Editor,

We read with great interest the article of Rasquin-Weber et al (1), by the title “childhood functional gastrointestinal disorders� in which the authors try to define criteria for functional gastrointestinal disorders in infancy, childhood and adolescence. In this paper the authors consider abdominal migraine as a distinct subgroup of recurrent abdominal pain. Even though it is known for a long time that headache is often associated with abdominal pain, the existence of abdominal migraine as an entity is not universally accepted yet (2,3). A present, abdominal migraine is considered as an episodic disorder with a particular predilection for time of onset (early in the morning) and is associated with autonomic features that are clearly lacking in the most children with recurrent abdominal pain (4). In a recent study of 475 children, 4 – 14 years of age, with recurrent abdominal pain (unpublished data) we found only three children, 5, 6 and 8 years old respectively with migraine (two of them with a positive family history of migraine) and 21 with sporadic episodes of headache, in correlation with other gastrointestinal symptoms, such as nausea, vomiting, early satiety etc. We consider that abdominal migraine is not a distinct entity but a well- known disorder, which is associated with gastrointestinal manifestations as happens in asthma and eczema (5,6). The authors also consider aerophagia as another subgroup of abdominal pain. Aerophagia is characterized by progressive abdominal distension during the day, non-distended abdomen in the morning and visible air swallowing. It is a vary rare condition and only a few cases of known or unknown origin have been published in the international literature (7,8). We agree with Ruppin (9) that aerophagia is not a separate entity but only a complaint met in different disorders such as ingestion of gas-producing foods, gastric hypersecretion or bacterial overgrowth in the small intestine. Based on our experience and previous articles of Boyle (10) and Hyams and Hyman (11) and until more data are available we suggest that we should divide recurrent abdominal pain as in the table followed. It must be stressed that Pediatricians should be familiarized with complaints such as migraine and aerophagia and ask for these in any child with chronic abdominal pain.

Chronic abdominal pain

1. Disordesrs with known pattern of symptoms

a. dyspepsia

b. irritable bowel syndrome

2. Disorders with non recognizable pattern of symptoms

a. paroxysmal or isolated

b. somatization of symptoms

c. psychologic or psychogenic disorders

d. Unspecified bowel disorder or idiopathic ?

Spiroglou K, Paroutoglou G#, Nikolaides N,#, Chatziparasidis G, Demertzidou V, Giuleme O, Eugenides N#
Department of Pediatrics and Department of Gastroenterology#, Aristotelle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece

References

1. Rasquin-Weber A, Hyman PE, Cucchiara S, Fleisher DR, Hyams JS, Milla PJ, Staiano A. Childhood functional gastrointestinal disorders. Gut 1999;45(suppl 2) : 1160-8
2. Symon DNK. Is there a place for “abdominal migraine� as a separate entity in the HIS classification? Yes! Cephalalgia 1992;12:345-6
3. Hockaday JM. Is there a place for “abdominal migraine� as a separate entity in the HIS classification? No! Cephalalgia 1992;12:346-8
4. Hyams JS, Hyman PE. Letter to the editor.Reply. J Pediatr 1999;135:401- 2
5. Caffarelli C, Deriu FM, Terzi V, Perrone F, de Angelis G, Atherton DJ. Gastrointestinal symptoms in patients with asthma. Arch Dis Child 2000;82:131-5
6. Caffarelli C, Cavagni G, Deriu FM, Zamotti P, Atherton DJ. Gastrointestinal symptoms in atopic eczema. Arch Dis Child 1998;78:230-4
7. Gauderer MW, Halpin TC Jr, Izant RJ Jr. Pathologic childhood aerophagia: a recognizeble clinical entity. J Pediatr Surg 1981;16:301-5
8. Lecine T, Michaud L, Gottrand F, Faure C, Bonnevalle M, Vaudour G, Turk D. Children who swallow air. Arch Pediatr 1998;5:1224-8
9. Ruppin H. Meteorism. Fortsschr Med 1991;109:421-3
10. Boyle JT. Recurrent abdominal pain: an update. Pediatr Rev 1997;18:310-21
11. Hyams JS, Hyman E. Recurrent abdominal pain and the biopsychosocial model of medical practice. J Pediatr 1998;133:473-8