Irritable Bowel Syndrome Message Boards | 10 y.o. w/ new IBS diagnosis

There are some 25 gi functional disorders.

Functional dyspepsia is an upper gi disorder.

IBS is a functional disorder with d or c or c/d and PAIN.

There is also CFAP or Chronic functional abdominal pain. Which does not have c or d or d/c.

TREATMENT
Chronic Functional Abdominal Pain

http://www.aboutibs.org/publications/CFAPTreatment.html

KIds GI Health

Functional abdominal pain: How can it be treated?

"Question from a 13-year-old in Oregon -- I have had stomach pains for over one year that make it hard for me to do anything. I have recurring abdominal pain syndrome. My doctor said there is nothing wrong with me and nothing he can do to treat me. Do you have any suggestions?
Answer -- We assume that you have been seen by a physician who gave you the diagnosis of "recurring abdominal pain syndrome," (functional recurrent abdominal pain).

Tests are done to look for the presence of disease as the cause of symptoms. If the tests find no evidence of disease, the symptoms are termed "functional." Diagnosis of this functional gastrointestinal disorder is based on the symptoms, after ruling out the presence of disease or tissue damage. These symptoms are defined as abdominal pain severe enough to disrupt routine activities three or more times during a three-month period. Studies show that it is pretty common, affecting 10%-15% of school-aged kids.

So if it is not a disease that is causing these symptoms (you are not sick and that is good news), what is causing it? The answer is not entirely clear. Ongoing research is looking for the explanation.

Recent studies point to an increased sensitivity of the sensory nerves in the intestines. Normal movements of your intestines may be perceived as cramps or other discomfort.

The intestines share nerve pathways with the brain. In many situations, when the brain reacts to something -- like the sound of a dentist's drill -- the intestines, or gut, pick up the same signals and react.

The majority of people will ultimately have some kind of gastrointestinal (GI) symptom when exposed to stressful situations. If your GI system is a bit too reactive, you will experience symptoms in more types of stressful situations than someone else will whose gut is not quite as reactive. What is stressful for one person may not be stressful to another, and lots of people don't even realize it when they get stressed -- they just feel sick.

Finally, there is the "gate theory" of how pain is experienced. When pain originates at some point, nerve messages pass through something like a gate on their way to the brain. The wider open the gate is, the more pain that is experienced. By thinking about and focusing on the pain site, we open the gate. Plus, feelings of anger or worry or sadness can open the gate.

However, we can also help close the gate. Turning attention away from the site or feeling of pain, through relaxation or focusing on some other activity, can help close the gate and lessen or even eliminate pain.

A well-known phenomenon that demonstrates this is that of the athlete who plays a game while injured, oblivious to the pain. The athlete is completely focused on the game and does not feel pain. Then, after the game is over, the athlete turns attention to the injury and feels pain.

Whatever the cause, you can do something about it! It takes some effort but there a number of ways that you can help yourself.

First, think about this example. Have you ever experienced a muscle cramp or a side-ache during strenuous running or exercise? You feel real pain in muscles that are not diseased. But they have been stressed beyond some point that in you causes discomfort. What do you do to avoid it in the future? You might think about what you were doing that resulted in the muscle pain. Maybe next time you do more warm-up exercises, or start out slower, or don't run as far.

The first time you felt a side-ache, you might have felt concerned and stopped running. After you learned that it was nothing to be concerned about, you may have barely taken notice the next time it happened, perhaps slowed down a bit, but then kept right on going.

This is the same type of thing that happens with functional recurrent abdominal pain. Your intestinal muscles may be causing you to feel pain. To get it under control, try this:

1) While the pain you feel is very real, do not worry that you are sick. You are not. Your body is reacting to events in a way that is causing you discomfort but is not cause for alarm.

2) Try to figure out if your symptoms are connected with anything else that may be triggering them. Do symptoms flare at certain times, before certain events, on weekdays, on weekends, etc? If you can identify triggering factors (like certain foods or activities) you can try to avoid them, or if that is not possible, try to deal with them in different ways.

3) Are you missing school because of this? Worry over missing school can make symptoms worse. Try to keep going.

4) Are you doing too much-school plus lots of outside activities? If so, take some time off to relax. Too much of anything can be stressful.

5) The next time you feel the pain, don't let it stop you. Keep on going. Practice focusing your thoughts on what it is you want to do next and then go ahead and do it. Don't let pain take your awareness hostage. "

http://www.aboutkidsgi.org/questionsandanswers.html#fap

Chronic Functional Abdominal Pain
By: Douglas A. Drossman, M.D.

http://www.aboutibs.org/publications/CFAP.html

NEW YORK (Reuters Health) - Childhood abdominal pain is a common complaint, and it may progress to adult irritable bowel syndrome (IBS) in some cases, according to a study in the American Journal of Gastroenterology.

IBS is marked by bloating, pain, constipation and diarrhea, and often doesn't seem to have a direct physical cause -- although the symptoms are certainly real.

"The natural history of childhood abdominal pain and its association with adult IBS remain poorly described," Dr. Nicholas J. Talley, of the Mayo Clinic College of Medicine, Rochester, Minnesota, and colleagues note in their report.

To investigate, they assessed the characteristics of childhood abdominal pain over the first 11 years of life in some 1,000 children born in Dunedin, New Zealand in 1972, and examined the association of childhood abdominal pain with IBS at when the participants reached 26 years of age.

A history of abdominal pain was documented in 18 percent of the children.

Childhood abdominal pain was more common in females than in males. The prevalence of abdominal pain peaked at age 7 to 9 years among boys, but it remained stable across assessments for females.

IBS at age 26 years was about 2 or 3 times more common among subjects with a history of childhood abdominal pain between the ages of 7 and 9 years compared to those with no history.

Factoring in gender, socioeconomic status, psychiatric disorder at age 26, childhood emotional distress, or maternal malaise did not alter this association.

"The emergence of multiple stressors in the home and school environment may present a plausible mechanism to account for these findings," Talley's team suggests.

As they point out, "The 7 to 9 year age-period follows closely from the school starting age in many cultures, and children who are predisposed to stress-related disorders may be at particular risk of developing symptomatic complaints at this point."

SOURCE: American Journal of Gastroenterology, September 2005.

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Kids' distress is no small thing

http://www.usatoday.com/news/health/2005-05-08-kids-pain_x.htm

New Recommendations for Treating Children With Chronic Abdominal Pain CME

http://www.medscape.com/viewarticle/500799

Mind-Body Technique Eases Kids' Gut Pain

Kids Have Fewer Days of Abdominal Pain When Using Relaxation Technique WEBMD

http://www.webmd.com/content/article/72/81542.htm

Defecation Anxiety Linked to Functional Constipation in Children

Charlene Laino

Oct. 15, 2003 (Baltimore) � Children with functional constipation have significantly more anxiety related to toileting behavior than healthy children � anxiety. This anxiety makes them more likely to continue to suffer from the problem, a prospective study suggests.

Moreover, some of these children develop generalized anxiety, reported researchers from the Cleveland Clinic Foundation.

"Constipated kids were not generally anxious overall, but among those with defecation anxiety we saw an increase in general anxiety," said Gerard Banez, PhD, a child psychologist at the Cleveland Clinic Foundation. "This does not prove cause-and-effect, but does suggest that those constipated children with greater defecation anxiety also exhibit increased general anxiety."

Painful bowel movements can make a child fearful of pain, Dr. Banez said. That fear can be generalized to sitting on the toilet.

The research was described here today at the American College of Gastroenterology 68th annual scientific meeting.

Up to 7.5% of children suffer from constipation, which accounts for about 3% of visits to pediatricians and up to 25% of visits to pediatric gastroenterologists, according to data cited in the study.

According to the researchers, constipation carries a host of physical and psychological consequences, and defecation anxiety is often implicated as a primary contributor to constipation.

Dr. Banez and colleagues studied 98 boys and girls aged 6 to 18 years who suffered from functional constipation. The youngsters completed the Defecation Anxiety Scale�Self-Report and Revised Children's Manifest Anxiety Scale, which measures generalized anxiety. The parents also rated their children's defecation anxiety on the Defecation Anxiety Scale�Parent Rating Scales.

By both self-report and parent report, children with functional constipation were found to have significantly more defecation anxiety than healthy children or children with asthma, the researchers said.

Overall, 70% of the children reported defecation anxiety compared with 58% of a control group of healthy children and 65% of children with asthma. The parents reported that 82% of their children suffered from defecation anxiety.

In addition, 30% of the children with constipation reported generalized anxiety. The greater the defecation anxiety, the greater the generalized anxiety, Dr. Banez said. Children with defecation anxiety have a higher chance of having generalized anxiety, although some children with no significant generalized anxiety still had defecation anxiety, he added.

Physicians who see children with constipation anxiety should rule out any medical cause, Dr. Banez said. Also, consider defecation anxiety in the differential diagnosis of any child whose parents report that their child seems to be withholding stool, is tearful at the urge to use the toilet, or shows vigorous resistance to using the toilet, he said.

Also, physicians should discuss strategies that promote relaxed toilet sitting as well as suggest dietary changes � possibly with a stool softener thrown in � to promote softer stools, Dr. Banez said.

William Whitehead, MD, professor of medicine at the University of North Carolina in Chapel Hill, said he has had some luck treating constipation anxiety with biofeedback, although he said that studies in Europe suggest that laxatives work just as well as the relaxation technique.

The question now, he said, is whether anxiety is the cause or the consequence of constipation. ?This study doesn?t really tell us, but it is still a major advance, the first trial I know of where they have linked defecation and anxiety directly using such a systematic approach.?

ACG 68th Annual Scientific Meeting: Abstract 723. Presented Oct. 15, 2003.

Reviewed by Gary D. Vogin, MD

Recurrent abdominal pain in children: forerunner to adult ir
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FYI

J Spec Pediatr Nurs. 2003 Jul-Sep;8(3):81-9. Related Articles, Links

Recurrent abdominal pain in children: forerunner to adult irritable bowel syndrome?

Jarrett M, Heitkemper M, Czyzewski DI, Shulman R.

Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, USA. jarrett@u.washington.edu

ISSUES AND PURPOSE: Review the etiology and pathophysiology of recurrent abdominal pain (RAP) and its potential role as a precursor to irritable bowel syndrome (IBS) in adults. CONCLUSIONS: Physiological mechanisms not easily identifiable as an organic cause may underlie symptoms in RAP patients. They may be triggered by psychosocial factors that result in greater functional disability, more clinic visits, and lower academic and social competence. Of these children, 25% will experience similar symptoms as adults; many will be diagnosed with IBS. PRACTICE IMPLICATIONS: Nurses can provide early and efficient management of these children's care if they view the issues of abdominal pain/discomfort from a broader focus that includes the context of the child's experiences.

PMID: 12942886

Childhood bellyaches can be gut-wrenching
Agony but no answers: Youngsters sometimes endure months of unsuccessful tests, bouncing from doctor to doctor
See BELLYACHES, D2

Bellyaches often defy easy cures
By Laurie Tarkan
The New York Times

Color illustration by Earl F. Lam III

When 12-year-old Hannah Scott began middle school last year, she was so nervous that her stomach was not just in knots, it was in serious pain.
''It would start in the morning when I'd leave the house,'' said Hannah, a wisp of a girl with light brown freckles and long sandy hair. ''And when I got to school, it was really, really bad. I'd go to the nurse every other day, and be sent home.''
When the bellyaches persisted for months, Hannah's parents took her to a pediatric gastroenterologist, who ordered tests, including X-rays, a colonoscopy and an endoscopy, to rule out serious problems.
After nothing showed up, the ailment was diagnosed as irritable bowel syndrome, a gastrointestinal disorder with no organic cause and no proven treatment in children. But the doctor said there was nothing to do about it; eventually, it got so bad that her parents pulled her out of school.
An estimated 10 percent to 20 percent of all school-age children suffer severe recurrent abdominal pain. But many children and adolescents go for 13 to 18 months before being treated, and some are never treated at all.
In some cases, untreated pain is so debilitating that they miss school, dance classes, sports activities and social events. They are at risk of falling behind academically, physically, socially and developmentally.
Experts say that organic causes like ulcers, inflammation or intestinal blockages are to blame in only a small minority of children, 5 percent to 10 percent.
A majority suffer instead from what are called functional gastrointestinal disorders. The most common are functional abdominal pain, in which pain is the only symptom; irritable bowel syndrome, which brings on pain along with diarrhea or constipation; and functional dyspepsia, which typically shows up as pain with nausea or a feeling of fullness.
Often, children who have recurrent abdominal pain are put through a battery of invasive tests. They are placed on restrictive diets and given large doses of acid-suppressing medications or anti-diarrhea drugs, which may offer some relief for the symptoms, but often do nothing for pain.
Some children are told that their illness is ''all in their head,'' or that they are faking it.
''There are a lot of misconceptions that make the life of these children more difficult,'' said Carlo Di Lorenzo, chief of pediatric gastroenterology at Children's Hospital of Columbus, Ohio.
''They bounce from doctor to doctor, get more and more tests, until things get better or they find a specialist who knows how to treat them,'' Di Lorenzo said. In fact, there are clear criteria for diagnosing disorders that cause recurrent abdominal pain, and for most children, the diagnosis can be made without invasive tests.

Brain and gut: New approaches to treating pain are already being used in adults, including cognitive behavioral therapy; alternative treatments like relaxation techniques and massage therapy; and antidepressants. But they have not been widely adopted for children, in part because only a handful of small studies support such use.
In recent years, however, experts have begun to understand more about the connections between the brain and the gut, a relationship that is reflected in popular expressions like ''a gut-wrenching experience'' or ''having butterflies in your stomach.''
The gastrointestinal tract is awash in nerve cells and neurotransmitters. About 95 percent of the body's neurotransmitter serotonin is in the intestinal tract. Stress, nervousness, fear and other emotions often play out their own drama in the gut. In children with abdominal pain, the intestinal tract becomes hypersensitive to stimuli, with the slightest bit of gas, for instance, sending a flood of pain signals to the brain.
The problem appears to be a mismatch in signaling between the brain and the gut, said Lonnie Zeltzer, director of the Pediatric Pain Program at the David Geffen School of Medicine at the University of California, Los Angeles. ''If you have ongoing pain, you can develop abnormal pain pathways, so that the volume of pain signaling is being turned up and up,'' Zeltzer said.
What causes the hypersensitivity is not completely understood, but experts believe that it is often set off by a stomach virus or an infection.
''It's not uncommon that a family will get viral gastroenteritis, the whole family gets better except the child,'' said Zeltzer, author of Conquering Your Child's Chronic Pain: A Pediatrician's Guide for Reclaiming a Normal Childhood. ''The pain system is turned on and stays on.''
Experts do not know why some children and adolescents develop this problem and others do not. One clue may be that children with abdominal pain tend to be unusually worried and anxious.
As an understanding of the brain-gut connection grows, however, some centers have begun to use techniques like cognitive behavioral therapy, relaxation training, massage therapy and other alternative approaches as a first line of treatment.
The effectiveness of these therapies is still debated, and the number of studies examining their effectiveness in children is very small, experts say. In one study published in the August issue of The Journal of Pediatric Gastroenterology and Nutrition, 18 children ages 8 through 17 who had pain for about a year were taught guided imagery and progressive relaxation.
In four to seven sessions, 89 percent of the children reported a reduction in pain, to an average of two episodes a week, from six, said Nader N. Youssef, a pediatric gastroenterologist at the Goryeb Children's Hospital in Morristown, N.J. and the lead author of the study. The children had fewer missed school days, and their quality-of-life scores rose significantly.

Tests can be stressful: Another novel approach is the use of antidepressants for the pain. An analysis of large studies of adults with functional abdominal pain found evidence for the effectiveness of low doses of tricyclic antidepressants, though the drugs have not been studied in children for such complaints.
Tricyclics, an older class of antidepressants, have also been associated with rare cases of unexplained sudden death, and some doctors require an electrocardiogram before prescribing them to children.
For those parents trying to help children cope with recurrent bellyaches, experts say it is important to understand that there does not have to be an organic reason for the pain, Zeltzer said. She advised parents to avoid unnecessary tests, because the tests themselves are stressful.
She and other experts recommend that parents help children learn relaxation techniques like breathing methods, progressive muscle relaxation or visualization to use when they are feeling stressed. The techniques are explained on many Web sites.
Children with recurrent stomach pain, experts say, should be kept in school and should stay involved in activities, if possible. These distractions help take the focus off the pain. Good sleep habits and exercise also help reduce pain.
In Hannah's case, her mother took her to a pain management center in Kansas City, Mo., where she learned cognitive behavioral strategies to help change her reactions to stress and relaxation exercises to reduce the stress and pain.
By late March, Hannah was back in school. ''I think I stopped thinking about it and worrying about it,'' she said.

http://www.sltrib.com/healthscience/ci_2546772;jsessionid=KDPSAI1MCRB1ECUUCBQSFEY

Top Pediactric docs and pain webmd

Mind-Body-Pain Connection: How Does It Work?

By Michael Henry Joseph
WebMD Live Events Transcript

Event Date: 05/11/2000.

Moderator: Welcome to WebMD Live's World Watch and Health News Auditorium. Today we are discussing "The Mind-Body-Pain Connection: How Does It Work?" with Brenda Bursch, Ph.D., Michael Joseph, M.D., and Lonnie Zeltzer, M.D.

Brenda Bursch, Ph.D., is the Associate Director of the Pediatric Pain Program, Co-Director of Pediatric Chronic Pain Clinical Service and Assistant Clinical Professor of Psychiatry & Biobehavioral Sciences at UCLA Department of Pediatrics in the School of Medicine. She has written about asthma, developmental & behavioral pediatrics, emergency medicine, AIDS education and prevention, chronic digestive diseases and pediatric bowel disorders. She has membership in the American Pain Society, American Psychological Association, Munchausen Syndrome by Proxy Network, and the UCLA Center for the Study of Organizational and Group Dynamics.

Michael Henry Joseph, MD, is an assistant professor of pediatrics and co-director of Chronic Pain Services at the University of California at Los Angeles Children's Hospital. He is a recipient of the Golden Apple Award for Excellence in Teaching.

Lonnie Zeltzer, M.D., is an expert in the field of pediatric pain. She is a former president of the Society for Adolescent Medicine and member of the National Institute of Health?s Human Development Study Section. She is currently a Professor of Pediatrics and Anesthesiology at the UCLA School of Medicine. She is Director of the UCLA Pediatric Pain Program and Associate Director of the Patients & Survivors Section, Cancer Prevention and Control Research Branch of the UCLA Jonsson Comprehensive Cancer Center. She has well over one hundred scientific publications, reviews and chapters in medical journals, and has lectured internationally.

http://www.webmd.com/content/article/1/1700_50465?src=Inktomi&condition=Event%20Archives

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