Understanding chronic abdominal pain in children: What are disorders of gut-brain interaction?
By Dr Rohan Malik
Paediatric gastroenterologist in Woolloongabba, Brisbane
When a child has ongoing stomach pain, but every test comes back normal, families are often left feeling frustrated.
Parents may wonder whether something has been missed, while children can feel as though their pain isn’t being believed.
The reality is that chronic abdominal pain can be very real, even when there is no visible damage or disease within the digestive system.
One of the most common causes of persistent abdominal pain in children is a group of conditions known as disorders of gut-brain interaction (DGBI). While the name may sound unfamiliar, these conditions are well recognised and account for many referrals to paediatric gastroenterologists.
What are disorders of gut-brain interaction?
The gut and the brain are constantly communicating through a complex network of nerves, hormones and immune signals. This communication helps regulate digestion, bowel movements and even how we experience pain.
In children with a disorder of gut-brain interaction, these signals become disrupted. The digestive tract becomes more sensitive than usual, meaning normal digestive processes that most people would never notice can be experienced as pain or discomfort.
Years ago, these conditions were commonly called functional gastrointestinal disorders. Unfortunately, the word functional has sometimes led families to believe the pain isn’t real. Nothing could be further from the truth.
Functional does not mean fictional. It simply means the bowel is functioning differently, even though routine tests may not show inflammation, infection or structural disease. The pain children experience is genuine.
Why do these conditions develop?
There isn’t one single cause.
For many children, several factors may contribute, including:
- a previous gastroenteritis or stomach bug
- changes in the gut microbiome
- increased sensitivity of the nerves within the digestive tract
- genetics
- stress or anxiety.
Not every child will have an obvious trigger, and symptoms often develop gradually over time.
What symptoms do children experience?
Although abdominal pain is the most common symptom, children may also experience:
- bloating
- nausea
- feeling full quickly when eating
- constipation or diarrhoea
- symptoms that come and go over weeks or months
Many children are otherwise healthy, continue to grow normally and have reassuring test results.
If the tests are normal, why does my child still have pain?
This is one of the most common questions parents ask.
Investigations are important because they help exclude conditions such as coeliac disease, inflammatory bowel disease and other gastrointestinal disorders that require specific treatment.
When these tests are normal, it doesn’t mean there is nothing wrong. Instead, it suggests the digestive system is working differently rather than being affected by a structural disease. Understanding this distinction is often an important step in helping families make sense of their child’s symptoms.
How are disorders of gut-brain interaction treated?
Treatment is about much more than simply reducing pain. The goal is to help children return to normal activities, including school, sport and spending time with friends.
Depending on the child’s symptoms, treatment may include:
- education about the condition
- dietary advice where appropriate
- managing contributing issues such as constipation
- strategies to improve gut function
- psychological therapies, such as cognitive behavioural therapy, when appropriate
- medication for selected children.
Every child is different, so management is tailored to their individual needs.
Looking ahead
Living with chronic abdominal pain can be challenging for children and their families, particularly when there isn’t a simple explanation. The good news is that disorders of gut-brain interaction are common, well understood and, in most cases, very manageable.
With an accurate diagnosis and an individualised treatment plan, many children experience significant improvement and can get back to enjoying the things they love.
