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The Overlap of Functional Abdominal Pain in Pediatric Crohn’s Disease

Zimmerman, Lori A. MD*; Srinath, Arvind I. MD; Goyal, Alka MD; Bousvaros, Athos MD, MPH*; Ducharme, Peter MSW; Szigethy, Eva MD, PhD§; Nurko, Samuel MD, MPH*

doi: 10.1097/MIB.0b013e3182802a0a
Original Clinical Articles

Background: Children with Crohn’s disease (CD) may report abdominal pain despite clinical remission, suggesting that functional abdominal pain (FAP) may be playing a role. The aim of this study was to explore the presence and impact of FAP in children with CD in remission.

Methods: Children, aged 9 to 17 years, with CD were enrolled. Demographic information, the Pediatric Crohn’s Disease Activity Index, and the Children’s Depression Inventory were obtained. Disease remission was defined by physician global assessment, normal laboratories findings, absence of 3 or more stools a day, nocturnal stooling, bloody diarrhea, concurrent steroid therapy, strictures, or disease flare within 6 months. FAP was defined as patients with abdominal pain and CD remission. Rates of depression (Children’s Depression Inventory >9) were compared.

Results: Of 307 children, 139 reported abdominal pain. Of this group, 18 of 139 (13%) children met the criteria for FAP. Despite clinical remission, 8 of 18 patients with CD having FAP were classified with active disease by Pediatric Crohn’s Disease Activity Index. These patients had a higher rate of depression than patients with CD in remission with no abdominal pain (55.6% versus 29.9%; P = 0.03), similar to patients with abdominal pain from active CD (55.6% versus 44.8%; P = 0.62).

Conclusions: A proportion of children with CD in remission have FAP. These children are at significant risk of depression. Future studies are needed to determine whether depression contributes to functional pain development or if pain itself leads to depression. Especially given that functional pain may exaggerate disease activity, clinicians caring for children with CD and FAP should consider evaluating for depressive disorders before escalating therapy.

Article first published online 12 February 2013

*Department of Gastroenterology/Nutrition, Children's Hospital Boston, Boston, Massachusetts

Department of Gastroenterology/Nutrition, Children’s Hospital Pittsburgh, Pittsburgh, Pennsylvania

Department of Psychiatry, Children’s Hospital Boston, Boston, Massachusetts

§Department of Psychiatry, University of Pittsburgh, Children’s Hospital Pittsburgh, Pittsburgh, Pennsylvania.

Reprints: Samuel Nurko, MD, Department of Gastroenterology and Nutrition, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115 (e-mail

Supported by NIMH R01 (R01MH07777 to E. Szigethy) and NIH K-24 (DK082792A to S. Nurko).

S. Nurko and E. Szigethy contributed equally to this study.

The authors have no conflicts of interest to disclose.

Received July 05, 2012

Accepted July 08, 2012

© Crohn's & Colitis Foundation of America, Inc.
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