ages of 4 and 16 years meet the criteria for recurrent abdominal pain (RAP) a condition that accounts for at least 5 percent of all pediatric office visits and often leads to significant disability (e.g., school absence). From 30-60 percent of children with RAP will go on to experience similar pain as adults leading to the suggestion that RAP and irritable bowel syndrome (IBS) may be the same syndrome at different developmental stages. Similar to IBS, 20-68 percent of children reporting abdominal pain also experience alterations in bowel patterns (constipation and/or diarrhea). Although the cause(s) of RAP (as well as IBS) are unknown, factors contributing to the symptom experience, including health care seeking, are likely to include both physiological and psychosocial. The relationships among physiologic abnormalities, psychological makeup, and parental responses/behaviors in RAP are largely unexplored (undefined). To study the contributions of these sets of factors and their potential interplay, we propose to compare three groups of children: those with RAP who are referred to tertiary medical attention (RAP-GI); who have RAP but do not seek medical attention beyond their pediatrician (RAP-Ped); and those who do not have RAP symptoms (Controls). Our Specific Aims are to describe and compare among these children (ages 7-10): 1) GI symptoms (abdominal pain and bowel patterns) and functional disability (pain interfering with activity, school absences) using retrospective and prospective symptom measures; 2) autonomic nervous system function (spectral and non-spectral analysis of heart rate variability and urine catecholamines); 3) child and parent pain coping skills, parent modeling and reinforcement of illness behavior; and 4) psychological distress (anxiety, depression, and somatization). Children will be recruited from pediatric practices in Houston. This proposed interdisciplinary study will be the first in children to examine concurrently both physiologic and psychosocial factors related to RAP, and its functional consequences, and to compare these to a sample of children with RAP who do not seek tertiary medical attention. Because so many children with RAP are identified as having IBS when they reach adulthood, this study may provide insight into the developmental progression of this disorder. These data could be used to develop guidelines for use by health care providers to intervene early with children who have this common complaint in order to prevent health care seeking behavior with its attendant financial and emotional cost.