Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://gr.elmerpub.com

Review

Volume 19, Number 4, August 2026, pages 175-183

Identifying Prognostic Factors Implicated in Chronic Functional Abdominal Pain in Children: A Systematic Review

↓ Figure 1. PRISMA flowchart. PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

↓ **Table 1.** Characteristics of Included Studies
Authors, year	Aim of study	Type of study	Number of patients	Target population	Outcome measure	Summary of results	Limitations
RAP: recurrent abdominal pain; FAP: functional abdominal pain; IBS: irritable bowel syndrome; FGID: functional gastrointestinal disorder; FD: functional dyspepsia; GI: gastrointestinal.
Sjolund et al, 2021 [21]	To assess the natural history of recurrent childhood abdominal pain from early childhood through adolescence	Prospective population-based birth cohort study	2,455, from original cohort of 4,089	Children born 1994–1996 in Stockholm, Sweden, followed from infancy to 16 years	RAP, AP-FGID and IBS at 16 years by parental/child questionnaires scored against Rome III criteria	Recurrent abdominal pain age 12 years is predictive of RAP/FGID at age 16 years	Recurrent abdominal pain at age 1–2 years defined as parent-reported colic. Outcome largely based on questionnaire/self-report; around 60% cohort retention with potential selection bias.
Cunningham et al, 2017 [23]	To identify link between pain intensity, pain-related disability and anxiety with pain-related disability at 6 months	Prospective cohort study	99 at baseline, 64 at follow-up	Pediatric FGID patients (ages 8–18, Rome III, gastroenterologist-diagnosed) at a large Midwestern children’s hospital, USA	Functional Disability Inventory-Child version (FDI-C, self-report) at 6 months	Patients categorized by number of risk factors (0–3). The presence of 2+ risk factors predicted pain-related disability at 6 months	Little differentiation between FAP/IBS/FD. Short duration follow-up. Small number of participants with 35% lost to follow-up
Russell et al, 2017 [22]	To identify the link between nausea and long-term morbidity in pediatric patients with FAP	Prospective cohort study	871 at baseline, 392 at followed-up	Pediatric FAP patients (8–17 years) seen in a pediatric GI clinic, USA	GI, non-GI symptoms, depression, functional disability > 4 years later	Nausea is associated with higher risk of depression, anxiety, GI and somatic symptoms 4 years later	No assessment of outcomes at start of assessment (e.g., correlation of nausea with current anxiety/non-somatic symptoms). Approx 52% follow-up; age difference between groups wer not adjusted for.
Czyzewski et al, 2016 [28]	To assess whether anxiety or pain–stooling relations predict long-term maintenance of abdominal pain	Prospective cohort study	76	Children aged 7–10 years with FAP recruited from primary and tertiary care, USA	Parent-reported abdominal pain frequency 18–24 months later	Anxiety not predictive of persistence of pain. IBS symptoms are predictive	Overlap between IBS and FAP in intervention group. Small sample. No adjustment for confounders.
Horst et al, 2014 [25]	Relation between GI symptoms, extra-intestinal somatic symptoms and depressive symptoms on likelihood of FGID at follow-up	Prospective cohort study	760 at baseline, 392 at followed-up	8–16Y with recurrent chronic abdominal pain (Apley criteria), at a single tertiary pediatric GI clinic, USA	ROME III FGID (IBS, FD, FAPS, abdominal migraine) > 3 years later	41% met ROME III criteria at follow-up, mostly IBS. Extraintestinal somatic and depressive symptoms were predictive. Severity of abdominal pain, age and gender were not.	ROME III used for follow-up but not for initial diagnosis. Some of GI symptoms at exposure may indicate a diagnosis of IBS/FD. Tertiary care sample may limit generalizability, interim treatment was not captured.
Walker et al, 2012 [26]	Identify childhood FAP profiles and test whether they predict FGID, psychiatric disorder and central sensitization in later life	Prospective cohort study	Baseline 843, 760 eligible for follow-up. 379 followed-up, 211 for lab subset	Consecutive new pediatric FAP patients at tertiary pediatric clinic, USA, average age 12 years	ROME III FGID and chronic pain (PPQ), DSM IV anxiety/depressive disorder	Three profiles identified. Association between high pain dysfunctional type and FGID at follow-up	Approx 50% attrition; no baseline psychiatric/chronic-pain assessment; tertiary-care sample may limit generalizability.
Bonilla et al, 2011 [24]	Investigate whether obesity predicts persistence of pain and disability at long-term follow-up of FGIDs	Prospective cohort study	Identified 301, 188 enrolled and followed-up	Children, mean age 13.3 years, with ROME II FAP/IBS/FD, single pediatric GI division, USA	Persistence of pain, pain intensity/frequency and school absenteeism at follow-up 12–15 months later	61.7% had persistent pain at follow-up. Obesity is associated with poor long-term outcome and disability	Included IBS/FAP/FD (not much differentiation). Diet was not controlled. Unadjusted for age, gender, baseline severity. No range for age given; however, all participants were recruited from pediatric clinic.
Helgeland et al, 2011 [27]	Whether pediatric FAP outpatients have more somatic/mental-health symptoms than a population sample, and whether child and maternal symptoms predict persistent abdominal pain and disability at follow-up	Prospective cohort study	Baseline 94, follow-up 88	8–15 years old, with FAP; four general pediatric outpatient clinics, Norway	Self-reported abdominal pain index and functional disability inventory at 6–9 months	Patients had far more somatic and emotional symptoms than school children. Older age at baseline and peer problems were associated with persistent abdominal pain. Older age, emotional symptoms, prosocial behavior and maternal somatic symptoms predicted disability.	Short follow-up, self-reported outcomes. Child emotional symptoms only by mother/teacher.

↓ Table 1. Characteristics of Included Studies

Authors, year

Aim of study

Type of study

Number of patients

Target population

Outcome measure

Summary of results

Limitations

RAP: recurrent abdominal pain; FAP: functional abdominal pain; IBS: irritable bowel syndrome; FGID: functional gastrointestinal disorder; FD: functional dyspepsia; GI: gastrointestinal.

Sjolund et al, 2021 [21]

To assess the natural history of recurrent childhood abdominal pain from early childhood through adolescence

Prospective population-based birth cohort study

2,455, from original cohort of 4,089

Children born 1994–1996 in Stockholm, Sweden, followed from infancy to 16 years

RAP, AP-FGID and IBS at 16 years by parental/child questionnaires scored against Rome III criteria

Recurrent abdominal pain age 12 years is predictive of RAP/FGID at age 16 years

Recurrent abdominal pain at age 1–2 years defined as parent-reported colic. Outcome largely based on questionnaire/self-report; around 60% cohort retention with potential selection bias.

Cunningham et al, 2017 [23]

To identify link between pain intensity, pain-related disability and anxiety with pain-related disability at 6 months

Prospective cohort study

99 at baseline, 64 at follow-up

Pediatric FGID patients (ages 8–18, Rome III, gastroenterologist-diagnosed) at a large Midwestern children’s hospital, USA

Functional Disability Inventory-Child version (FDI-C, self-report) at 6 months

Patients categorized by number of risk factors (0–3). The presence of 2+ risk factors predicted pain-related disability at 6 months

Little differentiation between FAP/IBS/FD. Short duration follow-up. Small number of participants with 35% lost to follow-up

Russell et al, 2017 [22]

To identify the link between nausea and long-term morbidity in pediatric patients with FAP

Prospective cohort study

871 at baseline, 392 at followed-up

Pediatric FAP patients (8–17 years) seen in a pediatric GI clinic, USA

GI, non-GI symptoms, depression, functional disability > 4 years later

Nausea is associated with higher risk of depression, anxiety, GI and somatic symptoms 4 years later

No assessment of outcomes at start of assessment (e.g., correlation of nausea with current anxiety/non-somatic symptoms). Approx 52% follow-up; age difference between groups wer not adjusted for.

Czyzewski et al, 2016 [28]

To assess whether anxiety or pain–stooling relations predict long-term maintenance of abdominal pain

Prospective cohort study

Children aged 7–10 years with FAP recruited from primary and tertiary care, USA

Parent-reported abdominal pain frequency 18–24 months later

Anxiety not predictive of persistence of pain. IBS symptoms are predictive

Overlap between IBS and FAP in intervention group. Small sample. No adjustment for confounders.

Horst et al, 2014 [25]

Relation between GI symptoms, extra-intestinal somatic symptoms and depressive symptoms on likelihood of FGID at follow-up

Prospective cohort study

760 at baseline, 392 at followed-up

8–16Y with recurrent chronic abdominal pain (Apley criteria), at a single tertiary pediatric GI clinic, USA

ROME III FGID (IBS, FD, FAPS, abdominal migraine) > 3 years later

41% met ROME III criteria at follow-up, mostly IBS. Extraintestinal somatic and depressive symptoms were predictive. Severity of abdominal pain, age and gender were not.

ROME III used for follow-up but not for initial diagnosis. Some of GI symptoms at exposure may indicate a diagnosis of IBS/FD. Tertiary care sample may limit generalizability, interim treatment was not captured.

Walker et al, 2012 [26]

Identify childhood FAP profiles and test whether they predict FGID, psychiatric disorder and central sensitization in later life

Prospective cohort study

Baseline 843, 760 eligible for follow-up. 379 followed-up, 211 for lab subset

Consecutive new pediatric FAP patients at tertiary pediatric clinic, USA, average age 12 years

ROME III FGID and chronic pain (PPQ), DSM IV anxiety/depressive disorder

Three profiles identified. Association between high pain dysfunctional type and FGID at follow-up

Approx 50% attrition; no baseline psychiatric/chronic-pain assessment; tertiary-care sample may limit generalizability.

Bonilla et al, 2011 [24]

Investigate whether obesity predicts persistence of pain and disability at long-term follow-up of FGIDs

Prospective cohort study

Identified 301, 188 enrolled and followed-up

Children, mean age 13.3 years, with ROME II FAP/IBS/FD, single pediatric GI division, USA

Persistence of pain, pain intensity/frequency and school absenteeism at follow-up 12–15 months later

61.7% had persistent pain at follow-up. Obesity is associated with poor long-term outcome and disability

Included IBS/FAP/FD (not much differentiation). Diet was not controlled. Unadjusted for age, gender, baseline severity. No range for age given; however, all participants were recruited from pediatric clinic.

Helgeland et al, 2011 [27]

Whether pediatric FAP outpatients have more somatic/mental-health symptoms than a population sample, and whether child and maternal symptoms predict persistent abdominal pain and disability at follow-up

Prospective cohort study

Baseline 94, follow-up 88

8–15 years old, with FAP; four general pediatric outpatient clinics, Norway

Self-reported abdominal pain index and functional disability inventory at 6–9 months

Patients had far more somatic and emotional symptoms than school children. Older age at baseline and peer problems were associated with persistent abdominal pain. Older age, emotional symptoms, prosocial behavior and maternal somatic symptoms predicted disability.

Short follow-up, self-reported outcomes. Child emotional symptoms only by mother/teacher.

↓ **Table 2.** Risk of Bias Assessment
Study	Selection^a	Comparability	Outcome	Quality assessment^b
^aAssessment using Newcastle-Ottawa Quality assessment scale. ^bConversion to AHRQ standards (good quality: three or four stars in selection domain, and one or two stars in comparability domain, and two or three stars in outcome/exposure domain; fair quality: two stars in selection domain, and one or two stars in comparability domain, and two or three stars in outcome/exposure domain; poor quality: zero or one star in selection domain, or zero stars in comparability domain, or zero or one star in outcome/exposure domain)
Sjolund et al, 2021 [21]	✰✰✰	✰✰	✰✰	Good
Cunningham et al, 2017 [23]	✰✰✰	✰	✰	Poor
Russell et al, 2017 [22]	✰✰	✰	✰✰	Fair
Czyzewski et al, 2016 [28]	✰✰		✰	Poor
Horst et al, 2014 [25]	✰✰	✰✰	✰✰✰	Fair
Walker et al, 2012 [26]	✰✰	✰✰	✰✰✰	Fair
Bonilla et al, 2011 [24]	✰✰✰		✰✰	Poor
Helgeland et al, 2011 [27]	✰✰	✰✰	✰✰	Fair

↓ Table 2. Risk of Bias Assessment

Study

Selection^a

Comparability

Outcome

Quality assessment^b

^aAssessment using Newcastle-Ottawa Quality assessment scale. ^bConversion to AHRQ standards (good quality: three or four stars in selection domain, and one or two stars in comparability domain, and two or three stars in outcome/exposure domain; fair quality: two stars in selection domain, and one or two stars in comparability domain, and two or three stars in outcome/exposure domain; poor quality: zero or one star in selection domain, or zero stars in comparability domain, or zero or one star in outcome/exposure domain)

Sjolund et al, 2021 [21]

✰✰✰

✰✰

Good

Cunningham et al, 2017 [23]

✰✰✰

✰

Poor

Russell et al, 2017 [22]

✰✰

✰

✰✰

Fair

Czyzewski et al, 2016 [28]

✰✰

✰

Poor

Horst et al, 2014 [25]

✰✰

✰✰✰

Fair

Walker et al, 2012 [26]

✰✰

✰✰✰

Fair

Bonilla et al, 2011 [24]

✰✰✰

✰✰

Poor

Helgeland et al, 2011 [27]

✰✰

Fair