The reason for persistence was not clear as repeat endoscopy to document eradication of H. pylori or healing of gastritis could not be done. Also unusual causes of abdominal pain such as porphyria, lead poisoning, etc. could have been the reason for persistence of pain. For these patients no further investigations could be done due to financial constraints. In these five children EEG and barium meal follow through was also done to exclude abodminal epilepsy and obstructive lesions but were found to be normal. Contrary to this belief, many studies have found organic causes of RAP to be more common.
Giardiasis is one of the most common pathogenic intestinal protozoal infection world-wide.
However, it is not generally regarded as a cause of severe illness. Worm infestation has never been taken seriously as cause of abdominal pain due to high prevalence even in asymptomatic patients. However, a possibility of worm infestation as an incidental finding in these two cases can not be ruled out because two other cases without any organic or psychogenic cause also had responded without treatment. Before the advent of newer diagnostic modalities like ultrasonography and UGI endoscopy all the patients without any obvious cause of abdominal pain were labelled to have psychogenic abdominal pain. But with modern diagnostic modalities, organic cause of RAP is more readily detectable.