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Gastroenterology, hepatology and nutrition

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1K Soondrum, 2G Farmer, 1D Candy. 1Paediatric Gastroenterology and Nutrition Services, RWSNHST, Chichester, UK; 2Paediatric Physiotherapy Department, West Sussex PCT, Chichester, UK

Aim: Up to one child in six suffers from chronic abdominal pain (CAP). Usually no underlying organic cause can be identified. The child’s general wellbeing is affected and often a poor school attendance is associated. Managing these patients can be challenging and can lead to invasive investigation and tertiary referral. It has been observed that in some patients with non-specific abdominal pain, symptoms were made worse by movement and a positive Carnett’s sign (pain made worse by tensing abdominal muscles) could be elicited. These features have been described in adults with abdominal wall pain (AWP). The aim of this study was to identify whether CAP in these children was of musculoskeletal origin and thus responsive to treatment with physiotherapy.

Methods: A retrospective case notes review was performed of all children aged 18 years or younger referred from the paediatric gastroenterology clinic to the paediatric physiotherapy department for assessment of CAP possibly caused by AWP. During physiotherapy assessment the children were examined for abnormal posture and whether or not pain was elicited on spinal palpation. After assessment six treatment sessions and a home exercise plan were offered to improve core stability. Telephone contact was maintained for a further 3 months. If no response was obtained they were referred back to paediatric gastroenterology.

Results: 59 patients (46 female) with possible AWP were identified with ages ranging from 6 to 16 years (mean age 11 years and 5 months). A total of 45 completed their course of physiotherapy. Of these, 33/45 (73.3%) showed a complete resolution of their symptoms, 8/45 (17.7%) showed reduced severity and duration of abdominal pain and four patients (9.0%) showed no response …

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