Table 2.

Alarm Signs and Symptoms for Youth with Chronic Abdominal Pain with Suggested Initial Evaluation

Alarm Sign or Symptom	Evaluation
Weight loss Deceleration of growth Delayed Puberty	Complete blood count, C-reactive protein, stool calprotectin (or lactoferrin), and celiac serology
Excessive vomiting Right upper quadrant pain	Liver function tests, amylase, lipase, urinalysis, and abdominal ultrasound
Hematemesis or hematochezia Right lower quadrant pain Severe chronic diarrhea Perianal disease Systemic symptoms such as unexplained fever or arthritis Family history of inflammatory bowel disease or celiac disease	Complete blood count, C-reactive protein, stool calprotectin (or lactoferrin), celiac serology, and endoscopy
Dysphagia	Barium swallow and endoscopy