Chronic or recurrent abdominal pain in children
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Recurrent pain without red flags
Laboratory tests
- IgA anti-tissue transglutaminase antibodies (tTG-IgA)
- Total IgA (diet containing gluten for at least 6 weeks)
- No testing for Helicobacter pylori (no serology, no stool antigen, no breath test).
Do not order
- Testing for Helicobacter pylori (stool antigen, breath test, serology) in a child with functional pain: strong recommendation against [4]; no “test and treat” in children [4]
- Helicobacter pylori serology: serological tests (blood, urine, saliva) not recommended in clinical practice in children [4]; NABM reimbursement limited to specific screening situations [3]
- Testing for Helicobacter pylori in the initial tests for iron-deficiency anaemia in a child: not recommended [4]
- Faecal calprotectin in primary care without suspected IBD: reserved for the child with suspected IBD referred to the specialist [6] and not reimbursed outside follow-up of known IBD [3]
Red flags: specialist advice
- Refer to the paediatric gastroenterologist if there is an alarm sign (see the note); do not delay the opinion for tests.
Laboratory tests
- IgA anti-tissue transglutaminase antibodies (tTG-IgA)if needednon-French guidelineFaltering growth, unexplained iron, B12 or folate deficiency, persistent digestive symptoms: coeliac disease serology [2].
- Total IgA (faltering growth, unexplained iron deficiency)if needednon-French guidelineFaltering growth, unexplained iron, B12 or folate deficiency, persistent digestive symptoms: coeliac disease serology [2].
- FBCif needednon-French guidelineFever, vomiting, blood in the stools or more than three alarm signs: an American Family Physician review then completes the work-up, and lists FBC (anaemia, infection) and ESR or CRP (infection, inflammatory disease) among the simple tests to consider (expert opinion, 2018) [7]. Take without delaying the paediatric gastroenterologist's opinion.
- CRPif needednon-French guidelineFever, vomiting, blood in the stools or more than three alarm signs: an American Family Physician review then completes the work-up, and lists FBC (anaemia, infection) and ESR or CRP (infection, inflammatory disease) among the simple tests to consider (expert opinion, 2018) [7]. Take without delaying the paediatric gastroenterologist's opinion.
- Urine microscopy and culture (if fever or history of urinary tract infection)if needednon-French guidelineFever or history of urinary tract infection: the American Family Physician review counts a history of urinary tract infection among the features pointing to an organic cause, and lists urinalysis and urine culture among the simple tests to consider (expert opinion, 2018) [7].
Sources (7)
- Groen J, et al. ESPGHAN/NASPGHAN guidelines for treatment of irritable bowel syndrome and functional abdominal pain-not otherwise specified in children aged 4-18 years. J Pediatr Gastroenterol Nutr. 2025;81:442-471.
- National Institute for Health and Care Excellence. Coeliac disease: recognition, assessment and management. NICE guideline NG20, septembre 2015 ; chapitre Recommendations consulté le 11 octobre 2026.
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : actes 1828 (anticorps anti-transglutaminase IgA), 5236 (antigène fécal de Helicobacter pylori), 1311 (sérologie de Helicobacter pylori), 1684 (calprotectine fécale).
- Jones NL, Koletzko S, Goodman K, et al. Joint ESPGHAN/NASPGHAN Guidelines for the Management of Helicobacter pylori in Children and Adolescents (Update 2016). J Pediatr Gastroenterol Nutr. 2017;64(6):991-1003.
- Homan M, Jones NL, Bontems P, Carroll MW, Czinn SJ, Gold BD, et al. Updated joint ESPGHAN/NASPGHAN guidelines for management of Helicobacter pylori infection in children and adolescents (2023). J Pediatr Gastroenterol Nutr. 2024;79(3):758-85.
- National Institute for Health and Care Excellence. Faecal calprotectin diagnostic tests for inflammatory diseases of the bowel. Diagnostics guidance DG11 (2013), devenue HealthTech guidance HTG320 ; consultée le 11 octobre 2026.
- Reust CE, Williams A. Recurrent Abdominal Pain in Children. Am Fam Physician. 2018;97(12):785-793.