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Functional Abdominal Pain (FAP)

Introduction

Functional abdominal pain (FAP) is diagnosed with abdominal pain that happens at least 4 times per month for at least 2 months. It must be episodic or continuous abdominal pain that does not occur solely during physiologic events, has insufficient criteria for functional GI disorder, and is not explained by any medical condition.

It commonly occurs in pediatrics above 4 years old, with a higher prevalence in girls. Children with FAP are usually absent from school to seek medical advice. The long-term vulnerability could lead to anxiety disorders.
Causes
Causes
  1. Disturbed gut-brain communication
  2. Visceral hypersensitivity
  3. Alteration of gut microbiota
  4. Poor gastric emptying & motility
  5. Genetic predisposition
Risk factors
Risk Factors
  1. Depression and anxiety
  2. Stress
  3. Low-grade inflammation
Risk Factors
  1. Depression and anxiety
  2. Stress
  3. Low-grade inflammation
Risk factors
Symptoms
Symptoms
  1. Sudden or gradual abdominal pain around the belly button
  2. Diarrhea or constipation
  3. Indigestion
  4. Feeling full after eating a small amount of food
  5. Nausea or vomiting

Graph + description of effects + citation, incl. studies for different age groups if applicable

  1. Romano, C., Ferrau’, V., Cavataio, F., Iacono, G., Spina, M., Lionetti, E., Comisi, F., Famiani, A., & Comito, D. (2014). lactobacillus reuteri in children with functional abdominal pain (FAP). Journal of Paediatrics and Child Health, 50(10). https://doi.org/10.1111/j.1440-1754.2010.01797.x
    • 56 children (aged 6-16) with FAP
    • 2 x 10⁸ CFU/ day of L. reuteri Protectis or placebo for 4 weeks followed by a 4-week follow-up without supplementation
    • Result: significant pain reduction intensity from week 0 to week 8 in the L. reuteri Protectis (n=26)
  2. Weizman, Z., Abu-Abed, J., & Binsztok, M. (2016). Lactobacillus reuteri DSM 17938 for the management of functional abdominal pain in childhood: A randomized, double-blind, placebo-controlled trial. The Journal of Pediatrics, 174. https://doi.org/10.1016/j.jpeds.2016.04.003
    • 93 children (average age 11-12) with at least one episode of abdominal pain per week
    • 10⁸ CFU/ day L. reuteri Protectis or placebo for 4 weeks followed by a 4 week follow-up without supplementation
    • Result: Insignificant reduction in pain intensity week 0 to week 8 in the L. reuteri Protectis (n=47)
    • Result: insignificant reduction of number of pain episodes from week 0 to week 8 in the L. reuteri Protectis (n=47)
  3. Jadrešin, O., Hojsak, I., Mišak, Z., Kekez, A. J., Trbojević, T., Ivković, L., & Kolaček, S. (2017). Lactobacillus reuteri DSM 17938 in the treatment of functional abdominal pain in children: RCT Study. Journal of Pediatric Gastroenterology & Nutrition, 64(6), 925–929. https://doi.org/10.1097/mpg.0000000000001478
    • 55 children aged 4-18 with FAP or IBS
    • 10⁸ CFU/ day L. reuteri Protectis or placebo for 12 weeks followed by a 4-week follow-up without supplementation
    • Result: 80% pain-free days in the L. reuteri group (n= 26)
    • Result: Significant reduction in severity of pain during the follow-up month (n=26)
Alleviation
  1. It is common for patients, particularly adolescents, to skip meals to avoid symptoms but this may trigger weight loss and constipation
  2. Increase total dietary fiber intake for FAP with abnormal bowel movement
  3. Improved coping: relaxation (muscle relaxation techniques such as deep breathing exercises), distraction (conversation, games, television to shift attention away from pain)
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