Recurrent abdominal pain (RAP) of childhood is a common reason for referral to pediatric gastroenterologists. Most causes of RAP are functional in nature and it is essential to determine which children with RAP would benefit from endoscopy. The authors of this study from Brisbane, Australia looked at the diagnostic yield of pediatric patients with RAP who subsequently underwent a colonoscopy.
This study consisted of a 4-year retrospective analysis of patients with RAP who underwent colonoscopy at a large, tertiary children’s hospital. Patients were included in the study if they had undergone a colonoscopy for abdominal pain and if the abdominal pain fit criteria for RAP (defined as occurring for at least 2 months, being present for several times weekly, and affecting activity). Medical records for included patients included endoscopic findings, including histology, C-reactive protein, erythrocyte sedimentation rate, fecal calprotectin, and tissue transglutaminase IgA antibody titers.
In total, 652 colonoscopies were performed, and 10% (total of 68) of these procedures were done for the indication of abdominal pain. All 68 patients met Rome IV criteria for RAP. The median age for pediatric patients undergoing colonoscopy for abdominal pain was 12 years (range 2 – 16 years), and 65% of these patients were female. Further analysis demonstrated that 10% of these 68 patients (total of 7) had endoscopic disease (Crohn disease, colonic polyps, or microscopic colitis). Rectal bleeding in the setting of RAP was significantly associated with the presence of colonic polyps, and no patient with RAP and no secondary symptoms had any GI pathology. The presence of abnormal histology was significantly associated with elevated fecal calprotectin levels and/or elevated serum inflammatory markers although this effect disappeared on multiple regression analysis used to evaluate the significance of secondary indications of endoscopy (such as rectal bleeding) and histologic findings.
This study strongly suggests that colonoscopy is not indicated in pediatric patients with isolated RAP and no other symptoms. Avoiding endoscopic procedures in such clinical settings will improve patient safety, reduce over-testing, and reduce healthcare costs.
Singh H and Ee L. Recurrent Abdominal pain in children: Is colonoscopy indicated? Journal of Pediatric Gastroenterology and Nutrition 2019; 68: 214-217