The primary care physician's approach to functional abdominal pain in childhood

BACKGROUND: Recurrent abdominal pain in children was defined initially by Apley and updated recently by Rome II criteria. The intent of the Rome II criteria is to provide greater insight into functional disorders of the gastrointestinal tract. Because markers for these disorders are lacking, diagnostic evaluations may vary. In this investigation, the individual approach of the primary care physician to the child with functional abdominal pain (as defined by Rome II criteria) is explored both in a hypothetical and clinical setting. STUDY: A clinical vignette and survey involving the evaluation of a school-aged child with prototypical functional abdominal pain was distributed to area primary care physicians (n=201 completed). The actual physician approach for functional abdominal pain was determined through chart review of children referred to gastroenterology clinic (n=103). RESULTS: Physicians favored limited organ-specific testing, with urinalysis, preferred most. Physicians with extreme anticipation of a positive yield requested more testing than their nonanticipatory counterparts (5.7±2.2 vs. 2.0±2.0, P<0.001). Ultrasound was the only diagnostic test requested with greater frequency in actual subjects than hypothetical (31% vs. 18%, P<0.005). CONCLUSIONS: In accordance with published guidelines, physicians requested minimal testing for functional abdominal pain. Increased ultrasound requests in the clinic setting may be more reflective of the need for reassurance rather than seeking an organic etiology.