Abdominal pain syndrome in children and adolescents: treatment options

Abdominal pain is a frequent cause for patients of different age groups to consult a doctor, and one of the most frequent complaints of children and their parents. Abdominal pain syndrome in children is a combination of symptoms associated with various surgical and non-surgical diseases with abdominal pain as one of the manifestations. Pain can be acute and chronic (recurrent). Acute abdominal pain can be a sign of surgical pathology, injury or acute infectious disease. Abdominal pain in most cases is caused by chronic gastrointestinal diseases or functional disorders. Pediatricians, general practitioners, gastroenterologists are more likely to face recurrent abdominal pain (prolonged intermittent or persistent pain). Recurrent abdominal pain in children is defined as three pain episodes that occur within three months and affect the normal child’s activity. The consensus document of the American Academy of Pediatrics and the North American Association of Pediatric Gastroenterology, Hepatology and Nutrition in 2005 suggested the use of the term “chronic abdominal pain” instead of “recurrent abdominal pain”. Most often (90–95 % of cases) chronic abdominal pain is considered to be functional (non-organic) abdominal pain without objective signs of the underlying organic disorder, and is characterized by a variety of manifestations. Visceral, parietal (somatic), referred (radiating) and psychogenic pains are distinguished by the mechanism of occurrence. In abdominal pain, it is necessary to assess time of occurrence, severity, nature, duration, localization. At the first stage of diagnosis, acute surgical pathology should be excluded. “Anxiety symptoms” indicate the high risk of surgical pathology. The next stage includes differential diagnosis of organic and functional causes of abdominal pain. Impaired visceral motility and spasms are observed in all kinds of functional pain. The contractile activity of smooth muscles is initiated by the parasympathetic nervous system. Treatment of recurrent abdominal pain is aimed at elimination of its cause: spasm control, normalization of the gastrointestinal motility. Currently, selective myotropic antispasmodics are preferred among the various groups of antispasmodics in the treatment of functional gastrointestinal disorders. Among them, mebeverine is an optimal drug due to its efficacy and safety. Mebeverine blocks fast sodium channels located on the myocyte cell membrane preventing the entry of sodium ions into the cell. This mechanism attenuates contractile function of the smooth muscles and eliminates spasm without causing hypotonia. Unlike anticholinergic drugs, mebeverine has a selective effect on the gastrointestinal smooth muscles. In clinical practice, mebeverine hydrochloride — Spark® (Farmak JSC) is of interest. This medicinal product provides preservation of normal tone and peristalsis after relieving muscle spasm. Spark® is available in capsules. One capsule contains mebeverine hydrochloride 200 mg. According to the instructions, mebeverine (Spark®) is indicated for adults and children over 10 years, 1 capsule twice daily. The drug does not have systemic effects. The use of mebeverine (Spark®) is pathogenically justified for the treatment of diseases associated with abdominal pain syndrome in adults and children over 10 years of age