Researchers seek tool for children's stomach trouble

Recurrent abdominal pain leads many young patients to the doctor's office, but ways to assess their pain and determine if treatment is working are lacking.

By Victoria Stagg Elliott, AMNews staff. Feb. 21, 2005.

The child in the office of Thomas Ball, MD, MPH, looked happy and energetic and hadn't missed a day of school. On a scale of one to 10, though, he rated his frequent attacks of stomach pain as a 10.

The next patient was glum and quiet. This child had missed his best friend's birthday party because of a stomachache. Still, he only rated the problem a 3.

"Those are extremes," said Dr. Ball, associate professor of pediatrics at the University of Arizona, Tucson. "There are all sorts of variations in between, but it is challenging."

These scenarios highlight one of the biggest difficulties physicians and researchers face when dealing with the 10% to 15% of children who complain of recurrent abdominal pain. Objective measures to assess the severity of the condition and the effectiveness of treatments are lacking but desperately needed.

"There's nothing you can measure," said Jeffrey Hyams, MD, head of the division of digestive diseases and nutrition at Connecticut Children's Medical Center in Hartford. "It's not like you can take a chest x-ray or do a blood test."

To that end, researchers at Baylor College of Medicine in Houston published a paper in the February issue of Pediatrics suggesting that questions about missed weekend activities, pain levels, nausea, loss of appetite, heartburn, diarrhea, constipation and bloating could measure the state of the disease. The multidimensional measure for recurrent abdominal pain -- MM-RAP -- was found to effectively assess children ages 4 to 18 and to work in both primary care and gastroenterology clinics.