recurrent abdominal pain ( rap ) is common among children , leading to absence from school and impaired quality of life .
a recent systemic review , including studies with a variety of definitions for rap , found a prevalence as high as 19% in children .
the rome iii diagnostic criteria established a uniform method of classifying rap into different categories of functional gastrointestinal disorders ( fgids ) , such as abdominal migraine , cyclic vomiting syndrome , functional abdominal pain syndrome , functional dyspepsia , and irritable bowel syndrome .
although the data are limited , children of lower socioeconomic status may harbor a higher risk for developing rap .
preliminary data from tertiary referral centers also suggest a relationship between fgids and somatic comorbidities , such as migraine headaches , fibromyalgia , sleep disturbances , and chronic fatigue .
however , these associations were found in a self - selected , more affected population and may not be present in all children with fgids .
this study aimed to investigate the prevalence of fgids in an inner - city primary care pediatric clinic in the united states using rome iii diagnostic criteria .
a secondary aim was identification of comorbid nonpsychiatric symptoms among children meeting criteria for fgids in this population .
this cross - sectional questionnaire study was approved by the university hospitals case medical center institutional review board .
it was conducted between august 2012 and may 2013 at a large urban primary care clinic in cleveland , ohio .
healthy patients between the ages of 9 and 17 seen in clinic for well - child visits were recruited .
patients in clinic for a sick visit or patients with a history of organic gastrointestinal disorders including inflammatory bowel disease , cancer , celiac disease , liver disease , peptic ulcer disease , and food allergies were excluded . a modified version of the ohio dysautonomia ( odysa ) instrument was administered to participants ( see the appendix ) .
the odysa is a comprehensive survey of somatic symptoms across organ systems developed for both adult and pediatric use .
it uses validated published question sets where available ( e.g. rome iii modular questions for fgids , international headache association criteria for migraine headache symptoms , and the epworth sleepiness scale for daytime sleepiness ) or , alternatively , face - valid questions . the odysa instrument was modified by removing question - sets relevant only to adults . besides fgids , the odysa instrument assessed participants for migraine headache symptoms , recurrent syncope , daytime sleepiness , chronic body pains , chronic fatigue , urinary frequency ( defined as feeling a strong need to urinate with little or no warning ) , orthostatic symptoms , and raynaud - like symptoms ( defined as fingers or toes turning white , red , or blue on cold exposure ) .
statistical analyses were performed using sas version 9.3 ( sas institute inc , cary , nc ) . the prevalence of fgids and other somatic complaints were summarized descriptively using frequency and percentage .
demographics were compared between patients with and without fgids using fisher exact tests and wilcoxon 2-sample tests .
two - sided p values were reported ; p < .05 was considered statistically significant .
a proportion of patients fulfilled criteria for several fgids , most commonly abdominal migraine ( table 2 ) . demographics and overall somatic symptoms in patients with and without fgids . abbreviations : fgid , functional gastrointestinal disorder ; iqr , interquartile range . characteristics of the patients with fgids . abbreviation : fgid , functional gastrointestinal disorder .
raynaud - like symptoms occurred more often in participants with fgids , and while trending toward significance , there was likely inadequate power to achieve true statistical significance . raynaud - like symptoms were reported in 3/11 ( 27.2% ) of participants with fgids as compared to 11/134 ( 8.2% ) of participants without fgids , p = .07 .
no statistical association was found between fgids and the other symptoms investigated ( figure 2 ) .
fgids , while not extensively studied , are highly prevalent and often underrecognized in the pediatric population .
children with fgids may manifest symptoms that affect physical and emotional well - being as well as have a negative effect on academic performance .
overall , it is a significant cause of impaired quality of life in pediatrics . in order to provide better care for children with fgids ,
it is necessary to understand the extent of the disorder , identify potential associated risk factors , and recognize comorbid conditions .
this study investigated the prevalence of fgids in an inner - city primary care pediatric practice in the united states and found the prevalence using rome iii diagnostic criteria to be 7.6% . to our knowledge , this is the first study investigating the prevalence of fgids based on rome iii criteria in this population .
there are several reasons why this study population may have had a lower prevalence of fgids . first , whereas other studies defined rap in a variety of ways , this study used rome iii diagnostic criteria , which has strict diagnostic cutoffs .
additionally , whereas several scandinavian studies suggested that socioeconomic status may be associated with rap , this is the only known us study to investigate this association .
the results of the current study may suggest a lower prevalence of fgids among us children of low socioeconomic status .
further research will need to investigate the association between socioeconomic status and fgids among children in the united states .
another difference found in this study , compared with prior literature , was the high prevalence of abdominal migraine , typically present in only a small portion of the population .
our cohort is too small to meaningfully interpret this finding , but this does suggest that the prevalence of fgids and the predominant type of fgids should be further investigated in this population .
additional thought - provoking findings from this data set include the high prevalence of any somatic symptom , daytime sleepiness , and orthostatic symptoms in this population , regardless of the presence or absence of fgids .
the high prevalence of these symptoms in an unselected group of subjects without fgids is surprising and requires further investigation to understand the basis of these findings
. the main limitations of this study include the small sample size and the use of a questionnaire as a diagnostic tool rather than physician assessment .
additionally , participants with food allergies were excluded from the study  possibly lowering the prevalence of fgids in the study population . in summary ,
the lower prevalence of fgids in this study compared to previous studies may suggest a link between socioeconomic status and the prevalence of fgids .
additionally , these data are consistent with the prior literature that depicts an association between fgids and other somatic complaints , such as raynaud - like symptoms , although likely related to the small sample size this was not statistically significant in our study . a similar population - based study with a larger sample size and a heterogeneous cohort from a variety of socioeconomic backgrounds may provide new insight regarding any possible association between fgids and socioeconomic status .
dizzy : a feeling of motion such as spinning , whirling or sliding , or a sensation that you may fall .
lightheaded : a feeling of weakness or loss of blood to the brain that might eventually lead to fainting .
for the following sections ( a through j ) listen to each statement and reply with which comes closest to how you have been feeling .
for each situation , please choose 
 one 
 number to describe the frequency of your symptom that is clearly linked to that situation . during the past month
 functional gastrointestinal disorders ( fgids ) are a common problem in pediatric patients and can affect quality of life . however , the extent of these disorders may vary in different subpopulations of children . 
 this study investigated the prevalence of fgids in an inner - city primary care practice . 
 healthy patients between the ages of 9 and 17 were administered a validated questionnaire that assessed for fgids and other somatic complaints . 
 eleven of 145 patients ( 7.5% ) met criteria for fgids based on rome iii diagnostic criteria . 
 raynaud - like symptoms tended to occur more often in patients meeting criteria for fgids , although this association was not statistically significant ( p = .07 ) . 
 the lower prevalence of fgids in this population compared with earlier studies may suggest a link between socioeconomic status and the prevalence of fgids . 
 larger population - based studies consisting of a heterogeneous cohort from a variety of socioeconomic backgrounds are necessary to further elucidate the true connection between fgids and socioeconomic status . 
Introduction
Methods
Results
Discussion
Modified ODYSA Questionnaire
Definitions of some terms used in the questionnaire:
HISTORY