Gastric myoelectrical activity, gastric emptying time and oro-caecal transit time in children with Recurrent Abdominal Pain Syndrome

Abstract

Recurrent abdominal pain syndrome is a common paediatric problem affecting approximately 10 percent children and adolescents worldwide. The exact aetiology of this troublesome syndrome is unclear in the majority of patients affected by this condition and attempts have been made to classify them into functional gastrointestinal diseases using Rome II and III criteria. Few studies have demonstrated gastrointestinal motility abnormalities in affected individuals. Despite the magnitude of the problem, knowledge on the effective management options is poor. This thesis attempts to answer some of the issues on pathophysiology and management of recurrent abdominal pain syndrome. The epidemiology and aetiology of recurrent abdominal pain syndrome in Sri Lankan children and adolescents was not known. An epidemiological survey was carried out in four randomly selected schools in Gampaha District of Sri Lanka using self-administered parental questionnaire. The study included 734 school children between 5 to 15 years and the prevalence, clinical profile, health care consultation behaviour, risk factors for recurrent abdominal pain syndrome, and its impact on education were determined. The epidemiology of childhood recurrent abdominal pain syndrome in Sri Lanka (prevalence 10.5 percent) is similar to other countries, except for health care consultation behaviour (70 percent ), which is higher than reported in previous studies. Fifty five recurrent abdominal pain patients identified in the epidemiological study were recruited for an aetiological investigation to detect possible organic and functional causes for recurrent abdominal pain. Clinical and laboratory evaluation revealed organic pathology in less than 24 percent of the affected children, and the majority had functional gastrointestinal diseases. A case control study to detect a possible association between Helicobacter pylori infection and recurrent abdominal pain syndrome performed in 39 patients and 20 healthy controls did not show a significant association between the two conditions. Gastrointestinal motility abnormalities have been suggested as a possible cause for symptoms in patients with non-organic recurrent abdominal pain, but very few studies have been done to prove or disprove this. Case controlled studies were performed in 42 patients and 20 healthy controls to investigate an association between gastric myoelectrical activity (electrogastrography), gastric motility (gastric emptying and antral motility), and oro-caecal transit (small intestinal transit) and non-organic recurrent abdominal pain. The results showed significantly decreased gastric emptying, decreased antral motility and delayed oro-caecal transit time in patients suggesting that gastrointestinal motility abnormalities may be responsible for generation of symptoms in non-organic recurrent abdominal pain. High dietary fat is proven to delay gastric emptying and small intestinal transit, and known to induce gastrointestinal symptoms in patients with functional gastrointestinal disease. Low fat diet has been suggested as a therapeutic option in patients with functional dyspepsia. There were no studies published on the value of a low fat diet in patients with recurrent abdominal pain. A single blind, randomized, controlled trial was conducted to investigate the therapeutic value of a low fat diet on 42 patients with non-organic recurrent abdominal pain. The results demonstrated a possible therapeutic value of low fat diet on recurrent abdominal pain patients with delayed gastric emptying.