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Copyright (c) 2025 Abdullah Mastour Alamar, Raneem Khalid Altuwayrish, Rawan Ayidh Alqahtani, Amwaj Qassem Alqahtani, Abduljalil Salah Alahmadi, Saeed Ali Yahya Najmi, Muath Ali Aqeel Halawi, Saud Ahmad Sultan Turkistani, Mohammed Abdullah Mathkur, Rawan Hussein Ali Khawaji, Fares Zaban Alrowiliy
This work is licensed under a Creative Commons Attribution 4.0 International License.
Multidisciplinary Diagnostic Challenges in Pediatric Functional Abdominal Pain: An Integrated Approach Across Diagnostic Radiology, Family Medicine, Nursing Practice, Public Health, Epidemiology, Clinical Pharmacy, Clinical Nutrition, and Surgical Special
Corresponding Author(s) : Abdullah Mastour Alamar
Saudi Journal of Medicine and Public Health,
Vol. 2 No. 2 (2025)
Abstract
Background: Functional abdominal pain (FAP) is a prevalent pediatric condition characterized by recurrent or persistent abdominal discomfort without identifiable structural or biochemical abnormalities. Diagnosis relies on the Rome IV symptom-based criteria, emphasizing the gut–brain axis dysregulation and minimizing unnecessary investigations.
Aim: To summarize multidisciplinary perspectives on the etiology, epidemiology, clinical presentation, diagnostic evaluation, and management of pediatric FAP.
Methods: A comprehensive narrative review of current evidence addressing biological, psychosocial, and environmental contributors to FAP, along with clinical guidelines for assessment and therapeutic approaches.
Results: FAP arises from a multifactorial interplay involving visceral hypersensitivity, altered gut microbiota, motility disturbances, and psychosocial stressors. The global prevalence is approximately 11.7%, with higher rates in females. Evaluation prioritizes history, physical examination, and identification of alarm features, whereas excessive testing offers limited diagnostic value. Effective management requires education, psychosocial interventions, lifestyle modifications, and selective dietary or pharmacological therapies.
Conclusion: FAP is a chronic, multifaceted disorder requiring a biopsychosocial, multidisciplinary management strategy to restore function and improve quality of life.
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- Baaleman DF, Di Lorenzo C, Benninga MA, Saps M. The Effects of the Rome IV Criteria on Pediatric Gastrointestinal Practice. Current gastroenterology reports. 2020 Mar 19:22(5):21. doi: 10.1007/s11894-020-00760-8. Epub 2020 Mar 19
- Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, van Tilburg M. Functional Disorders: Children and Adolescents. Gastroenterology. 2016 Feb 15:():. pii: S0016-5085(16)00181-5. doi: 10.1053/j.gastro.2016.02.015.
- Thapar N, Benninga MA, Crowell MD, Di Lorenzo C, Mack I, Nurko S, Saps M, Shulman RJ, Szajewska H, van Tilburg MAL, Enck P. Paediatric functional abdominal pain disorders. Nature reviews. Disease primers. 2020 Nov 5:6(1):89. doi: 10.1038/s41572-020-00222-5.
- Korterink J, Devanarayana NM, Rajindrajith S, Vlieger A, Benninga MA. Childhood functional abdominal pain: mechanisms and management. Nature reviews. Gastroenterology & hepatology. 2015 Mar:12(3):159-71. doi: 10.1038/nrgastro.2015.21.
- Faure C, Giguère L. Functional gastrointestinal disorders and visceral hypersensitivity in children and adolescents suffering from Crohn's disease. Inflammatory bowel diseases. 2008 Nov:14(11):1569-74. doi: 10.1002/ibd.20506.
- Vermeijden NK, de Silva L, Manathunga S, Spoolder D, Korterink J, Vlieger A, Rajindrajith S, Benninga M. Epidemiology of Pediatric Functional Abdominal Pain Disorders: A Meta-Analysis. Pediatrics. 2025 Feb 1:155(2):. pii: e2024067677. doi: 10.1542/peds.2024-067677.
- Gordon M, Sinopoulou V, Tabbers M, Rexwinkel R, de Bruijn C, Dovey T, Gasparetto M, Vanker H, Benninga M. Psychosocial Interventions for the Treatment of Functional Abdominal Pain Disorders in Children: A Systematic Review and Meta-analysis. JAMA pediatrics. 2022 Jun 1:176(6):560-568. doi: 10.1001/jamapediatrics.2022.0313.
- Halac U, Noble A, Faure C. Rectal sensory threshold for pain is a diagnostic marker of irritable bowel syndrome and functional abdominal pain in children. The Journal of pediatrics. 2010 Jan:156(1):60-65.e1. doi: 10.1016/j.jpeds.2009.06.062.
- Llanos-Chea A, Saps M. Utility of Diagnostic Tests in Children With Functional Abdominal Pain Disorders. Gastroenterology & hepatology. 2019 Aug:15(8):414-422
- Paul SP, Basude D. Non-pharmacological management of abdominal pain-related functional gastrointestinal disorders in children. World journal of pediatrics : WJP. 2016 Nov:12(4):389-398
- Müller A, Franke H, Resch KL, Fryer G. Effectiveness of osteopathic manipulative therapy for managing symptoms of irritable bowel syndrome: a systematic review. The Journal of the American Osteopathic Association. 2014 Jun:114(6):470-9. doi: 10.7556/jaoa.2014.098.
- Korterink JJ, Ockeloen LE, Hilbink M, Benninga MA, Deckers-Kocken JM. Yoga Therapy for Abdominal Pain-Related Functional Gastrointestinal Disorders in Children: A Randomized Controlled Trial. Journal of pediatric gastroenterology and nutrition. 2016 Nov:63(5):481-487
- Keefer L, Blanchard EB. A one year follow-up of relaxation response meditation as a treatment for irritable bowel syndrome. Behaviour research and therapy. 2002 May:40(5):541-6
- Nurko S, Saps M, Kossowsky J, Zion SR, Di Lorenzo C, Vaz K, Hawthorne K, Wu R, Ciciora S, Rosen JM, Kaptchuk TJ, Kelley JM. Effect of Open-label Placebo on Children and Adolescents With Functional Abdominal Pain or Irritable Bowel Syndrome: A Randomized Clinical Trial. JAMA pediatrics. 2022 Apr 1:176(4):349-356. doi: 10.1001/jamapediatrics.2021.5750.
- Vandenplas Y, Darma A, Indrio F, Aw M, Vieira MC, Vivatvakin B, Treepongkaruna S, Cruchet S, Acharyya BC, Vázquez R, Yeung CY, Gutiérrez P. Understanding functional abdominal pain disorders among children: a multidisciplinary expert consensus statement. Frontiers in pediatrics. 2025:13():1576698. doi: 10.3389/fped.2025.1576698.
- Bonilla S, Nurko S. Focus on the use of antidepressants to treat pediatric functional abdominal pain: current perspectives. Clinical and experimental gastroenterology. 2018:11():365-372. doi: 10.2147/CEG.S146646.
- Rexwinkel R, de Bruijn CMA, Gordon M, Benninga MA, Tabbers MM. Pharmacologic Treatment in Functional Abdominal Pain Disorders in Children: A Systematic Review. Pediatrics. 2021 Jun:147(6):. pii: e2020042101. doi: 10.1542/peds.2020-042101.
- Horst S, Shelby G, Anderson J, Acra S, Polk DB, Saville BR, Garber J, Walker LS. Predicting persistence of functional abdominal pain from childhood into young adulthood. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2014 Dec:12(12):2026-32. doi: 10.1016/j.cgh.2014.03.034.
References
Baaleman DF, Di Lorenzo C, Benninga MA, Saps M. The Effects of the Rome IV Criteria on Pediatric Gastrointestinal Practice. Current gastroenterology reports. 2020 Mar 19:22(5):21. doi: 10.1007/s11894-020-00760-8. Epub 2020 Mar 19
Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, van Tilburg M. Functional Disorders: Children and Adolescents. Gastroenterology. 2016 Feb 15:():. pii: S0016-5085(16)00181-5. doi: 10.1053/j.gastro.2016.02.015.
Thapar N, Benninga MA, Crowell MD, Di Lorenzo C, Mack I, Nurko S, Saps M, Shulman RJ, Szajewska H, van Tilburg MAL, Enck P. Paediatric functional abdominal pain disorders. Nature reviews. Disease primers. 2020 Nov 5:6(1):89. doi: 10.1038/s41572-020-00222-5.
Korterink J, Devanarayana NM, Rajindrajith S, Vlieger A, Benninga MA. Childhood functional abdominal pain: mechanisms and management. Nature reviews. Gastroenterology & hepatology. 2015 Mar:12(3):159-71. doi: 10.1038/nrgastro.2015.21.
Faure C, Giguère L. Functional gastrointestinal disorders and visceral hypersensitivity in children and adolescents suffering from Crohn's disease. Inflammatory bowel diseases. 2008 Nov:14(11):1569-74. doi: 10.1002/ibd.20506.
Vermeijden NK, de Silva L, Manathunga S, Spoolder D, Korterink J, Vlieger A, Rajindrajith S, Benninga M. Epidemiology of Pediatric Functional Abdominal Pain Disorders: A Meta-Analysis. Pediatrics. 2025 Feb 1:155(2):. pii: e2024067677. doi: 10.1542/peds.2024-067677.
Gordon M, Sinopoulou V, Tabbers M, Rexwinkel R, de Bruijn C, Dovey T, Gasparetto M, Vanker H, Benninga M. Psychosocial Interventions for the Treatment of Functional Abdominal Pain Disorders in Children: A Systematic Review and Meta-analysis. JAMA pediatrics. 2022 Jun 1:176(6):560-568. doi: 10.1001/jamapediatrics.2022.0313.
Halac U, Noble A, Faure C. Rectal sensory threshold for pain is a diagnostic marker of irritable bowel syndrome and functional abdominal pain in children. The Journal of pediatrics. 2010 Jan:156(1):60-65.e1. doi: 10.1016/j.jpeds.2009.06.062.
Llanos-Chea A, Saps M. Utility of Diagnostic Tests in Children With Functional Abdominal Pain Disorders. Gastroenterology & hepatology. 2019 Aug:15(8):414-422
Paul SP, Basude D. Non-pharmacological management of abdominal pain-related functional gastrointestinal disorders in children. World journal of pediatrics : WJP. 2016 Nov:12(4):389-398
Müller A, Franke H, Resch KL, Fryer G. Effectiveness of osteopathic manipulative therapy for managing symptoms of irritable bowel syndrome: a systematic review. The Journal of the American Osteopathic Association. 2014 Jun:114(6):470-9. doi: 10.7556/jaoa.2014.098.
Korterink JJ, Ockeloen LE, Hilbink M, Benninga MA, Deckers-Kocken JM. Yoga Therapy for Abdominal Pain-Related Functional Gastrointestinal Disorders in Children: A Randomized Controlled Trial. Journal of pediatric gastroenterology and nutrition. 2016 Nov:63(5):481-487
Keefer L, Blanchard EB. A one year follow-up of relaxation response meditation as a treatment for irritable bowel syndrome. Behaviour research and therapy. 2002 May:40(5):541-6
Nurko S, Saps M, Kossowsky J, Zion SR, Di Lorenzo C, Vaz K, Hawthorne K, Wu R, Ciciora S, Rosen JM, Kaptchuk TJ, Kelley JM. Effect of Open-label Placebo on Children and Adolescents With Functional Abdominal Pain or Irritable Bowel Syndrome: A Randomized Clinical Trial. JAMA pediatrics. 2022 Apr 1:176(4):349-356. doi: 10.1001/jamapediatrics.2021.5750.
Vandenplas Y, Darma A, Indrio F, Aw M, Vieira MC, Vivatvakin B, Treepongkaruna S, Cruchet S, Acharyya BC, Vázquez R, Yeung CY, Gutiérrez P. Understanding functional abdominal pain disorders among children: a multidisciplinary expert consensus statement. Frontiers in pediatrics. 2025:13():1576698. doi: 10.3389/fped.2025.1576698.
Bonilla S, Nurko S. Focus on the use of antidepressants to treat pediatric functional abdominal pain: current perspectives. Clinical and experimental gastroenterology. 2018:11():365-372. doi: 10.2147/CEG.S146646.
Rexwinkel R, de Bruijn CMA, Gordon M, Benninga MA, Tabbers MM. Pharmacologic Treatment in Functional Abdominal Pain Disorders in Children: A Systematic Review. Pediatrics. 2021 Jun:147(6):. pii: e2020042101. doi: 10.1542/peds.2020-042101.
Horst S, Shelby G, Anderson J, Acra S, Polk DB, Saville BR, Garber J, Walker LS. Predicting persistence of functional abdominal pain from childhood into young adulthood. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2014 Dec:12(12):2026-32. doi: 10.1016/j.cgh.2014.03.034.