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Protozoa as a Cause of Recurrent Abdominal Pain in Children

Gijsbers, Carolien F.M.*; Schweizer, Joachim J.; Büller, Hans A.

Journal of Pediatric Gastroenterology and Nutrition: November 2013 - Volume 57 - Issue 5 - p 603–606
doi: 10.1097/MPG.0b013e31829f1bc0
Original Articles: Gastroenterology

Objectives: The aim of this study was to investigate whether protozoa can be identified as a cause of recurrent abdominal pain (RAP), and whether protozoan infections can be recognized by a specific clinical presentation.

Methods: For 2 years, all patients (ages 4–16 years) fulfilling the Apley criteria of RAP referred to secondary care were prospectively evaluated for protozoa (Giardia lamblia, Dientamoeba fragilis, Blastocystis hominis) and treated if positive. Re-examination followed at least 10 days after treatment. Disappearance of pain with eradication and a pain-free follow-up of at least 6 months were considered to be indicative of a causal relation with RAP. The predictive value of the characteristics of the pain for protozoan infections was calculated.

Results: Of 220 included patients (92 boys, mean age 8.8 years), 215 brought a stool sample; 73 (34%) carried parasites, 10 of whom had 2 parasites, 2 had 3 parasites. Sixty-five patients were treated. Twenty-five (11%) were pain-free after eradication (21 had D fragilis, 8 B hominis, 4 G lamblia), of whom 11 had another infection (2) or constipation (9) as second diagnosis for the pain. Five had recurrence of infection with D fragilis and were again pain-free with eradication. Patients with protozoa as cause of their pain did not show differences with respect to their presentation when compared with patients with an asymptomatic infection and patients without protozoa.

Conclusions: Protozoa were found as the cause of pain in 6% to 11% of children with RAP. These patients did not show a characteristic presentation when compared with patients with other causes of abdominal pain.

*Department of Paediatric Gastroenterology, Juliana Children's Hospital/Haga Teaching Hospital, The Hague

Department of Paediatric Gastroenterology, Willem-Alexander Children's Hospital/Leiden University Medical Centre, Leiden

Sophia Children's Hospital/Erasmus Medical Centre, Rotterdam, The Netherlands.

Address correspondence and reprint requests to Carolien F.M. Gijsbers, Department of Paediatric Gastroenterology, Juliana Children's Hospital/Haga Teaching Hospital, Sportlaan 600, 2566 MJ The Hague, The Netherlands (e-mail:

Received 7 February, 2013

Accepted 17 May, 2013

The authors report no conflicts of interest.

© 2013 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,