Rectal Sensory Threshold for Pain is a Diagnostic Marker of Irritable Bowel Syndrome and Functional Abdominal Pain in Children

doi:10.1016/j.jpeds.2009.06.062

The Journal of Pediatrics

Volume 156, Issue 1, January 2010, Pages 60-65.e1

https://doi.org/10.1016/j.jpeds.2009.06.062 Get rights and content

Objective

To evaluate the diagnostic value of the rectal sensory threshold for pain (RSTP) in children and adolescents with chronic abdominal pain.

Study design

Fifty-one patients (25 girls; median age 14.2 years; range 8.4-17.6) with abdominal pain >2 months underwent a series of rectal distensions with an electronic barostat. RSTP and viscerosomatic referrals were assessed. Three months after the barostat, the final diagnosis was documented.

Results

Thirty-five patients had a functional gastrointestinal disorder (FGID) (irritable bowel syndrome or functional abdominal pain), and 16 had an organic disease. RSTP was lower in the FGID group than in the organic disease group (25.4mm Hg vs 37.1mm Hg; P = .0002). At the cutoff of 30mm Hg, the RSTP measurement for the diagnosis of FGID had a sensitivity of 94% and a specificity of 77%. Both groups similarly reported aberrant viscerosomatic projections.

Conclusion

In children, RSTP is a diagnostic marker of irritable bowel syndrome and functional abdominal pain. Viscerosomatic referrals are similar in children with FGID and organic diseases.

Section snippets

Methods

Children aged 8 to 18 years were recruited from the tertiary care Pediatric Gastroenterology Clinic at Hôpital Sainte-Justine (University of Montreal). The included subjects reported abdominal pain (not exclusively epigastric in location) for more than 2 months. Patients with severe neurologic or muscular problems, with a history of rectocolonic surgery, with encopresis or fecal impaction, with acute enteric infection (gastroenteritis), or those unable to collaborate with the study procedures

Results

Fifty-one patients (25 girls; median age 14.2 years, range 8.4-17.6) were included in the study. At the end of the study period, 35 patients (69%) had a FGID; 31 fulfilled the Rome III criteria (IBS, n = 20; FAP, n = 11). The remaining 4 patients did not fulfill the frequency of abdominal pain episodes criteria reporting pain as “1 per week” and not “many times a week.” They fulfilled the remaining Rome criteria with regard to localization of pain, changes in stool frequency and consistence,

Discussion

We have shown that rectal sensory threshold for pain in response to phasic rectal distension is lower in children with IBS or FAP than in children with abdominal pain secondary to organic disease. More importantly, we have demonstrated that a RSTP value of 30 mm Hg or less is a sensitive and specific test for the diagnosis of functional gastrointestinal disorders in children prospectively evaluated for chronic abdominal pain. We also show that in children with chronic recurrent abdominal pain,

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: This study was supported by a grant from the Groupe Francophone d'Hépatologie, de Gastroentérologie et Nutrition Pédiatriques (GFHGNP).

: The authors declare no conflicts of interest.

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Original ArticleRectal Sensory Threshold for Pain is a Diagnostic Marker of Irritable Bowel Syndrome and Functional Abdominal Pain in Children

Objective

Study design

Results

Conclusion

Section snippets

Methods

Results

Discussion

J Pediatr

Gastroenterology

J Pediatr

Gastroenterology

Gastroenterology

Gastroenterology

Gastroenterology

Gastroenterology

Gastroenterology

Clin Gastroenterol Hepatol

Gastroenterology

Gastroenterology

Best Pract Res Clin Gastroenterol

Psychosomatics

Functional GI disorders: from animal models to drug development

Gut

Chronic abdominal pain in children

Pediatrics

Characterization of symptoms in children with recurrent abdominal pain: resemblance to irritable bowel syndrome

J Pediatr Gastroenterol Nutr

Development and preliminary validation of the Questionnaire on Pediatric Gastrointestinal Symptoms to assess functional gastrointestinal disorders in children and adolescents

J Pediatr Gastroenterol Nutr

Original Article
Rectal Sensory Threshold for Pain is a Diagnostic Marker of Irritable Bowel Syndrome and Functional Abdominal Pain in Children