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• Presumption of functional abdominal pain needs re-evaluation in presence of eosinophilic infiltrates
  Anjan Chakrabarty
  Published on: 3 May 2005
• Investigations in functional abdominal pain
  Ellen Crushell
  Published on: 26 April 2005
• Postmodern Paediatrics
  Dr Timothy Chambers
  Published on: 4 April 2005

• Published on: 3 May 2005

  Presumption of functional abdominal pain needs re-evaluation in presence of eosinophilic infiltrates

  • Anjan Chakrabarty, Pediatrician
  • Other Contributors:
    • Suhas Hydros, Jacob M. Puliyel.

  Dear Editor,

  Lindley and colleagues [1] found that eosinophilic infiltration was common in their cohort of children with abdominal pain. Ordinarily this finding would militate against the diagnosis of functional pain but the authors say that mucosal biopsy abnormalities have been established in functional gastrointestinal disease of adulthood. They quote 2 references to support this statement. We find this mislea...

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  Dear Editor,

  Lindley and colleagues [1] found that eosinophilic infiltration was common in their cohort of children with abdominal pain. Ordinarily this finding would militate against the diagnosis of functional pain but the authors say that mucosal biopsy abnormalities have been established in functional gastrointestinal disease of adulthood. They quote 2 references to support this statement. We find this misleading. One of the references pertains to a ‘review article’ by one of the present authors. Only the other paper quoted, refers to original research.[2] This is a paper by Gwee and colleagues which found increased mucosal expression of interleukin 1beta in recently acquired post-infectious irritable bowel syndrome. Lindley and colleagues fail to mention that in the paper by Gwee et al., the authors retract their earlier presumption of a functional disorder after finding the increased interleukin. The paper concludes that post infectious irritable bowel syndrome is a post-inflammatory response.

  There is thus little evidence - in the quoted reference - to support the claim of biopsy changes in functional disease. Eosinophilic infiltration has previously been described with food allergy.[3,4] Such pain could be self limiting and so get better without specific intervention. We hope the eosinophilic infiltration in this cohort will prompt more research into an organic explanation for the pain in these children.

  puliyel@vsnl.com

  References

  1. Lindley KJ, Glaser D, Milla PJ. Consumerism in healthcare can be detrimental to child health:lessons from children with functional abdominal pain. Arch Dis Child 2005;90:335-337

  2. Gwee KA Collins SM, Read NW et al. Increased rectal mucosal exprsion of interleukin 1beta in recently acquired post-infectious irritable bowel syndrome. Gut 2003;52:523-6

  3. Stringel G, Mercer S, Sharpe D, Shipman R, Jimenez C. Eosinophilic gastroenteritis.Can J Surg. 1984;27:182-3

  4. Park HS, Kim Hs, Jang HJ. Eosinophilic gastroenteritis associated with food allergy and bronchial asthma. J Korean Med Sci. 1995 ;10:216-9

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  Conflict of Interest:
  None declared.

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• Published on: 26 April 2005

  Investigations in functional abdominal pain

  • Ellen Crushell, Paediatric Lecturer
  • Other Contributors:
    • Marion Rowland

  Dear Editor,

  We read with interest the article by Lindley et al. [1] outlining their concerns about consumerism in healthcare focusing on the potential detrimental effects on the child with functional abdominal pain (FAP). All of the children had extensive investigations carried out by the authors according to in house clinical service guidelines for the management of children with abdominal pain.

  While th...

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  Dear Editor,

  We read with interest the article by Lindley et al. [1] outlining their concerns about consumerism in healthcare focusing on the potential detrimental effects on the child with functional abdominal pain (FAP). All of the children had extensive investigations carried out by the authors according to in house clinical service guidelines for the management of children with abdominal pain.

  While this is surprising in itself, it is even of more concern when it is noted that most children already had extensive investigations in other centres. Clinical service guidelines should take into account the fact that children referred with abdominal pain to a tertiary referral practice have a high probability of having a functional disorder. Rather than embark on an extensive, expensive and traumatic list of procedures, protocols should encompass a biopsychosocial approach to the management of abdominal pain. We are potentially doing a great disservice to children if we first resort to invasive investigations while failing to make a positive diagnosis of FAP.

  Ellen Crushell, Marion Rowland

  Dept of Paediatrics, University College Dublin, Children's Research Centre, Our Lady's Hospital for Sick Children, Dublin

  Reference

  1. Lindley KJ, Glaser D, Milla PJ. Consumerism in healthcare can be detrimental to child health: lessons from children with functional abdominal pain. Arch. Dis. Child. 2005; 90: 335-337.

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  Conflict of Interest:
  None declared.

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• Published on: 4 April 2005

  Postmodern Paediatrics

  • Dr Timothy Chambers, Paediatrician

  Dear Editor,

  If one substitutes CFS/ME for FAP in the paper of Lindley and colleagues it would lose none of its sense. The situations of confrontation they describe are similar to those the Chief Medical Officer aimed to address and resolve when he established the working party on CFS/ME. It has resulted in healthy (and healing?) dialogue between professions and patients and collaborative work; the recently publi...

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  Dear Editor,

  If one substitutes CFS/ME for FAP in the paper of Lindley and colleagues it would lose none of its sense. The situations of confrontation they describe are similar to those the Chief Medical Officer aimed to address and resolve when he established the working party on CFS/ME. It has resulted in healthy (and healing?) dialogue between professions and patients and collaborative work; the recently published RCPCH/AYME guidelines are a good example.

  Multidisciplinary services, such as those described by Eccleston in his commentary, for all ages of patients are being improved and extended. These include management of pain, with complimentary pharmacological and behavioural interventions, as well as stress: all this is probably best co-ordinated locally by a general paediatrician. We should also be humble: today's condition labelled "functional" might in future be found to have an "organic" explanation - if indeed the distinction between the two remains valid.

  Consumerism in healthcare is an element of postmodern medicine [1]. No party is likely to benefit fom robust protective systems; rather, the Bath approach of engagement seems more constructive.

  Reference

  1. Muir Gray J, Lancet 1999, 354, 1550-3.

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  Conflict of Interest:
  None declared.

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