Long term follow up of children with recurrent abdominal pain

Editor—Large longitudinal studies of children with recurrent abdominal pain, such as the one Hotopf et al conducted, are needed. Current knowledge is limited, and studies on the long term follow up of patients with recurrent abdominal pain should fill the gaps. Hotopf et al have addressed this important subject by trying to answer two questions, as the title of their paper indicates.¹ The prevalence of recurrent abdominal pain in their cohort (2%) was lower than that reported in cross sectional studies (8-12%).²,³ This suggests problems with the collection and reliability of the data.

Hotopf et al’s first question was, “Why do children have chronic abdominal pain?” Their study was not, however, designed to answer this question. They did not have enough information and did not look for any to help them identify possible causes of abdominal pain. The subjects of the study were identified from a cohort born in 1946, and the information was collected at the ages of 7, 11, and 15. The information could not be verified by further questioning, and Apley’s definition of recurrent abdominal pain was not applied.² Hotopf et al described the abdominal pain as recurrent, persistent, and chronic, but interchangeably, which added to the confusion and lack of conviction about the condition in question. Although there is no unifying definition that applies to all cases of recurrent abdominal pain in children, the children were treated as if they were a homogeneous group.

Hotopf et al’s second question related to what happens to children with recurrent abdominal pain when they grow up. Without a proper definition of recurrent abdominal pain, their conclusions could be true for any non-specific painful condition. Although Hotopf et al’s conclusions are useful to describe any child with recurrent ache and pain of unidentifiable cause, they are not specific to recurrent abdominal pain as described and defined by Apley.