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Predictors of abdominal pain in schoolchildren: A 4-year population-based prospective study.
  1. A El-Metwally (a.el-metwally{at}
  1. Epidemiology Group, Department of Public Health, University of Aberdeen, United Kingdom
    1. Smita LS Halder (smita.halder{at}
    1. Gastrointestinal Sciences, University of Manchester, United Kingdom
      1. David G Thompson (david.thompson{at}
      1. School of Medicine, The University of Manchester, United Kingdom
        1. Gary J Macfarlane (g.j.macfarlane{at}
        1. Epidemiology Group, Department of Public Health, University of Aberdeen, United Kingdom
          1. Gareth T Jones (gareth.jones{at}
          1. Epidemiology Group, Department of Public Health, University of Aberdeen, United Kingdom


            Background: Chronic abdominal pain (CAP) is common among schoolchildren and is a major cause of school absenteeism and medical care visits. On physical examination, an obvious organic cause is seldom found and risk factors contributing to onset are still largely unknown.

            Aims: To determine the frequency of onset of CAP in schoolchildren and to investigate risk factors for its development.

            Methods: 1411 schoolchildren aged 11-14 years were recruited from schools in North-West England. Information was collected regarding recent pain symptoms and a group of children free of abdominal pain were identified. Information was collected on potential risk factors for the development of CAP: weight, height, headache, sore throat, low back pain, daytime tiredness, level of physical activity, lifestyle factors, psychosocial factors and enjoyment of school. Participants were followed-up 1 and 4 years later and new episodes of CAP were identified.

            Results: 22% reported new-onset abdominal pain at 1-year follow-up which persisted at 4-year follow-up (CAP). Development of CAP was almost three times higher in girls than boys (34% versus 13%; chi2: 26.0; p<0.001). In girls, reporting headache at baseline was the only predictive factor for CAP onset: those who reported headaches on >7days in the month prior to the baseline survey experienced a doubling in the risk of symptom onset (relative risk: 2.1; 95% confidence interval: 0.95-4.7). In contrast, in boys, development of CAP was independently predicted by: daytime tiredness (3.0; 1.2-7.6), lack of school enjoyment (2.0; 0.95-4.2), adverse psychosocial exposures (2.3; 1.2-4.5) and taller stature (1.9; 0.8-4.5).

            Conclusion: Our results suggest that over one-fifth of adolescent schoolchildren experience new-onset non-self limiting abdominal pain over a one-year period, the majority of whom are girls. In terms of factors for which intervention is possible, previous somatic symptom reporting predicts future abdominal pain in girls; whereas, in boys, both somatic symptoms reporting and psychosocial factors predict future pain. These risk factors indicate a possible mechanism for understanding the development of CAP, and might have important implications for both primary and secondary preventive strategies.

            • abdominal pain
            • daytime tiredness
            • psychosocial factors
            • risk factors

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              BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health