838 pain that occurs for at least 3 months without any identifiable cause and in- terferes with daily activities. During the past 2 decades, it has been pro- posed that a disturbance of gastro- intestinal (GI) motility, possibly triggered by physical or mental stress, may contribute to abdominal pain. However, despite extensive studies in both adults and children, no character- istic motor abnormalities have been identified. More emphasis is now being placed on the interaction between motility, sensory, and psychosocial fac- tors as elements that contribute to a variety of functional disorders in chil- dren. 3 Children with irritable bowel syndrome (IBS) have alterations in rectal sensitivity with lowered thresh- olds for pain and motility distur- bances. 4 This lower threshold for pain in response to noxious stimuli has been termed “hyperalgesia.” 5 Population-based studies have shown a prevalence of RAP and IBS in 17% and 14% of high school students, re- spectively. 6 Functional abdominal pain in children is costly to society and has been associated with unnecessary med- ical investigations, including surgery. 7 Chronic abdominal pain in children has often been associated with comor- bid symptoms of anxiety and depres- sion, 9 similar to the high prevalence of psychologic disturbances in adults with Symptom-based criteria for functional gastrointestinal disorders (FGID), known as “Rome II,” have been estab- lished for adults and have recently been proposed for children. 1 These criteria take into account the location Visceral hyperalgesia in children with functional abdominal pain Carlo Di Lorenzo, MD, Nader N. Youssef, MD, Luther Sigurdsson, MD, Lisa Scharff, PhD, Janet Griffiths, BSN, and Arnold Wald, MD From the Division of Gastroenterology, Departments of Pediatrics and Medicine, University of Pittsburgh School of Medicine, Pennsylvania, and Pain Evaluation and Treatment Institute, Children’s Hospital of Boston, Massachu- setts. Supported in part by a grant from the American College of Gastroenterology and the Research Advisory Committee of Children’s Hospital of Pittsburgh. Submitted for publication Feb 16, 2001; revision received May 3, 2001; accepted July 17, 2001. Reprint requests: Carlo Di Lorenzo, MD, Professor of Pediatrics, Division of Gastroenterology, Children’s Hospital of Pittsburgh, Pittsburgh, PA 15213. Copyright © 2001 by Mosby, Inc. 0022-3476/2001/$35.00 + 0 9/21/118883 doi:10.1067/mpd.2001.118883 CDI Children’s Depression Inventory FGID Functional gastrointestinal disorders GI Gastrointestinal IBS Irritable bowel syndrome RAP Recurrent abdominal pain STAIC State–Trait Anxiety Inventory for Children of pain and associated changes in bowel patterns. Before the Rome crite- ria, the term recurrent abdominal pain (RAP) was introduced by Apley and Naish 2 to describe children who have intermittent episodes of abdominal Objective: Our purpose was to evaluate visceral sensitivity and psychologic profiles in children with functional gastrointestinal disorders. Study design: We measured visceral perception in the stomach and in the rectum by using an electronic barostat. Psychologic questionnaires were com- pleted. Ten children with recurrent abdominal pain (RAP)(8 female, mean age 11.3 ± 0.8 years), 10 children with irritable bowel syndrome (IBS) (8 female, mean age 13.0 ± 0.9 years), and 15 control children (8 female, mean age 12.7 ± 1.2 years) completed the study. Results: Thresholds for visceral perception in the rectum were decreased in patients with IBS (P < .001 vs control patients) and in patients with RAP (P < .05 vs control patients). Children with IBS had lower thresholds than children with RAP (P < .01). In contrast, thresholds for perception were de- creased in the stomach of children with RAP (P < .005 vs control patients) but not in children with IBS. There were elevated anxiety scores in 45% of patients. Duration of symptoms was associated with higher scores of anxiety (P < .001) and depression (P < .02). Conclusions: Hyperalgesia was demonstrated in children with RAP and IBS; sites of hyperalgesia appear to be associated with different symptom phenotypes; anxiety was common, and there was an association between the duration of symptoms and increased scores for both anxiety and depression. (J Pediatr 2001;139:838–43)