University of Missouri School of Medicine, Columbia, MO, USA.
Am Fam Physician. 2018 Jun 15;97(12):785-793.
Recurrent abdominal pain (RAP) in children is defined as at least three episodes of pain that occur over at least three months and affect the child's ability to perform normal activities. RAP is most often considered functional (nonorganic) abdominal pain, but an organic cause is found in 5% to 10% of cases. Further workup is warranted in children who have RAP and fever, vomiting, blood in the stool, more than three alarm symptoms, or a history of urinary tract infections. Physical examination findings that should prompt further workup include weight loss or failure to grow; jaundice; costovertebral tenderness or back pain with lower extremity neurologic symptoms; liver, spleen, or kidney enlargement; an abdominal mass; or localized tenderness on abdominal examination. Workup may include complete blood count, erythrocyte sedimentation rate, C-reactive protein level, fecal guaiac testing, fecal ova and parasite testing, or urinalysis. Pregnancy testing and screening for sexually transmitted infections should be considered in adolescents or if there are concerns about sexual abuse. Abdominal radiography can be helpful for diagnosing obstruction or constipation. Abdominal ultrasonography identifies an abnormality in up to 10% of children with RAP who meet criteria for further workup, compared with 1% of those who do not meet these criteria. Functional abdominal pain is a clinical diagnosis and no workup is needed. Management of functional abdominal pain focuses on improving quality of life, reducing parent and child concerns about the seriousness of the condition, and reducing the disability associated with pain rather than complete resolution of pain. Although evidence is lacking for most pharmacologic treatments of functional abdominal pain, psychological therapies such as cognitive behavior therapy and hypnotherapy have been shown to be beneficial.
儿童复发性腹痛（RAP）定义为至少 3 次发作的疼痛，持续至少 3 个月，影响儿童进行正常活动的能力。RAP 通常被认为是功能性（非器质性）腹痛，但在 5%至 10%的病例中可发现器质性病因。对于有 RAP 且伴有发热、呕吐、粪便带血、超过 3 个报警症状或尿路感染史的儿童，需要进一步检查。应进一步检查的指征包括体重减轻或生长不良、黄疸、肋脊角压痛或伴有下肢神经症状的背痛、肝脾或肾脏肿大、腹部肿块或腹部检查时局部压痛。检查可能包括全血细胞计数、红细胞沉降率、C 反应蛋白水平、粪便隐血试验、粪便虫卵和寄生虫检查或尿液分析。应考虑对青少年进行妊娠检测和性传播感染筛查，或如果怀疑有性虐待。如果符合进一步检查标准，腹部放射摄影术有助于诊断梗阻或便秘。与不符合这些标准的患者相比，腹部超声检查在符合进一步检查标准的 RAP 儿童中可发现高达 10%的异常，而在不符合这些标准的患者中仅发现 1%。功能性腹痛是一种临床诊断，无需进行检查。功能性腹痛的管理重点是改善生活质量，减轻父母和儿童对病情严重程度的担忧，并减少与疼痛相关的残疾，而不是完全缓解疼痛。尽管缺乏大多数功能性腹痛药物治疗的证据，但心理疗法，如认知行为疗法和催眠疗法已被证明是有益的。
