April 25, 2000 -- Frequent abdominal pain or heartburn in children does not generally indicate serious disease or lingering digestive problems, according to a study published in the April Journal ofPediatric Gastroenterology and Nutrition. Researchers say most kids with such symptoms get better over time and do not end up having chronic digestive disorders, such as peptic ulcer disease, or cancer.
Recurrent abdominal pain or heartburn "is a common problem in children and the symptoms are very similar to those seen in adults. But only a small percentage of children have serious underlying disease," says study author Jeffrey S. Hyams, MD, of the Connecticut Children's Medical Center.
While stomachaches are among the most frequent medical complaints of children and adolescents, pain in the upper part of the stomach -- called dyspepsia -- has not been widely studied in this group. The most common signs of dyspepsia are nausea, heartburn, and acid reflux symptoms.
"Serious disease such as [upper gastrointestinal] cancer is virtually unheard of in children, as opposed to adults, where cancer is a concern. In children with dyspepsia who have no other warning signs such as vomiting blood or weight loss, it is perfectly legitimate to go ahead and treat for symptoms," says Hyams.
Hyams and colleagues evaluated children and adolescents treated in their gastroenterology practice for recurrent abdominal pain, nausea, or vomiting. Of the 257 patients surveyed, just over half were found to have reoccurring upper abdominal discomfort or dyspepsia.
Although diseases can cause dyspepsia in children, the researchers found that 62% of children with dyspepsia had no obvious cause for it. For example, none of the children in the study had peptic ulcers and fewer than 10% showed evidence of infection with Helicobacter pylori, which has been found to be a frequent cause of gastritis and ulcers in adults. Within six months to two years, more than two-thirds of the children in the study -- about 70% -- were greatly improved or had no symptoms at all, regardless of the cause of dyspepsia.
Hyams says he was not surprised to see little evidence in his young patients of the diseases that frequently accompany adult dyspepsia. Invasive diagnostic procedures such as endoscopy are only rarely needed for children with frequent dyspepsia, Hyams says. Most of the patients in this study who did not undergo endoscopy had excellent outcomes when given standard therapies such as Zantac, Tagamet, or Prilosec.
"These drugs have been shown to be perfectly safe, so why not try them first?" Steven Lichtman, MD, tells WebMD.
Lichtman, a professor of pediatric gastroenterology at the University of North Carolina at Chapel Hill, says far too many endoscopic procedures are conducted in children and adolescents, but that it is often the parents, and not the physicians, who insist on them.
- Children who experience frequent nausea or heartburn generally do not have a serious underlying disease.
- Standard treatment of symptoms with drugs such as Zantac, Tagamet, or Prilosec should be effective, and invasive diagnostic procedures are only rarely needed for children.
- Most kids with these symptoms get better over time and do not experience chronic digestive disorders as adults.