Diagnostic Classification

Youth with chronic abdominal pain that is medically unexplained have been referred to as suffering from FAP. The Rome III classification system for FGIDs parses FAP into a number of narrower, spe cific diagnoses, including a narrowly defined diagnosis of functional abdominal pain. In the remainder of this chapter, the specific Rome III diagnosis of functional abdominal pain will be spelled out and italicized to distinguish it from FAP in the more global, descriptive sense. The most widely used Rome III diagnoses associated with abdominal pain are listed in Table 18-1 and include irritable bowel syndrome (IBS), functional dyspepsia, childhood functional abdominal pain, childhood functional abdominal pain syndrome, and abdominal migraine (Rasquin et al. 2006). Baber et al. (2008) found that the Rome III criteria classified nearly 90% of youth with FAP, an improvement from the 68% classified using the previous Rome II criteria. In their study, 45% of youth with FAP met Rome III criteria for IBS, 23% for abdominal migraine, 15% for functional dyspepsia, 11% for functional abdominal pain, and 6% for functional abdominal pain syndrome. Nevertheless, despite the growing use and acceptance of the Rome III criteria among gastroenterologists, their validity and reliability have yet to be demonstrated (Ford et al. 2008).

Abdominal migraine is a diagnosis that is also addressed by the International Classification of Headache Disorders, in which it is defined as a recurrent idiopathic disorder seen mainly in children and characterized by episodic midline abdominal pain manifesting in attacks lasting 1-72 hours, with normality between episodes; the pain is of moderate to severe intensity and associated with vasomotor symptoms, nausea, and vomiting (Lewis and Pearlman 2005). Abdominal migraine has been reported to have a prevalence of 1%-4% in children, is more common in females (Rasquin et al. 2006), and appears to predict migraine headache in adulthood (Dignan et al. 2001). A strong family history of migraine tends to support the diagnosis of abdominal migraine in the presence of classic symptoms (Rasquin et al. 2006).

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