Outpatient Specialty Care Clinical Pathway for the Evaluation/Treatment of the Child with Chronic Abdominal Pain
- H&P
- Assess Red Flags,
- Risk for Underlying Disease
- Consideration for Laboratory Studies
- Behavioral Health Screening
≥ 1 Red Flag Present
More evaluation may
be required
More evaluation may
be required
Diagnosis of Functional Abdominal Pain Disorders
- Treatment based on predominant symptom and intensity of symptoms
- Pharmacologic Treatment Options
- Consider Non-pharmacologic Treatment Options
Red Flags
- Symptoms
- Continued weight loss/growth deceleration
- Bloody or significant diarrhea
- Consistent right-sided abdominal pain/fullness
- Frequent and/or nighttime vomiting
- Difficult/painful swallowing
- CVA tenderness, dysuria
- Extra-intestinal manifestations:
- Unexplained fever
- Rash
- Arthritis
- Secondary amenorrhea
- Oral ulcers
- Delayed puberty
- Nocturnal diarrhea
- Physical Signs
- Perirectal disease
- Rashes
- Other concerning physical findings
- Laboratory Abnormalities
- Anemia
- Low albumin
- Elevated calprotectin
- Positive celiac panel
- Elevated amylase and lipase
- ESR and/or C-reactive protein
- Family history
- Inflammatory bowel disease
- Celiac disease
- Peptic ulcer disease
1st Line | 2nd Line | 3rd Line | 4th Line | 5th Line | Testing As indicated |
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Functional Dyspepsia |
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IBS Constipation |
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IBS Diarrhea |
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IBS Mixed |
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IBS Pain |
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Abdominal migraine |
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Functional Abdominal Pain NOS |
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Posted: August 2015
Revised: July 2020
Authors: K. Baber, PHD; P. Bierly, P. CRNP; T. Boyle, MD; K. Fiorino, MD; P. Kapavarapu, MD; A. Nepa RD, A. Moore, PharmD; S. Mayer-Brown, PHD; K. Rodriguez, PHD; N. Stanley, BSN, RN; M. Szabo, PHD; C. Thomas, MS, RD, LDN
Revised: July 2020
Authors: K. Baber, PHD; P. Bierly, P. CRNP; T. Boyle, MD; K. Fiorino, MD; P. Kapavarapu, MD; A. Nepa RD, A. Moore, PharmD; S. Mayer-Brown, PHD; K. Rodriguez, PHD; N. Stanley, BSN, RN; M. Szabo, PHD; C. Thomas, MS, RD, LDN
Evidence
- Functional Abdominal Pain
- Biopsychosocial Aspects of Functional Gastrointestinal Disorders
- Functional Abdominal Pain and Separation Anxiety: Helping the Child Return to School
- The Effect of Dietary Intervention on Irritable Bowel Syndrome: A Systematic Review
- Integration of Biomedical and Psychosocial Treatments in Pediatrics Functional Gastrointestinal Disorders
References