Evaluation of S-adenosyl Methionine (SAM-e) for Recurrent Abdominal Pain in Children
Evaluation of S-adenosyl Methionine (SAM-e) for Recurrent Abdominal Pain in Children
This pilot study will investigate the efficacy of SAM-e for the treatment of recurrent
 abdominal pain in children. This will be an open-labeled study and all participants will
 receive SAM-e therapy. Given that SAM-e has been demonstrated to improve symptoms of
 depression and pain with minimal side effects as compared to other antidepressant therapy, we
 hypothesize that SAM-e will reduce pain symptoms among children with recurrent abdominal
 pain.
Inclusion Criteria:

 -  8 to 22 years old

 -  Diagnosed with RAP as verified by a physician, and having at least twice weekly
 episodes of abdominal pain which cause the patient to withdraw from normal activities.

 -  At least one month trial on a high fiber diet without resolution of abdominal pain.

 -  Ambulatory

 Exclusion Criteria:

 -  Focal abdominal pain by history or physical exam, unless a negative (including
 endoscopic) evaluation has been performed

 -  Current diagnosis of inflammatory bowel disease, pancreatitis (acute or recurrent),
 peptic ulcer disease, gastrointestinal infection (unresolved), or ongoing
 gastrointestinal inflammation.

 -  Current or recent (within the past year) pregnancy and/or current breastfeeding.

 -  Current diagnosis of nephropathy or genitourinary disease.

 -  Blood in stools or emesis (EXCEPTION: blood in the stool secondary to hemorrhoids is
 not an exclusion criterion).

 -  Unintentional loss of over 10% body weight over the past 3 months or weight < 100%
 ideal body weight.

 -  Recurrent fevers (T>100F) at least once a week or with abdominal pain episodes.

 -  Recurrent dehydration with abdominal pain episodes requiring intravenous rehydration.

 -  Current personal diagnosis of depression or report of suicidality, mania or bipolar
 disorder.

 -  Family history of mania or bipolar disorder.

 -  Current use of opiates or other prescription pain medications and/or refusal to remain
 off opiate/prescription pain medications during the study period.

 -  Currently receiving additional therapies besides diet for recurrent abdominal pain
 and/or refusal to remain off such therapies during the study period, including but not
 limited to anticholinergic medications, antidepressant medications, biofeedback
 therapy, cognitive behavioral therapy.

 -  Hypersensitivity to SAM-e.

 -  Inability of child to provide assent and/or inability of parent/custodian to give
 consent.