Recurrent abdominal pain in children: When should colonoscopy be performed?

Abstract

Introduction: Recurrent abdominal pain in children is common and may result from a multitude of conditions, including functional disorders, celiac disease, constipation, and inflammatory bowel disease (IBD). While pain is not considered to be an indication for colonoscopy, many colonoscopies are performed to exclude significant pathology. Several reviews have reported abdominal pain to be the primary indication for colonoscopy in 13%-20% of pediatric patients. The utility of colonoscopy in recurrent abdominal pain in children remains unclear. Our aim was to assess the diagnostic yield and role of colonoscopy when assessing children with recurrent abdominal pain. Methods: A retrospective review of all colonoscopies between November 2011 and October 2015 in a tertiary pediatric hospital was performed. All patients in whom abdominal pain was an indication for colonoscopy were included in this study. Patient demographics, reason for procedure, secondary indications, endoscopic findings, and histology were noted. Levels of stool calprotectin and serum inflammatory markers, if measured, were also recorded. Results: A total of 652 colonoscopies were performed during this period, of which 65 (10%) had abdominal pain as one of the indicators for the procedure. Median age of the patients was 12 (2-16) years, and 42/65 (65%) were female. Photographs and/or biopsy were used to confirm the extent of colonoscopy in 99.2% of patients, with a cecal intubation rate of 96.3% (628/652) and ileal intubation rate of 92.5% (602/652). Only 2% of procedures (15/652) were performed for isolated abdominal pain, while the rest had other indications including altered bowel habit (n = 15), weight loss (n = 14), significant family history of IBD or polyps (n = 8), iron deficiency anemia (n = 7), food allergy (n = 3), and rectal bleeding (n = 3). All patients had serum inflammatory markers measured (C-reactive protein or erythrocyte sedimentation rate), and 52% (34/65) had stool calprotectin testing performed. Of the patients with abdominal pain, 6% (4/65) had elevated stool calprotectin or inflammatory markers. Only 11% of patients (7/65) had positive findings at colonoscopy, which included Crohn's disease (n = 3), polyps (n = 2), and microscopic colitis (n = 2). No patient with isolated abdominal pain had positive findings. Patients with associated altered bowel habit or weight loss were more likely to have positive findings; these patients also had abnormal calprotectin and inflammatory markers. Conclusion: The likelihood of significant findings on colonoscopy in children with abdominal pain is low (11%) and unlikely in the absence of other symptoms or findings. Colonoscopy is not warranted in children with isolated abdominal pain in the absence of secondary symptoms or abnormal calprotectin or inflammatory markers.L6180064372017-08-31 <br />