Possible Magnesium Deficiency Should Be Investigated
Since the existence of polymorphous functional syndromes is the actual clinical correlate of magnesium deficiency (MD), it is almost a “model disorder” for functional impairments—in the past known as “spasmophilia” (France), “neuronal hyperexcitability syndrome” (Italy), or “chronic tetanic syndrome” (German speaking countries). Compared with cerebral (central nervous system, vegetative nervous system, psyche), cardiovascular and muscular-tetanic forms of MD, the abdominal-visceral form dominates in children—depending on age—but was not mention by Bufler et al in their article (1).
The Rome III classification puts functional abdominal pain into the H-subgroup (1) (eTable 1). As “functional abdominal syndrome/FAS” (according to Heinisch), 46% of such disorders manifest in children with several functional syndromes (2). A positive von-Bonsdorff-test in 69% does not differentiate these children significantly from genuine hyperventilation tetany patients (2), in whom MD is well documented (3). The effectiveness of magnesium treatment in >90% does not only affect the episodic symptoms in this group but also associated FAS, similar to the way in which children with FAS benefit from magnesium treatment (4).
Since the Rome III criteria allow the term “functional” only if the pain “cannot be accounted for by any structural or biochemical disease” (1), the criterion “no evidence for .... metabolic ... process” (subgroups H1a, H2a–H2d) exclusively contradicts the categorization of “isomorphous” symptoms of FAS in MD among the Rome III-H-subgroups; none the less they are functional disorders. In order to evaluate these diagnostically, the diagnosis of MD, which was not mentioned, is required; in order to treat the deficiency, treatment with sufficient magnesium is required. To focus on cognitive behavioral therapeutic measures as the only therapeutic approach should therefore not be a learning objective.
Dr. med. Gerd W. Ratzmann
Conflict of interest statement
The author has received travel expenses from Lilly Germany.
|1.||Bufler Ph, Groß M, Uhlig HH: Recurrent abdominal pain in childhood. Dtsch Arztebl Int 2011; 108(17): 295–304. VOLLTEXT|
|2.||Ratzmann GW, Lühder H: Gesteigerte tetanische Erregbarkeit bei Kindern mit funktionellen (psychosomatischen) Störungen. Kinderärztl Prax 1988; 56: 487–94. MEDLINE|
|3.||Ratzmann GW, Ratzmann L: Parameters of magnesium metabolism in children and adolescents with hyperventilation syndrome (abstr.). Magnesium-Bull 1999; 21: 26.|
|4.|| Ratzmann GW, Lühder H, Berg A, Ratzmann M, Gehler W: Magnesium-Therapie: Ein wirksames Prinzip zur Reduktion psychoreaktiver, neurose-äquivalenter Symptome bei Kindern. In: Anke M, Brückner C, Gürtler H, Grün M (eds.): Mengen- und Spurenelemente. Leipzig. Karl-Marx-Universität 1988, 8/Teil 2: 278-82. |