Evaluation of S-adenosyl Methionine (SAM-e) for Recurrent Abdominal Pain in Children

Inclusion Criteria:

• 8 to 22 years old

• Diagnosed with RAP as verified by a physician, and having at least twice weeklyepisodes 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 (includingendoscopic) evaluation has been performed

• Current diagnosis of inflammatory bowel disease, pancreatitis (acute or recurrent),peptic ulcer disease, gastrointestinal infection (unresolved), or ongoinggastrointestinal 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 isnot 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 bipolardisorder.

• Family history of mania or bipolar disorder.

• Current use of opiates or other prescription pain medications and/or refusal to remainoff opiate/prescription pain medications during the study period.

• Currently receiving additional therapies besides diet for recurrent abdominal painand/or refusal to remain off such therapies during the study period, including but notlimited to anticholinergic medications, antidepressant medications, biofeedbacktherapy, cognitive behavioral therapy.

• Hypersensitivity to SAM-e.

• Inability of child to provide assent and/or inability of parent/custodian to giveconsent.