Clinical and Sonographic Biomarkers in the Evaluation of Pediatric Recurrent Abdominal Pain

Introduction: Recurrent abdominal pain (RAP) affects 10-12% of children aged 5-15 years and poses a diagnostic challenge, as the majority of cases are functional with no identifiable organic cause. Mesenteric lymphadenopathy is commonly observed in children with RAP during ultrasonography (USG), but its clinical relevance remains uncertain. Additionally, psychosomatic factors, particularly stress, play a significant role in RAP symptom persistence. This study aimed to assess clinical and sonographic markers, including mesenteric lymphadenopathy, in RAP diagnosis and to explore the impact of psychosomatic factors on symptom severity and persistence. Materials and Methods: This prospective study included 82 pediatric patients aged 5-15 years who met Apley’s criteria for RAP, defined as at least three episodes of significant abdominal pain over three months. Clinical assessments involved pain characteristics, associated symptoms, and psychosomatic stressor evaluations. Diagnostic tests included complete blood count (CBC), urinalysis, and stool examinations, while abdominal USG was performed to assess mesenteric lymphadenopathy and other potential abnormalities. Follow-up USG was conducted after six months for patients with lymphadenopathy, and psychosomatic evaluations were repeated to assess their role in symptom persistence. Data analysis was performed using SPSS, with statistical significance set at p < 0.05. Results: Of the 82 children (mean age 7.9 years), 56.1% were male. Periumbilical pain with diurnal variation was present in 92.68% of patients, and 41.46% reported psychosomatic stressors, primarily related to school performance. Mesenteric lymphadenopathy was detected in 17.07% of patients. Follow-up USG showed resolution in 85.71% of cases, but 58.33% of those with resolved lymphadenopathy continued to experience pain. Psychosomatic stressors were significantly associated with pain recurrence, particularly in the absence of organic findings. Discussion: This study demonstrates that mesenteric lymphadenopathy, although frequently observed in children with RAP, may not be directly linked to pain persistence, as lymph node resolution did not always correspond to symptom resolution. Instead, psychosomatic factors, especially school-related stress, were more strongly associated with the persistence of RAP. These findings underscore the importance of considering psychological factors in the management of RAP and highlight the limited diagnostic utility of USG in functional cases. A holistic approach that integrates both medical and psychological interventions is crucial for improving outcomes in children with RAP.