Table 4

Organic causes for chronic abdominal pain in children

Medical	Surgical
Infective: urinary tract infections, helicobacter pylori related gastritis/ ulcer, tuberculosis, giardiasis, rheumatic fever, brucellosis, typhoid, other parasitic infection Inflammatory: inflammatory bowel disease, gastro-oesophageal reflux disease, non-steroidal anti-inflammatory drug related gastritis/ ulcer Metabolic: lactose intolerance, diabetes mellitus, porphyria, sickle cell, lead poisoning. Autoimmune: coeliac disease Gynaecological: pelvic inflammatory disease, endometriosis, polycystic ovaries, simple ovarian cyst Psychological: school phobia/ bullying, child abuse. Other: constipation*, splenic disease, leukaemia	Urological: urolithiasis, obstructive uropathy/hydronephrosis, polycystic kidneys Gastrointestinal: Meckel's diverticulum, duplication cyst, malrotation with or without volvulus, post-surgical adhesions, recurrent intussusception, bezoar, appendicular colic Hepatobiliary: gallstones, choledochal cyst, other congenital malformations, chronic pancreatitis Other: small bowel lymphoma, other neoplastic disease, ovarian pathology, referred pain from testes

Medical

Surgical

Infective: urinary tract infections*, helicobacter pylori related gastritis/ ulcer, tuberculosis, giardiasis, rheumatic fever, brucellosis, typhoid, other parasitic infection
Inflammatory: inflammatory bowel disease, gastro-oesophageal reflux disease, non-steroidal anti-inflammatory drug related gastritis/ ulcer
Metabolic: lactose intolerance, diabetes mellitus, porphyria, sickle cell, lead poisoning.
Autoimmune: coeliac disease*
Gynaecological: pelvic inflammatory disease, endometriosis, polycystic ovaries, simple ovarian cyst
Psychological: school phobia/ bullying, child abuse.
Other: constipation*, splenic disease, leukaemia

Urological: urolithiasis, obstructive uropathy/hydronephrosis, polycystic kidneys
Gastrointestinal: Meckel's diverticulum, duplication cyst, malrotation with or without volvulus, post-surgical adhesions, recurrent intussusception, bezoar, appendicular colic
Hepatobiliary: gallstones, choledochal cyst, other congenital malformations, chronic pancreatitis
Other: small bowel lymphoma, other neoplastic disease, ovarian pathology, referred pain from testes

*The most common organic causes are highlighted. A detailed history and examination is paramount to help identify rarer causes and guide investigations appropriately.