Recurrent abdominal pain: A potential precursor of irritable bowel syndrome in adolescents and young adults,☆☆,,★★

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Abstract

Objectives: To assess symptoms of irritable bowel syndrome (IBS) in patients with recurrent abdominal pain (RAP) 5 years after their initial evaluation, to identify the relation of IBS symptoms to functional disability and health service use, and to determine the extent to which IBS symptoms are associated with life stress and poor psychosocial adjustment. Methods: Patients with RAP (n = 76) and control subjects (n = 49) completed a telephone interview; measures included the Bowel Disease Questionnaire, the Functional Disability Inventory, the Life Events Questionnaire, the Family Inventory of Life Events, the Center for Epidemiological Studies Depression Scale, the Self-Perception Profile for Adolescents, and the Health Resources Inventory. Results: Five years after the initial evaluation, patients with RAP reported significantly more episodes of abdominal pain than did control subjects, as well as significantly higher levels of functional disability, school absence, and clinic visits for abdominal distress. Female patients with RAP were more likely than female control subjects to meet the Manning criteria for IBS. Among patients with RAP, higher levels of IBS symptoms were associated with significantly greater functional disability, more clinic visits, more life stress, higher levels of depression, and lower academic and social competence. Conclusion: Female patients with a history of RAP may be at increased risk of IBS during adolescence and young adulthood. Among adolescents and young adults with a history of RAP, IBS symptoms are likely to be associated with high levels of disability and health service use. (J Pediatr 1998;132:1010-5)

Section snippets

Patients With RAP

Case subjects were patients referred to the Vanderbilt University Medical Center Pediatric Gastroenterology Clinic for evaluation of abdominal pain. Patients with chronic illness, physical disability, or mental retardation were excluded. Psychosocial characteristics of these patients at the initial evaluation have been reported elsewhere.16 The present analyses focus on patients for whom the medical evaluation yielded no identifiable medical explanation for pain and who reported pain of more

Demographic Characteristics

The sample consisted of 76 former patients with RAP and 49 control subjects, representing 84% of patients with RAP and 94% of well subjects who had been interviewed 5 years earlier. Of the 76 RAP patients, 51 (67%) were female. Patients with RAP ranged in age from 11 to 23 years at follow-up, with a mean of 15.7 years (SD = 3.2 years). Of the 49 control subjects, 23 (47%) were female. Control subjects ranged in age from 12 to 22 years, with a mean of 16.2 years (SD = 3.0) at follow-up. The

Discussion

The literature on adults shows that although IBS symptoms are common in the general population, considerable individual variability exists in the relation of symptoms to disability and physician visits.28 Prior investigations indicate that psychosocial distress is predictive of clinic visits for IBS symptoms.10, 14 The present study suggests that a childhood history of RAP is another important predictor of clinic visits and disability related to IBS symptoms. Specifically, among former RAP

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    From the Divisions of Adolescent Medicine and of Pediatric Gastroenterology and Nutrition, Vanderbilt University School of Medicine, Nashville, Tennessee.

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    Supported by a grant (HD23264) from the national Institute of Child Health and Human Development.

    Reprint requests: Lynn S. Walker, PhD, Division of Adolescent Medicine, 436 Medical Center South, Vanderbilt University School of Medicine, Nashville, TN 37232-3571.

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