Recurrent Abdominal Pain in Children: Is Colonoscopy Indicated?

Introduction: Recurrent abdominal pain in children is common, with most functional in origin. Colonoscopy has sometimes been performed to exclude pathology but its role is unclear. Our aim therefore was to assess the diagnostic yield and role of colonoscopy in these children. Methods: Retrospective review of consecutive colonoscopies in a tertiary pediatric hospital between November 2011 and October 2015 was undertaken. Only those with recurrent abdominal pain as an indication for procedure were included. Chart review of patients with pain was undertaken to ensure they fulfilled Rome IV criteria. Patient demographics, indication for procedure, and adjunct pre-procedure tests were noted. Statistical analyses were performed with SPSS software. Results: 652 colonoscopies were performed, of which 68 (10%) had abdominal pain as one of the indications; and was the sole indication in 15 (2%) patients. All 68 patients had pre-procedure serum inflammatory markers measured and 53% (36/68) had stool calprotectin. Positive histology was found in 10% (7/68) including Crohn disease (n = 3), polyps (n = 2), and microscopic colitis (n = 2). The remaining 61 patients had normal colonoscopy and ileocolonic biopsies. 5/36 patients had raised fecal calprotectin, and all had abnormal histology. Serum inflammatory markers were raised in 4 patients and all also had abnormal calprotectin. No patient with isolated abdominal pain had positive histology. Rectal bleeding was the only associated indication to predict abnormal histology (p = 0.019). Conclusions: Colonoscopy is likely not warranted in children with recurrent abdominal pain without bleeding, weight loss or altered bowel habit. Fecal calprotectin is useful in helping predict positive findings. Address correspondence and reprint requests to Harveen K. Singh, Dr, Department of Gastroenterology, Hepatology and Transplant, Lady Cilento Children's Hospital, 501 Stanley St, South Brisbane, Queensland, 4101, Australia (e-mail: Harveen.k.singh1@gmail.com). Received 12 April, 2018 Accepted 9 September, 2018 Sources of support- We have not received any funding or have any interest in any company or technology that could be perceived as a conflict of interest in this study. Authors Roles: Dr Harveen K Singh: Obtainment of ethics approval, collection and interpretation of data, statistical analysis and drafting of article. Dr Looi C Ee: Involvement in conception and design of article, interpretation of data, critical revision of article and final approval. The authors report no conflicts of interest. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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