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Dolor abdominal crónico o recurrente

Creado por Isabel Rubio en 9 mayo 2012 under Educación para la Salud: La Adolescencia, Educación para la Salud: La Etapa Escolar, Enfermedades de la Infancia, General | Read the First Comment

Hoy acude a consulta María, tiene 13 años y viene de nuevo por dolor abdominal desde que se ha levantado. Como en otras ocasiones, desde que empezó este curso, cuando tiene dolor no va al instituto. No tiene nada más, ni vomita, ni diarrea, ni fiebre…
Va superbien en el instituto, es muy estudiosa y ordenada. Tiene pocas amigas y sólo se relaciona en clase, fuera del instituto no sale con nadie, “prefiere estar en casa con el ordenador” apunta su madre.
Habíamos acordado en la visita anterior que anotaría en un calendario los días que tenía dolor y cuando veo el registro, de entrada llama la atención que durante el periodo de vacaciones de Semana Santa no ha presentado ningún episodio de dolor, el resto de las semanas al menos uno o dos días con dolor…

El dolor abdominal crónico o recurrente en la edad pediátrica es muy frecuente.

La inmensa mayoría de niños y adolescentes con dolor abdominal recurrente presentan lo que denominamos Trastorno funcional digestivo en relación con dolor abdominal.
Para hablar de este diagnóstico debe tratarse de un niño o adolescente entre 4 y 18 años, con al menos 8 semanas no consecutivas de dolor abdominal que interfiere la actividad normal, generalmente sin nada más acompañante.

Podemos hablar de la existencia de un “cerebro intestino”, que está constituido por neuronas y que es sensible a nuestra forma de ser, de vivir, existiendo una relación con problemas emocionales, sobre todo ansiedad, con la fobia social, con el miedo.
Es decir, interaccionan lo biológico, lo psicológico y lo social.

Se habla también que estos niños y adolescentes tendrían disminuído el umbral doloroso visceral, es decir, sienten más el dolor, con aumento de las sensaciones del aparato gastrointestinal y “calambres” intestinales.

Los Trastornos funcionales digestivos en relación con dolor abdominal pueden adoptar 4 formas de presentarse:

  1. Síndrome de intestino irritable
  2. Dispepsia funcional
  3. Migraña abdominal
  4. Dolor abdominal funcional
  • 1. El Síndrome de intestino irritable es el más frecuente y sobre todo en la edad de María, provocando, como le está pasando ella, una mala calidad de vida. Para poder hacer este diagnóstico debe presentar dolor al menos una vez por semana y al menos 2 meses, unido a cambios en la frecuencia o en la consistencia (más duras o más líquidas) de las heces o que mejore el dolor con la defecación. Evidentemente no padecerá otra enfermedad que explique los síntomas.
  • 2. Diagnosticaremos Dispepsia funcional cuando el niño o adolescente presente al menos una vez a la semana y al menos durante 2 meses dolor recurrente que refiera a la parte alta, sobre el ombligo, no mejore con la defecación ni se acompañe de cambios en la frecuencia ni consistencia de las heces. Puede acompañar al dolor sensación de ardor, regurgitación, naúseas o vómitos, o bien eructos, sensación de saciedad precoz o hipo excesivo. Al igual que antes, no habrá evidencias de otra enfermedad que explique los síntomas.
  • 3. Diagnosticaremos Migraña abdominal si ha presentado dos o más veces en el último año episodio de dolor abdominal intenso de una hora o más que interfiere con su vida normal y se puede acompañar de naúseas o vómitos, pérdida de apetito, cefalea, fotofobia o palidez, pero entre los episodios de dolor está completamente asintomática.
  • 4. Por último queda un poco un cajón de sastre que es lo que se denomina Dolor abdominal funcional, es decir, el niño o adolescente tiene dolor abdominal al menos una vez a la semana y al menos 2 meses, pero no se ajusta a los criterios anteriores. El dolor puede ser episódico o continuo; interrumpe, pero no siempre, su vida cotidiana; puede tener también cefalea, o dolor de piernas o dificultad para dormir. Como siempre, no habrá evidencia de otra enfermedad que explique los síntomas.

(Continuará)

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