Approach to evaluating a child with chronic abdominal pain

CBC: complete blood count; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; IBD: inflammatory bowel disease; H. pylori: Helicobacter pylori; IgA: immunoglobulin A; tTg: tissue transglutaminase.

* For children with suspected organic abdominal pain, additional testing is tailored to the suspected cause. Considerations include IBD, food allergy, chronic constipation, enteric infection, H. pylori infection, pancreatitis, eating disorder, or pregnancy.

¶ For children with likely functional abdominal pain, testing should be kept to a minimum and tailored to alleviate the family's concerns. Importantly, the following studies have low yield and are generally unnecessary: imaging (abdominal/pelvic ultrasound), esophageal pH or impedance monitoring, and noninvasive tests for H. pylori.