Chronic abdominal pain of childhood and adolescence is a common problem. Esophagitis, Gastritis, Peptic ulcer, Celiac disease, Malrotation of gut, Polyps, Hernias, Inflammatory bowel disease, Chronic constipation, Parasitic infection, Carbohydrate malabsorption are some of the causes for chronic abdominal pain. Even after extensive investigation diagnosis might not be found and we call it functional pain. In functional abdominal pain, the goal of therapy is to decrease stress or tension for the child while promoting normal patterns of activity and school attendance. Long-term follow-up to assist medically in symptom control as well as provision of reassurance and support helps many children.
Parents often consult about their child’s stool pattern. Personal and cultural beliefs influence their perception of about diarrhea in children. Most common cause of diarrhea in children is due to virus, which is self limiting. Bacteria and parasites some times causes diarrhea. During these episodes it is essential to maintain the hydration oral rehydration solution. Antibiotics are not essential, as they only prolong the shedding of bacteria. Diarrhea due to parasites such as amoebae requires appropriate medication. Some times diarrhea can be protracted resulting in dehydration and malnutrition. Tropical enteropathy or post-enteritis syndrome, Food-sensitive enteropathy, unrecognized immunodeficiency, cystic fibrosis, swachmann’s syndrome, crohn’s disease, ulcerative colitis, Blind loop syndrome with bacterial overgrowth etc are few of the causes of protracted diarrheas. Investigation would include blood tests, genetic tests, enzyme quantification, upper and lower endoscopy and biopsies. Some times this children might need total parental nutrition to support their nutritional requirement and decrease the diarrheal episodes.
Crohn’s disease and ulcerative colitis are two diseases, which come under the category of IBD. They cause inflammation of bowel and presents with bloody diarrhea, weight loss, intestinal strictures etc.Inflammatory bowel disease not only can affect mouth to rectum, it can affect other systems of body and produce extra intestinal manifestation. It can affect eyes, spine, liver etc. The cause for this disease is thought to be multifactorial involving interaction between environment, genetic predisposition and microbial. Diagnosis is based on endoscopy findings and biopsy. The complications and management varies between these diseases. These diseases require long term management and follow up. Resistant disease might require biological agents, such as Infliximab for treatment.
Constipation is a chronic problem where the stools are very hard and often difficult to treat. Most of the time it is a behavioral problem rather than underlying disease or disorder that causes constipation. Children tend to withhold passing motion as they eager playing \involved in activities or due to inappropriate surrounding ( such as school). After few days when they could no longer able to with hold, they open bowel. In the rectum all the water is absorbed from the stools and they are very hard and bulky. When this had stools are passed, it tears rectal/ anal mucosa and causes severe pain and spasm of spintcher. Over months the child associated pain with passing motion and tend to with hold longer and constipation worsens. Over months the colon/ rectum distends and becomes baggy and loose the sensation of fullness and urge to defecate. Management of constipation is requires understanding of the disease process by the parents and their support to the child. It requires medication to soften the stools, positive re-enforcement to the child and parental education. Rectal pressure studies could be done to see any abnormalities in intestinal motility such as hirsprung disease.