Abstract 717
Poster Session IV, Tuesday, 5/4 (poster 22)
Background: Recurrent abdominal pain (RAP) is a common childhood problem with an estimated prevalence of 10%. RAP accounts for numerous visits to health professionals and days absent from school. Although many etiologies have been postulated, the pathogenesis of RAP remains unclear. Celiac disease can present with a wide spectrum of clinical symptoms, including abdominal pain. Celiac disease is likely underdiagnosed in North America because of a low index of suspicion and because, until recently, this enteropathy could not be diagnosed by intestinal biopsy. Serologic markers, including antiendomysial antibody(EMA),are now available for the initial investigation of celiac disease. There have been no reports of screening for celiac disease in children with RAP. Purpose: To determine if children with RAP have a higher prevalence of EMA, compared with healthy children. Methods: A case-control study design was used. Cases were children with incident RAP, based on Apley's criteria, and controls were children attending one of six pediatricians' offices for routine health visits. Samples were tested using the monkey esophagus immunofluorescence assay. Results: Of the 200 eligible children, 173(87%) had blood samples collected. Of these, 92 were cases and 81 were controls. Only 2 of 173(1.2%)children were EMA positive. The frequency of EMA positivity in children with RAP was 1/92 (1%,95% confidence interval:0%-6%), while in controls, it was 1/81 (1%,95% confidence interval:0%-7%). The height percentiles of the children with positive EMA were greater than the third percentile. There was no correlation between RAP and unexplained short stature, as defined by height less than the third percentile. Conclusion: These findings indicate that occult celiac disease is an unlikely cause of RAP in the primary care setting.
