Recurrent Abdominal Pain: An Update

The definition of recurrent abdominal pain (RAP) derives from the seminal description by Apley of paroxysmal abdominal pain in children between the ages of 4 and 16 years that persists for more than 3 months and affects normal activity. RAP is not a diagnosis. It may be the predominant clinical manifestation of a large number of precisely defined organic disorders, but in the majority of cases, RAP is due to a functional bowel disorder. The modifier “functional” is used in gastroen-terology if no specific structural, infectious, inflammatory, or biochemical cause for the abdominal pain can be determined. It is the delicate interface between organic and functional forms of pediatric RAP that challenges the primary care pediatrician. Because the exact etiology and pathogenesis of the pain are unknown and because no specific diagnostic markers exist, a diagnosis of functional bowel disorder often is viewed as a diagnosis of exclusion. Yet, functional...