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Abdominal pain


My 6-year-old daughter with cystic fibrosis, complains of very strong abdominal pain. Nothing to x-ray, nothing in the stools and pancreatic enzyme dose has been changed several times ..
How con one relieve it???
Thank you because we don’t know what to do.
Abdominal pain is a common symptom in children with cystic fibrosis, with sometimes a significant impact on the quality of life of the child and its entourage. A such recurrent pain has to be analysed in order to identify the cause.
The interview (kind of pain, precipitating factors, localization, aspect of stool, weight evolution), the abdominal palpation, sometimes additional investigations are an important guidance for the medical team.
The uncontrolled pancreatic insufficiency is a common cause of recurrent pain in children. Indeed, the pancreatic enzymes replacement therapy must be adjusted to the needs of the child. Enzymes should be taken at the beginning of the meal, without chewing them; if the meal lasts a long time, the dose can be divided at the beginning and middle of the meal. The intake should be adjusted according to the fat content of the meal or snack. In case of inadequate control of pancreatic insufficiency, an investigation of the steatorrhea, or fecal fat, can confirm the diagnosis.
Another common cause of recurrent abdominal pain is the distal intestinal obstruction syndrome or DIOS, due to the obstruction of the distal small intestine by bowel content. Stools less frequent, nausea, loss of appetite, abdominal mass suggest the DIOS. The treatment is a laxative therapy.
In addition to these main abdominal pain reasons in children with cystic fibrosis, a lot of causes of pain may be considered depending on the context, including gastroesophageal reflux, pancreatitis, constipation, but also sometimes psychological factors.
The management of these recurrent pain needs a multidisciplinary approach in the cystic fibrosis center, with the physician, the dietician, the psychologist, in order to identify the cause of the pain, and improve it.
Dr Michèle Gérardin