Abused children more likely to suffer unexplained abdominal pain, nausea or vomiting

"Therefore, when young patients complain about unexplained gastrointestinal symptoms, their doctors should ask questions to determine if they might have been abused," said Miranda van Tilburg, Ph.D., lead author of the study, an assistant professor of gastroenterology and hepatology in the UNC School of Medicine and a member of UNC's Center for Functional GI & Motility Disorders.

The study is published in the March/April 2010 issue of Annals of Family Medicine. In the study, van Tilburg and study co-authors analyzed data that was obtained as part of the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Their analysis included 845 children ages 4 through 12 years. Every two years they collected information about the childrens' gastrointestinal symptoms from their parents and maltreatment allegations concerning these children from child protective services agencies. Then the children, at age 12, gave their own reports of GI symptoms, life-time maltreatment and psychological distress. A statistical method called logistic regression was used to analyze the data.

The results showed that among children in the study, sexual abuse preceded or coincided with abdominal pain in 91 percent of cases. In addition, in children who said they recalled ever being abused physically, psychologically or sexually, there was a statistically significant association between abuse and both abdominal pain and nausea/vomiting.

An additional analysis aimed at separating the effect of psychological distress alone from physical or sexual abuse showed that most effects dropped below the level of statistical significance, except for the relationship between physical abuse and nausea/vomiting. This is consistent with other results reported in the medical literature, van Tilburg said, but psychological distress was only partly responsible for weakening the relation between physical abuse and nausea. Other factors, such as permanent changes in the nervous system due to injury associated with physical abuse, must play a role as well, she said.

In addition to van Tilburg, UNC co-authors of the study are Desmond K. Runyan, M.D. Dr.P.H., Adam J. Zolotor, M.D., M.P.H., Denesh K. Chitkara, M.D. and William E. Whitehead, Ph.D.

Co-authors from outside UNC include J. Christopher Graham, Ph.D. (University of Washington), Howard Dubowitz, M.D., M.S. (University of Maryland), Alan J. Litrownik, Ph.D. (San Diego State University), Emalee Flaherty, M.D. (Northwestern University Feinberg School of Medicine).