-

Öz

Recurrent abdominal pain (RAP) is a disorder hard to diagnose and treat in children, that is distressing to both child and family, impairs quality of life and is frequently accompanied by psychiatric disorders, and that involves high financial costs. Despite being a widespread medical problem, very little is known about the etiology. Determining which agent initiates or worsens symptoms is important to the therapeutic approach. Organic causes that may lead to abdominal pain must first be excluded in these patients, after which symptoms should be assessed in the light of psychological and social conditions. An accompanying picture of psychiatric impairment has been reported in approximately 30% of patients. Studies have reported that psychosocial interventions are of considerable benefit in treating RAP. Accompanying psychiatric disorders should be considered in the diagnosis and treatment of children with RAP, and psychiatric therapeutic approaches should be tried, especially in resistant cases

Anahtar Kelimeler

• -

Çocukluk Çağı Tekrarlayan Karın Ağrılarının Psikososyal Yönü

Öz

Tekrarlayan karın ağrıları çocuklarda tanı ve tedavisi güç, aile ve çocuk için oldukça yıpratıcı, yaşam kalitesini bozan ve psikiyatrik rahatsızlıkların sıklıkla eşlik ettiği, maliyeti yüksek bir durumdur. Yapılan çalışmalarda hastaların yaklaşık olarak %30’unda psikiyatrik bir bozukluğun tabloya eşlik ettiği bildirilmiştir. TKA’da tedavide bilişsel davranışçı terapilerin oldukça faydalı olduğunu bildiren çalışmalar mevcuttur. Son yıllarda internet ve videokonferans aracılığıyla da bilişsel davranışçı terapilerin başarıyla uygulanabileceğine dair çalışmalar yapılmıştır. Sonuç olarak TKA olan çocukların takip ve tedavisinde eşlik eden psikiyatrik bozukluklar göz önünde bulundurulup özellikle dirençli olgularda psikiyatrik tedavi yaklaşımları denenmelidir.

Anahtar Kelimeler

• Çocuk, tekrarlayan karın ağrıları, psikososyal faktörler

Kaynakça

1. Apley J, Naish N. Recurrent abdominal pains: a field survey of 1,000 school children. Arch Dis Child. 1958;33(168):165-70.
2. Garber J, Zeman J, Walker LS. Recurrent abdominal pain in children: psychiatric diagnoses and parental psychopathology. Psychiatry. 1990;29(4):648-56. Child Adolesc
3. Stickler GB, Murphy DB. Recurrent abdominal pain. Am J Dis Child. 1979;133(5):486-9.
4. Scharff L. Recurrent abdominal pain in children: a review of psychological factors and treatment. Clin Psychol Rev. 1997;17(2):145-66.
5. Boey CC, Goh KL. Psychosocial factors and childhood recurrent abdominal pain. J Gastroenterol Hepatol. 2002;17(12):1250-3.
6. Hyams JS, Hyman JE. Recurrent abdominal pain and the biopsychosocial model of medical practice. J. Pediatr. 1998;133:473–8.
7. Bufler P, Gross M, Uhlig HH. Recurrent abdominal pain in childhood. Dtsch Arztebl Int. 2011;108(17):295- 304. Review.
8. Baber KF, Anderson J, Puzanovova M, Walker LS. Rome II versus Rome III classification of functional gastrointestinal abdominal pain. J Pediatr Gastroenterol Nutr. 2008;47(3):299-302. in pediatric chronic

9. Horvath A, Dziechciarz P, Szajewska H. Systematic review supplements for abdominal pain-related functional gastrointestinal disorders in childhood. Ann Nutr Metab. 2012;61(2):95-101. controlled trials: fiber
10. Rasquin A, Di Lorenzo C, Forbes D, et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology 2006;130(5):1527-37.
11. Srinath AI, Walter C, Newara MC, Szigethy EM. Pain management in patients withinflammatory bowel disease: insights for the clinician. Therap Adv Gastroenterol. 2012;5(5):339-57.
12. Sagami Y, Shimada Y, Tayama J, et al. Effect of a corticotropin releasing hormone receptor antagonist on colonic sensory and motor function in patients with irritable bowel syndrome. Gut. 2004;53(7):958-64.
13. Lebenthal E, Rossi TM, Nord KS, Branski D. Recurrent abdominal pain and lactose absorption in children. Pediatrics. 1981;67(6):828-32.
14. Feldman W, McGrath P, Hodgson C, et al. The use of dietary fiber in the management of simple, childhood, idiopathic, recurrent, abdominal pain. Results in a prospective, double-blind, randomized, controlled trial. Am J Dis Child. 1985;139(12):1216-8.
15. Shelby GD, Shirkey KC, Sherman AL, et al. Functional Abdominal Pain in Childhood and Long-term Vulnerability to Anxiety Disorders. Pediatrics. 2013;132(3):475-82.
16. Sprenger L, Gerhards F, Goldbeck L. Effects of psychological treatment on recurrent abdominal pain in children - a meta-analysis. Clin Psychol Rev. 2011;31(7):1192-7.
17. Bury RG. A study of 111 children with recurrent abdominal pain. Aust Paediatr J. 1987;23(2):117-9.
18. Apley J, Hale B. Children with recurrent abdominal pain: how do they grow up? Br Med J. 1973;3(5870):7- 9.
19. Levine MD, Rappaport LA. Recurrent abdominal pain in school children: the loneliness of the long-distance physician. Pediatr Clin North Am. 1984;31, 969-991.
20. Liebman WM. Recurrent abdominal pain in children: a retrospective survey of 119 patients. Clin Pediatr (Phila). 1978;17(2):149-53.
21. Hughes MC. Recurrent abdominal pain and childhood depression: clinical observations of 23 children and their families. Am J Orthopsychiatry. 1984;54(1):146- 55.
22. Livingston R, Taylor JL, Crawford SL. A study of somatic complaints and psychiatric diagnosis in children. J Am Acad Child Adolesc Psychiatry. 1988;27(2):185-7.
23. Campo JV, Bridge J, Ehmann M, et al. Recurrent abdominal pain, anxiety, and depression in primary care. Pediatrics. 2004;113(4):817-24.
24. Hodges K, Gordon Y, Lennon MP. Parent-child agreement on symptoms assessed via a clinical research interview for children: the Child Assessment Schedule (CAS). J Child Psychol Psychiatry. 1990;31(3):427-36.
25. Hodges K, Kline JJ, Barbero G, Flanery R. Life events occurring in families of children with recurrent abdominal pain. J Psychosom Res. 1984;28(3):185-8.
26. Robinson JO, Alverez JH, Dodge JA. Life events and family history in children with recurrent abdominal pain. J Psychosom Res. 1990;34(2):171-81.
27. Walker LS, Garber J, Greene JW. Somatic complaints in pediatric patients: a prospective study of the role of negative life events, child social and academic competence, and parental somatic symptoms. J Consult Clin Psychol. 1994;62(6):1213-21.
28. Boey CC, Goh KL. The significance of life-events as contributing factors in childhood recurrent abdominal pain in an urban community in Malaysia. J Psychosom Res. 2001;51(4):559-62.
29. Banez GA. Chronic abdominal pain in children: what to do following the medical evaluation. Curr Opin Pediatr. 2008;20(5):571-5.
30. Weydert JA, Ball TM, Davis MF. Systematic review of treatments for recurrent abdominal pain. Pediatrics. 2003;111(1):e1-11.
31. Kline RM, Kline JJ, Di Palma J, Barbero GJ. Enteric- coated, pH-dependent peppermint oil capsules for the treatment of irritable bowel syndrome in children. J Pediatr. 2001;138(1):125-8.
32. Zagustin TK. The role of cognitive behavioral therapy for chronic pain in adolescents. PM R. 2013;5(8):697- 704.
33. Eccleston C, Palermo TM, Williams AC, et al. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Sys Rew 2009;(2):CD003968.
34. Youssef NN, Rosh JR, Loughran M, et al. Treatment of functional abdominal pain in childhood with cognitive behavioral strategies. J Pediatr Gastroenterol Nutr. 2004;39(2):192-6.
35. Finney JW, Lemanek KL, Cataldo MF, Katz HP. Pediatric psychology in primary health care: Brief targeted therapy for recurrent abdominal pain. Behav Ther. 1989;20:283–91.
36. Sanders MR, Rebgetz M, Morrison M, et al. Cognitive- behavioral abdominal generalization, maintenance, and side effects. J Consult Clin Psychol. 1989;57(2):294-300. nonspecific analysis in an of
37. Sanders MR, Shepherd RW, Cleghorn G, Woolford H. The treatment of recurrent abdominal pain in children: a controlled comparison of cognitive-behavioral family intervention and standard pediatric care. J Consult Clin Psychol. 1994;62(2):306-14.
38. Palermo TM, Wilson AC, Peters M, et al. Randomized controlled trial of an Internet-delivered family cognitive- behavioral therapy intervention for children and adolescents with chronic pain. Pain. 2009;146(1- 2):205-13.
39. Shepherd L, Goldstein D, Whitford H, et al. The utility of videoconferencing to provide innovative delivery of psychological treatment for rural cancer patients: results of a pilot study. J Pain Symptom Manage. 2006;32(5):453-61.
40. Humphreys PA, Gevirtz RN. Treatment of recurrent abdominal pain: components analysis of four treatment protocols. J Pediatr Gastroenterol Nutr. 2000;31(1):47- 51.