Chronic abdominal pain (CAP) is a common complaint encountered in pediatric clinics and a great concern for patients and their caretakers as well as health care professionals. A constant challenge is detecting individuals with organic diseases or psychosomatic disorders from the majority of patients who have a functional disorder including functional dyspepsia, irritable bowel syndrome, functional abdominal pain, and abdominal migraine. Beginning with a detailed history and physical examination, physicians must determine a differential diagnosis of CAP by applying the symptom-based Rome III criteria to positively identify a functional disorder. These findings should then be further analyzed based on diagnostic clues and red flags that indicate the presence of specific organic diseases and/or the need for further testing. Once a functional diagnosis has been made or an organic disease is suspected, physicians can initiate an empiric therapeutic trial. Since psychological distress accompanies both organic and non-organic abdominal pain in children, a cooperative diagnostic approach involving pediatricians and psychiatrists is recommended.
Abdominal Pain ; Child ; Delivery of Health Care ; Diagnosis, Differential ; Dyspepsia ; Humans ; Irritable Bowel Syndrome ; Migraine Disorders ; Physical Examination ; Psychiatry ; Psychophysiologic Disorders ; Rome

Inflammatory bowel disease (IBD) develops during childhood or adolescence in approximately 25% of patients with IBD. Recent studies on pediatric IBD have revealed that early-onset IBD has distinct phenotype differences compared to adult onset IBD. Pediatric early-onset IBD differs in many aspects including disease type, location of the lesions, disease behavior, gender preponderance and genetically attributable risks. This review examines the currently published data on the clinical, epidemiological and genetic differences between early-onset and adult-onset IBD. And finally, therapeutic considerations in the management of pediatric-onset IBD are also discussed.
Adolescent ; Adult ; Colitis, Ulcerative ; Crohn Disease ; Humans ; Inflammatory Bowel Diseases ; Phenotype

Food protein induced proctocolitis (FPIPC) is a non-IgE mediated food allergy. FPIPC occurs exclusively among breast-fed infants within the first months of life. FPIPC is often diagnosed clinically in normal-conditioned infants with rectal bleeding. But FPIPC among infancy with rectal bleeding is less general than conceived. The endoscopic findings reveal an edematous and erythematous mucosa with superficial erosions or ulcerations, bleeding and lymphoid nodular hyperplasia. The prominent eosinophilic infiltrates in the rectosigmoid mucosa are important for the histopathologic diagnosis of FPIPC. However, in explaining eosinophilic infiltration within the lamina propria of the mucosa, it is necessary to differentiate whether it is a part of normal findings or occurs due to inflammatory reactions. Oral food challenge and elimination test is performed to identify the same clinical reaction as the symptom of FPIPC by the administration of a specific type of food to infants. The most common causal food is cow's milk. Thus oral food challenge and elimination test can be the effective way of confirming FPIPC, reducing the possibility of misdiagnosis. The purpose of this report is to identify the characteristics of FPIPC, to introduce its diagnostic methods, and to suggest the future direction of research.
Diagnostic Errors ; Eosinophils ; Food Hypersensitivity ; Hemorrhage ; Humans ; Hyperplasia ; Infant ; Milk ; Mucous Membrane ; Proctocolitis ; Ulcer

Stem cell is characterized with self-renewal and mult-potency. Many pediatric gastrointestinal diseases have defect in enterocytes, enteric nervous system, and Interstitial cell of Cajal. Various kinds of stem cell could be applied to these diseases. Here, the author introduces stem cell for pediatric gastrointestinal diseases, particularly Hirschsprung disease.
Enteric Nervous System ; Enterocytes ; Gastrointestinal Diseases ; Gastrointestinal Tract ; Hirschsprung Disease ; Stem Cells

Inflammatory bowel disease in children shows the rising incidence with evidence of more CD than UC. So the clinical field of childhood IBD is evolving. Recognition of the rising incidence and other epidemiologic results will have important implications for diagnosis and management of inflammatory bowel disease in children. The clinical characteristics of IBD developing in pediatric age somewhat differs from that in adult. This review had been summarized that the incidence, clinical manifestations, practical diagnosis, and utilization of non invasive disease activity index of IBD in pediatric age.
Adult ; Child ; Colitis, Ulcerative ; Crohn Disease ; Humans ; Incidence ; Inflammatory Bowel Diseases

Childhood chronic abdominal pain usually doesn't have an organic etiology. It may cause social impairment and emotional distress in children as well as their families. In view of cognitive and behavioral aspect, passive coping style, maladaptive social modeling, and reinforced secondary gain could contribute to the development and maintenance of pediatric somatization. Integrative etiological model includes biological factors due to the enteric sensitization process, psychosocial factors which encompass family influences, psychodevelomental vulnerability, and life event-related stress. These factors interact with each other and manifest as various psychosomatic symptoms. In the treatment of childhood chronic abdominal pain, multimodal treatment program, which includes cognitive behavioral therapeutic methods, emotional support, family education, selective serotonin reuptake inhibitor, and so on, is known to be most effective.
Abdominal Pain ; Biological Factors ; Child ; Combined Modality Therapy ; Humans ; Serotonin

Abdominal migraine is a syndrome characterized by recurrent episodes of paroxysmal abdominal pain and nausea or vomiting with wellness between episodes. It is often associated with a positive family history of migraine and no other apparent underlying disease. Abdominal epilepsy is an infrequent syndrome which occurs with gastrointestinal complaints caused by a seizure activity. It is characterized by paroxysmal onset of abdominal pain without visceral disorders, but comes along with the alteration of awareness during the attack and abnormal electroencephalogram findings. Like other epilepsies, this abdominal epilepsy is improved with anticonvulsant medication.
Abdominal Pain ; Child ; Dizziness ; Electroencephalography ; Epilepsies, Partial ; Epilepsy ; Headache ; Humans ; Migraine Disorders ; Nausea ; Seizures ; Vomiting

Functional gaonic or recurrent gastrointestinal symptoms not explained by structural or biochemical abnormalities. The Rome II pediatric criteria for FGIDs were announced in 1999. The Rome III criteria, update and revise the pediatric criteria, included FGIDs criteria of infant and toddler to child and adolescent (aged 4 to 18 years). The aerophagia was classified into abdominal pain-related FGIDs in the ROME II criteria. However, cyclic vomiting syndrome and aerophagia, both were classified into vomiting and aerophagia part in the ROME III criteria. We describe the clinical features, diagnostic criteria, and treatments of cyclic vomiting syndrome and aerophaiga among pediatrstrointestinal disorders (FGIDs) are defined as a chric FGIDs
Adolescent ; Child ; Gastrointestinal Diseases ; Humans ; Infant ; Rome ; Vomiting

Helicobacter pylori (H. pylori) may be one of the most common pathogen in gastrointestinal tract. Although several recent articles have reported a decline in the prevalence of H. pylori infection in both children and adults over the last several years, H. pylori infection usually occurs early in life and persists for a long time. The role of H. pylori in some digestive diseases, such as gastritis, ulcer and gastric cancer has been well established. And the possible role of H. pylori as a trigger for some extraintestinal diseases in children and adults has been considered in the last year. H. pylori infection might be associated with refractory iron deficiency anemia, idiopathic thrombocytopenic purpura, growth retardation and obesity etc, directly or indirectly. Most of the studies are classified as epidemiological, clinical researches about effects on extraintestinal manifestations after eradication, or case reports. This review describes the possibility of association with several extraintestinal diseases and H. pylori infection and their possible mechanisms based on reported studies in the world and our several studies, even though there are still many conflicting results about that.
Adult ; Anemia, Iron-Deficiency ; Child ; Gastritis ; Gastrointestinal Tract ; Helicobacter ; Helicobacter pylori ; Humans ; Obesity ; Prevalence ; Purpura, Thrombocytopenic, Idiopathic ; Stomach Neoplasms ; Ulcer

Gastric outlet obstruction (GOO) results from obstructing lesions in the region of the pyloric channel. In neonates, hypertrophic pyloric stenosis (HPS) is the most common cause while peptic ulcer is a rare cause. Neonatal gastric ulcer is relatively frequent in preterm newborn babies or in neonates treated in intensive care units. In healthy neonates, mucosal ulcers are associated with stressful conditions. In gastric ulcer diseases, gastric outlet obstruction is usually caused by a combination of edema, spasm, fibrotic stenosis and gastric atony. We experienced a case of neonatal gastric ulcer with a large hematoma in a 3-day-old infant presenting with repeated vomiting, poor oral intake, and abdominal distension. For the differential diagnosis, we did abdominal ultrasonography. Hematoma was diagnosed by abdominal ultrasonography. Endoscopic examination confirmed the hematoma and the presence of gastric ulcerations. We report this case with a brief review of the literature.
Constriction, Pathologic ; Diagnosis, Differential ; Edema ; Gastric Outlet Obstruction ; Hematoma ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units ; Peptic Ulcer ; Pyloric Stenosis, Hypertrophic ; Spasm ; Stomach Diseases ; Stomach Ulcer ; Ulcer ; Vomiting