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. 2013 Mar-Apr;19(4):826-31.
doi: 10.1097/MIB.0b013e3182802a0a.

The overlap of functional abdominal pain in pediatric Crohn's disease

Lori A Zimmerman  1 , Arvind I Srinath, Alka Goyal, Athos Bousvaros, Peter Ducharme, Eva Szigethy, Samuel Nurko
Affiliations

The overlap of functional abdominal pain in pediatric Crohn's disease

Lori A Zimmerman et al. Inflamm Bowel Dis. 2013 Mar-Apr.

Abstract

Background: Children with Crohn's disease (CD) may report abdominal pain despite clinical remission, suggesting that functional abdominal pain (FAP) may be playing a role. The aim of this study was to explore the presence and impact of FAP in children with CD in remission.

Methods: Children, aged 9 to 17 years, with CD were enrolled. Demographic information, the Pediatric Crohn's Disease Activity Index, and the Children's Depression Inventory were obtained. Disease remission was defined by physician global assessment, normal laboratories findings, absence of 3 or more stools a day, nocturnal stooling, bloody diarrhea, concurrent steroid therapy, strictures, or disease flare within 6 months. FAP was defined as patients with abdominal pain and CD remission. Rates of depression (Children's Depression Inventory >9) were compared.

Results: Of 307 children, 139 reported abdominal pain. Of this group, 18 of 139 (13%) children met the criteria for FAP. Despite clinical remission, 8 of 18 patients with CD having FAP were classified with active disease by Pediatric Crohn's Disease Activity Index. These patients had a higher rate of depression than patients with CD in remission with no abdominal pain (55.6% versus 29.9%; P = 0.03), similar to patients with abdominal pain from active CD (55.6% versus 44.8%; P = 0.62).

Conclusions: A proportion of children with CD in remission have FAP. These children are at significant risk of depression. Future studies are needed to determine whether depression contributes to functional pain development or if pain itself leads to depression. Especially given that functional pain may exaggerate disease activity, clinicians caring for children with CD and FAP should consider evaluating for depressive disorders before escalating therapy.

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Figures

Figure 1
Figure 1. Classification of patients by presence of abdominal pain and disease activity
FAP patients are defined as patients with abdominal pain but no active disease. *Clinical signs and symptoms of active disease included abnormal labs [ESR (<10), albumin (>3.5), and CRP(<1.0)], three or more stools a day; bloody diarrhea, nocturnal stooling, and the need for current steroid treatment.
Figure 2
Figure 2. Difference in proportion of patients categorized with active disease* by total PCDAI and by modified PCDAI
*Active disease categorization is defined by PCDAI>10. In the modified PCDAI, the abdominal pain score is removed.; ** p=0.02; *** p=0.003
Figure 3
Figure 3. Proportion of CD FAP patients with depressive symptoms* compared to other CD patients
*Depressive symptoms defined by CDI>9; **p = 0.03; ***p = 0.62
See this image and copyright information in PMC

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