Prevalence and Characteristics of Abdominal Pain in the United States

Efficacy of water infusion combined with defoamers in colonoscopy

BACKGROUND

Currently, colonoscopy still needs continuous optimization and exploration of novel alternative approaches to enhance the experience of patients during colonoscopy.

AIM

To analyze the efficacy of water infusion combined with defoamers in colonoscopy.

METHODS

This study included 97 patients undergoing colonoscopy from January 2024 to June 2024. The participants were categorized into two groups, namely, the control group (n = 47), who underwent conventional colonoscopy, and the experimental group (n = 50), who received colonoscopy using water injection combined with defoamers. A comparative analysis was then conducted on the disease detection rate (colonic polyps, colonorrhagia, colonic ulcers, colonic mucosal lesions, and others), colonoscopy duration, abdominal pain [visual analog scale (VAS)], Boston bowel preparation scale (BBPS), self-rating anxiety scale (SAS), bowel preparation comfort, complications (intestinal perforation, bleeding, nausea and vomiting, abdominal pain, and abdominal distension), and patient satisfaction.

RESULTS

The experimental group demonstrated a significantly higher total disease detection rate, BBPS scores, and patient satisfaction compared with the control group. Further, the research group exhibited shorter colonoscopy duration, lower VAS and SAS scores and total complication rate, and better patient comfort and satisfaction.

CONCLUSION

These results indicate that the combination of water injection and defoamers exhibited an overall better therapeutic effect than conventional colonoscopy, mainly reflected in higher disease detection rate, faster examination efficiency, lower abdominal pain, anxiety, and complication incidences, and significantly better bowel preparation, comfort, and patient satisfaction.

International Classification of Diseases, Tenth Revision Diagnosis Codes Are Overutilized in the Diagnosis of Chronic Pancreatitis

BACKGROUND

Retrospective studies and large databases, such as the OneFlorida Clinical Research Consortium, rely on International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes to identify patients with specificity. This study aimed to determine if ICD-10 codes for CP are overutilized.

MATERIALS AND METHODS

Retrospective analysis was conducted for patients with ICD-10 codes K86.0 (alcohol-induced CP) and K86.1 (other CP) from February 2018 to February 2020. Data were extracted from the integrated electronic data repository. This study was approved by the institutional review board. The diagnosis of CP was defined as either being made by a gastroenterologist, proven by biopsy, or having characteristic findings on cross-sectional imaging with appropriate symptoms.

RESULTS

Five hundred four (37%) out of the 1360 patients had no evidence of CP. When broken down by diagnosis code, 41 of 176 charts (23.3%) with K86.0 and 461 of 1184 charts (38.6%) with K86.1 had no evidence of CP. Two hundred ninety-nine of these patients had either a single episode of acute pancreatitis, recurrent acute pancreatitis, or episode of acute necrotizing pancreatitis. Of note, 81 patients had no identifiable abdominal pathology.

CONCLUSIONS

Although the OneFlorida database makes multicenter research more accessible, it does not replace labor-intensive chart review given the propensity for overdiagnosis.

Factors Associated With Abdominal Pain in Patients With Active and Quiescent Ulcerative Colitis: A Multicohort Study

BACKGROUND

Abdominal pain can be an overlooked symptom in patients with ulcerative colitis (UC).

AIMS

The aim of this study was to investigate the prevalence and factors associated with abdominal pain in active and quiescent UC.

METHODS

Three study cohorts of adult UC patients were used. Cross-sectional cohorts I and II included 130 (46 active) and 288 (156 active) patients. Longitudinal cohort III included 83 patients with active disease at diagnosis that reached deep remission during follow-up. The Gastrointestinal Symptom Rating Scale was used to assess abdominal pain and other validated questionnaires to assess psychological distress, fatigue and quality of life (QoL).

RESULTS

In the two cross-sectional cohorts, 63% and 58% of the active vs. 54% and 33% of the quiescent UC patients reported abdominal pain (both p ≤ 0.02). In the longitudinal cohort, 71% had abdominal pain at diagnosis vs. 46% when in remission (p < 0.001). In multivariable models, symptoms of anxiety were associated with higher abdominal pain levels in both cross-sectional cohorts (OR 1.75 [IQR 1.11-2.76] and OR 1.99 [1.45-2.73]), whereas in cohort II, active disease (OR 2.68 [1.61-4.45]) and female sex (OR 2.03 [1.21-3.41]) were also associated with pain. QoL was negatively correlated with higher levels of abdominal pain, both in active and quiescent disease.

CONCLUSIONS

Abdominal pain in UC is prevalent and associated with lower QoL in both active and quiescent disease. Associated factors are active disease, female sex and psychological symptoms, especially anxiety. We suggest considering a holistic approach when treating UC patients with abdominal pain.

Community-Based View on Diagnostic Imaging at the End of COVID-19 Pandemic: Online Survey-Assisted Study

(1) Background: An online survey-based observational cross-sectional study aimed at elucidating the experience and attitudes of an unstructured population regarding diagnostic imaging. (2) Methods: Invitations to participate were distributed using mixed-mode design to deidentified residents aged 18 years and older. Main outcome measures included morbidity structure and incidence of diagnostic imaging administrations. (3) Results: Respondents (n = 1069) aged 44.3 ± 14.4 years; 32.8% suffered from cardiovascular diseases (CVD); 9.5% had chronic respiratory pathology; 28.9% considered themselves healthy. Respondents with COVID-19 history (49.7%) reported higher rates of computed tomography (CT) (p < 0.0001), magnetic resonance imaging (MRI) (p < 0.001), and ultrasound (p < 0.05). COVID-19 history in CVD respondents shifted imaging administrations towards CT and MRI (p < 0.05). Every tenth respondent received MRI, CT, and ultrasound on a paid basis; 29.0% could not pay for diagnostic procedures; 13.1% reported unavailable MRI. Professional status significantly affected the pattern of diagnostic modalities (p < 0.05). MRI and CT availability differed between respondents in urban and rural areas (p < 0.0001). History of technogenic events predisposed responders to overestimate diagnostic value of fluorography (p < 0.05). (4) Conclusions: Preparedness to future pandemics requires the development of community-based outreach programs focusing on people's awareness regarding medical imaging safety and diagnostic value.

Parietal abdominal pain with lower leg discrepancy: a case report

BACKGROUND

This report involves the first publication describing a case of parietal abdominal pain due to lower limb length discrepancy.

CASE PRESENTATION

A Caucasian male patient in his 50s was referred to our rehabilitation department with chronic abdominal pain that began in childhood. This chronic pain was associated with episodes of acute pain that were partially relieved by grade 3 analgesics. The patient was unable to sit for long periods, had recently lost his job, and was unable to participate in recreational activities with his children. Investigations revealed contracture and hypertrophy of the external oblique muscle and an limb length discrepancy of 3.8 cm (1.5 inches) in the left lower limb. The patient was effectively treated with a heel raise, physiotherapy, intramuscular injection of botulinum toxin, and lidocaine. The patient achieved the therapeutic goals of returning to work, and reducing analgesic use.

CONCLUSIONS

Structural misbalances, as may be caused by lower leg discrepancy, may trigger muscular compensations and pain. Complete anamnesis and clinical examination must not be trivialized and may reveal previously ignored information leading to a proper diagnosis.

Novel Implantation Technique for Thoracoabdominal Peripheral Nerve Stimulation via a Transversus Abdominal Plane Approach for Treatment of Chronic Abdominal Pain

Background

Chronic abdominal pain (CAP) is a common and challenging to treat condition with a global prevalence of up to 25%. Despite extensive evaluation, approximately 40% of patients with CAP have an unknown diagnosis. Medications may be ineffective, and surgery is rarely indicated. Interventional treatment including sympathetic blocks, sympathetic neurolysis, and transversus abdominal plane (TAP) blocks may be an option, but their efficacy can wane over time. Neuromodulation has emerged as an option for these patients, as there is evidence of success with dorsal column spinal cord and dorsal root ganglion (DRG) stimulation. Peripheral nerve stimulation (PNS) may be an alternative option, particularly in higher risk patients or in patients for whom neuraxial access may be unsafe or too technically challenging. Thoracoabdominal nerve peripheral nerve stimulation via a TAP approach may be more specifically targeted in comparison to dorsal column or DRG stimulation. In this short report, we detail a technique that the authors have successfully used for thoracoabdominal nerve PNS via a TAP approach for management of CAP.

Methods

This article describes a novel medial to lateral ultrasound guided thoracoabdominal nerve PNS via a TAP approach technique for lead placement and implantation.

Results

A medial to lateral ultrasound guided TAP approach as described to successfully implant percutaneous thoracoabdominal nerve PNS leads for management of CAP.

Conclusion

The thoracoabdominal nerve PNS via a TAP approach lead placement technique noted in this report has been used as a means for management of CAP utilizing peripheral neuromodulation. Here, we present a short report detailing a potential technique for PNS utilization for management of CAP. Further studies are needed to validate the safety and efficacy of this therapy modality, although the authors have found it to be a viable management option for patients with medically refractory neuropathic CAP.

A Case of Left-Sided Acute Appendicitis in a 45-Year-Old Man with Situs Inversus Totalis Managed by Emergent Laparoscopic Appendectomy

BACKGROUND Situs inversus totalis (SIT) is a rare congenital abnormality that includes mirror-image transposition of both the abdominal and the thoracic organs. It may remain undetected into adulthood until an acute medical emergency results in diagnostic imaging. This report presents a challenging case of left-sided acute appendicitis in a 45-year-old man with SIT. CASE REPORT A 45-year-old man with a medical history of gastroesophageal reflux disease, class 2 obesity, prediabetes, and elevated low-density lipoprotein cholesterol presented with severe acute abdominal pain localized in the left lower quadrant with localized tenderness, nausea, and 2 episodes of non-bloody and non-bilious emesis that started a day before the clinical encounter. Computed tomography of the abdomen and pelvis revealed previously undiagnosed congenital SIT. In addition, physical, laboratory, and radiological findings suggested early acute appendicitis with no evidence of complications. Hence, the patient was managed with an emergent laparoscopic appendectomy. Acute appendicitis was confirmed in the post-surgery histopathological examination. The post-surgery recovery was uneventful, and the patient was discharged home on the second postoperative day. CONCLUSIONS This report highlights that SIT may remain undiagnosed into adulthood and poses a challenge in the diagnosis of left-side appendicitis due to atypical symptom presentation, supporting the findings of previous case reports. Therefore, the inclusion of left-sided acute appendicitis in the differential diagnosis of abdominal pain in the left lower quadrant is warranted.

Median arcuate ligament syndrome: a cost analysis to determine the economic burden of a rarely diagnosed disease

Background

Chronic abdominal pain (CAP) is a medical condition resulting in enormous economic burden and healthcare utilization costs. One understudied source of CAP is the median arcuate ligament syndrome (MALS). MALS is often not diagnosed and treated for a variety of reasons, including the fact that MALS is highly comorbid with psychological symptoms and psychiatric disorders similar to CAP. To better inform future work on the study of MALS, we undertook a pilot study to estimate the economic impact and public health burden of this condition. We hypothesized that MALS imposes a significant public health burden.

Methods

Pediatric and adult patients enrolled in a prospective study undergoing multidisciplinary evaluation and treatment for MALS at a tertiary care facility were invited to participate in a brief self-report survey, the Direct and Indirect Medical Care Impact of MALS Form, to capture health care resources including procedures, surgeries, health care visits, and absenteeism (school and work). To estimate costs from the Direct and Indirect Medical Care Impact of MALS Form, the medical care usage data self-reported by patients were converted to dollar value utilizing FSC-93 billing data and corresponding current procedural terminology (CPT) codes for procedures and provider visits one year prior to surgery and then following surgery. Descriptive analyses were conducted to characterize the sample in terms of demographics and reported absences from school and work.

Results

One hundred and nineteen patients (mean age = 30.9 ± 13.0) completed the questionnaires, yielding a 57% response rate. 82.4% (n = 98) of the participants were female and 90.8% (n = 108) were non-Hispanic/Latine white. The mean and median surgical follow-up periods were 5.3 and 5.4 years, respectively. Overall, median cost of provider and ancillary healthcare provider visits for each patient was (US)$19,119 including the pre-operative and post-operative visits. The mean cost for providers alone was (US)$28,908. Wilcoxon signed-ranks tests indicated that the postoperative missed number of days of school were significantly lower than the pre-surgical number of missed school days (Z = -3.36, p = 0.001). Similarly, there were significantly less missed work-days following surgery than before for the entire sample (Z = -2.86, p = 0.004).

Conclusion

Median arcuate ligament syndrome imposes a large economic burden on patients and the healthcare system. The current findings, although reflective of a homogenous population, are adding to a growing body of literature suggesting that healthcare disparities play a role in the low rates of diagnosis and treatment of MALS.

A case report of acute intermittent porphyria leading to severe disability

Acute intermittent porphyria (AIP) is a rare inherited metabolic disorder resulting from increased production of porphyrins and their precursors, δ-aminolevulinic acid (ALA) and porphobilinogen (PBG), due to deficiencies in the enzymatic activity of the heme synthesis pathway. The disease is typically characterized by a triad of abdominal pain, neurologic impairment symptoms, and psychiatric abnormalities. However, only a small percentage of patients present with this classic triad of symptoms. Our female patient, aged 23, was admitted to the hospital with a 4-year history of abnormal mood episodes and weakness in the limbs for over 1 week. She had a previous medical history of intestinal obstruction. After admission, a cranial MRI revealed reversible posterior leukoencephalopathy imaging manifestations, and the patient exhibited weakness of the extremities, respiratory failure, seizures, and severely reduced serum sodium concentration. The diagnosis of AIP was ultimately confirmed by a positive urine PBG-sunlight test and analysis of HMBS gene variants. The absence of typical triadic signs in acute attacks of AIP can make early recognition of the disease challenging. We present a case with multiple typical clinical manifestations of AIP in the hope of aiding clinicians in fully recognizing acute intermittent porphyria.

Quantitative somatosensory testing of the abdomen: establishing initial reference values across developmental age and biological sex

ABSTRACT

Abdominal pain is a common symptom of several debilitating conditions (eg, inflammatory bowel disease, irritable bowel syndrome, and endometriosis) and affects individuals throughout their lifespan. Quantitative sensory testing (QST) reference values exist for many body sites but not the abdomen. Using a QST battery adapted from the German Research Network on Neuropathic Pain, we collected QST data on the upper and lower abdomen in 181 pain-free participants, ages 12 to 50 years, to establish reference values by age and biological sex. The normative values are presented as medians for each QST measure by sex (male, n = 63; female, n = 118) and across 3 age categories (adolescents: 12-19 years, n = 48; young adults: 20-30 years, n = 87; and adults: 31-50 years, n = 46). Evaluating the sensory functioning of the abdomen and characterizing ranges of QST measures is an essential first step in understanding and monitoring the clinical course of sensory abnormalities in patients with underlying diseases affecting the abdomen and pelvis. The impact of age and development on sensory functioning is necessary, given age-related changes in pain perception and modulation.

Level of Knowledge and Attitude Toward Acute Abdomen Among the Public: A Nationwide Study

Introduction Treatment of patients suffering from acute abdominal pain (AAP) is often challenging due to its wide range of associated illnesses, which could delay or prevent the identification of the correct diagnosis. Multiple diagnoses should be considered, particularly those in life-threatening situations needing urgent intervention. Aim This study aimed to assess the level of knowledge among the general population related to acute abdomen and which specialty should be sought for consultation in AAP situations. Subject and methods This cross-sectional study was conducted among the general population living in Saudi Arabia. A self-administered questionnaire was sent to the Saudi population through the Google survey. The questionnaire included basic demographic characteristics (i.e., age, gender, etc.), perceived causes, barriers, the most common symptoms of AAP, and a five-item questionnaire to assess the general population's knowledge about AAP. Results Of the 2,703 respondents, 68.1% were females, and 42.4% were aged between 18 and 25 years old. The digestive system disorders (esophagus, stomach, intestine, and colon) were the most perceived causes that led to AAP (76.6%). The overall mean knowledge score was 1.35 (SD 1.07) out of five points. Accordingly, nearly all (87.2%) were considered to have poor knowledge, 9.5% were considered to have moderate knowledge, and only 3.3% were considered to have good knowledge. Being younger, being a male, and living in the Central Region were the factors associated with increased knowledge. Conclusion There was a lack of knowledge about AAP among the general population in Saudi Arabia. Younger age, gender males, and living in the Central Region were identified as the significant factors of increased knowledge. It is necessary to increase the knowledge of the population regarding acute abdomen. Media awareness campaigns may play a significant role in providing the necessary information to the general public.

Clinical feature and genetic analysis of HMBS gene in Chinese patients with acute intermittent porphyria: a systematic review

Background: Early detection and diagnosis are important crucial to prevent life-threatening acute attacks in patients with acute intermittent porphyria (AIP). We aim to provide comprehensive data on the clinical and hydroxymethylbilane synthase (HMBS) gene variant characteristics and genotype-phenotype association of Chinese patients with AIP in order to improve clinicians' knowledge of AIP and reduce misdiagnosis and mistaken treatment. Methods: We searched the literature on Chinese patients with AIP in PubMed, Web of Science, Wiley Online Library, ScienceDirect and Chinese literature databases up to August 2023 in our analysis to explore the clinical and HMBS gene variant characteristics of Chinese patients with AIP. Results: A total of 41 original articles associated with Chinese AIP patients were included for analysis: 97 variants were detected in 160 unrelated families, including 35 missense, 29 frameshift, 24 splicing and 9 nonsense variants, with c.517C>T being the most common variant. Clinical data were reported in 77 of 160 patients: Most of them were female (67/77) and the age was 28.8 ± 9.9 years. The most common symptom was abdominal pain (73/77, 94.8%), followed by central nervous system symptoms (45/77, 58.4%). 13.0% (10/77) of patients experienced psychiatric symptoms. Hyponatremia was the most common electrolyte abnormality (42/77). 31 patients received carbohydrate loading therapy, and 30 of them were improved. 6 patients were treated with carbohydrate loading combined with hemin therapy and 5 eventually improved. All variants causing premature stop codons, frameshifts or enzyme activity center may experience more severe clinical phenotypes such as seizures, respiratory paralysis, intracranial hemorrhage disorder or respiratory failure. Conclusion: The most common presenting symptom in Chinese AIP patients was abdominal pain, followed by central nervous system symptoms. The HMBS gene analysis in Chinese AIP patients revealed that the heterogeneity is strong and the most common variant was missense mutation, with c.517C>T being the most common variant. The genotype-phenotype association helps guide clinical diagnosis and treatment. However, the treatment for AIP in China is limited and monolithic, and more attention needs to be paid to the treatment.

Racial and Ethnic Disparities in Opioid Prescriptions for Patients with Abdominal Pain: Analysis of the National Ambulatory Medical Care Survey

BACKGROUND

Disparities in pain control have been extensively studied in the hospital setting, but less is known regarding the racial/ethnic disparities in opioid prescriptions for patients with abdominal pain in ambulatory clinics.

METHODS

We examined opioid prescriptions during visits by patients presenting with abdominal pain between the years of 2006 and 2015, respectively, in the National Ambulatory Medical Care Survey database. Data weights for national-level estimates were applied.

RESULTS

We identified 4006 outpatient visits, equivalent to 114 million weighted visits. Rates of opioid use was highest among non-Hispanic White patients (12%), and then non-Hispanic Black patients (11%), and was the lowest in Hispanic patients (6%). Hispanic patients had lower odds of receiving opioid prescriptions compared to non-Hispanic White patients (OR = 0.49; 95% CI, 0.31-0.77, p = 0.002) and all non-Hispanic patients (OR 0.48; 95% CI 0.30-0.75; p = 0.002). No significant differences were noted in non-opioid analgesia prescriptions (p = 0.507). A higher frequency of anti-depressants/anti-psychotic prescriptions and alcohol use was recorded amongst the non-Hispanic patients (p = 0.027 and p = 0.001, respectively).

CONCLUSIONS

Rates of opioid prescriptions for abdominal pain patients were substantially lower for the Hispanic patients compared with the non-Hispanic patients, despite having a decreased rate of high-risk features, such as alcohol use and depression. The root cause of this disparity needs further research to ensure equitable access to pain management.

Approach to Disorders of Gut-Brain Interaction

Disorders of gut-brain interaction, previously known as functional gastrointestinal disorders (eg, functional dyspepsia and irritable bowel syndrome), are commonly encountered in both the primary care and gastroenterology clinics. These disorders are often associated with high morbidity and poor patient quality of life and often lead to increased health care use. The management of these disorders can be challenging, as patients often present after having undergone an extensive workup without a definite etiology. In this review, we provide a practical five-step approach to the clinical assessment and management of disorders of gut-brain interaction. The five-step approach includes (1) excluding organic etiologies of the patient's symptoms and using Rome IV criteria for diagnosis, (2) empathizing with the patient to develop trust and a therapeutic relationship, (3) educating the patient about the pathophysiology of these gastrointestinal disorders, (4) expectation setting with a focus on improving function and quality of life, and (5) establishing a treatment plan with central and peripherally acting medications and nonpharmacological modalities. We discuss the pathophysiology of disorders of gut-brain interaction (eg, visceral hypersensitivity), initial assessment and risk stratification, as well as treatment for a variety of diseases with a focus on irritable bowel syndrome and functional dyspepsia.

Global patterns of prescription pain medication usage in disorders of gut-brain interactions

BACKGROUND

Forty percent of individuals globally meet Rome IV criteria for a disorder of gut-brain interaction (DGBI). The global burden of pain across these disorders has not been characterized.

METHODS

Our study included 54,127 respondents from the 26 Internet survey countries. Prescription pain medication usage was selected as the proxy for pain. The associations between prescription pain medications and the environmental, sociodemographic, psychosocial, and DGBI diagnosis variables were investigated using the multivariate generalized robust Poisson regression model.

KEY RESULTS

Respondents with DGBI used prescription pain medications at higher rates than those without a DGBI diagnosis with pooled prevalence rate of 14.8% (95% confidence interval [CI], 14.4-15.3%), varying by country from 6.8% to 25.7%. The pooled prevalence ratio of prescription pain medication usage in respondents with and without DGBI was 2.2 (95% CI: 2.1-2.4). Factors associated with higher prevalence of pain medication usage among respondents with a DGBI diagnosis included living in a small community, increased anxiety, depression or somatization, increased stress concern or embarrassment about bowel functioning and having more than one anatomic DGBI diagnosis.

CONCLUSION

14.8% of patients globally with at least one diagnosis of DGBI were on prescription pain medications with wide geographic variation, about twice as many as their counterparts without a diagnosis of DGBI. Environmental, sociodemographic, and individual factors may influence clinicians to consider personalized, multimodal approaches to address pain in patients with DGBI.

Application of capsule endoscopy in patients with chronic and recurrent abdominal pain: Abbreviated running title: capsule endoscopy in abdominal pain

OBJECTIVE

The incidence of chronic and recurrent abdominal pain increases every year, while the diagnosis is still unsatisfactory even after a number of check-ups. This study aimed to evaluate the diagnosis value of capsule endoscopy in patients suffering from chronic and recurrent abdominal pain.

METHODS

A retrospective case study was performed in 80 chronic and recurrent abdominal pain patients at Xiangyang Central Hospital from January 2013 to November 2017. Meanwhile, diagnoses by capsule endoscopy were collected for analysis.

RESULTS

Abnormal findings were found in 54 of 80 (67.5%) patients. The findings in chronic and recurrent abdominal pain patients include small intestinal erosion and congestion, small intestinal ulcers, small intestinal parasites, small intestinal vascular malformations, small intestinal polyps, small intestinal diverticulum, and small intestinal lymphangiectasia. There were no immediate significant side effects without being reported up to 1 month after ingestion of the capsule. The capsule was evacuated by all patients.

CONCLUSIONS

Capsule endoscopy has a great value in the diagnosis of chronic and recurrent abdominal pain with satisfactory safety and less pain for patients. Inflammatory lesions and ulcers in the small intestine account for the majority of positive findings in these patients.

Abdominal Bloating in the United States: Results of a Survey of 88,795 Americans Examining Prevalence and Healthcare Seeking

BACKGROUND & AIMS

Although abdominal bloating is a common symptom, comparatively little is known about its prevalence in the community. This study aimed to examine the prevalence of bloating and assess related health care seeking using survey data from a nationally representative sample of nearly 89,000 Americans.

METHODS

Participants completed the National Gastrointestinal (GI) Survey II to measure the presence and severity of GI symptoms including bloating. We assessed the prevalence of bloating in the past 7 days, as well as severity and health care seeking for bloating. Multivariable regression was performed to identify associations between the outcomes and covariates.

RESULTS

Of 88,795 survey completers, 12,324 (13.9%) reported bloating in the past 7 days. Women and those with comorbidities (eg, irritable bowel syndrome, chronic constipation, ulcerative colitis) and concomitant GI symptoms (eg, abdominal pain, excess gas) had higher odds for bloating (all P < .001). These factors were also associated with more severe bloating (all P < .001). Among those who reported recent bloating, 58.5% never sought care for bloating-29% of whom were self-managing symptoms or were uncomfortable discussing symptoms with their providers.

CONCLUSIONS

Bloating is common in the community because nearly 1 in 7 Americans have experienced this symptom in the past week. Women and those with certain comorbidities and concomitant GI symptoms are more likely to experience bloating and have more severe symptoms. Nearly one third of sufferers who have not sought care are managing symptoms on their own or are uncomfortable discussing it with their providers, emphasizing that efforts should be made to proactively inquire about bloating.

Review article: diagnostic and therapeutic approach to persistent abdominal pain beyond irritable bowel syndrome

BACKGROUND

Persistent abdominal pain (PAP) poses substantial challenges to patients, physicians and healthcare systems. The possible aetiologies of PAP vary widely across organ systems, which leads to extensive and repetitive diagnostic testing that often fails to provide satisfactory answers. As a result, widely recognised functional disorders of the gut-brain interaction, such as irritable bowel syndrome and functional dyspepsia, are often diagnosed in patients with PAP. However, there are a number of less well-known differential diagnoses that deserve consideration.

AIM

To provide a comprehensive update on causes of PAP that are relatively rare in occurrence.

METHODS

A literature review on the diagnosis and management of some less well-known causes of PAP.

RESULTS

Specific algorithms for the diagnostic work-up of PAP do not exist. Instead, appropriate investigations tailored to patient medical history and physical examination findings should be made on a case-by-case basis. After a definitive diagnosis has been reached, some causes of PAP can be effectively treated using established approaches. Other causes are more complex and may benefit from a multidisciplinary approach involving gastroenterologists, pain specialists, psychologists and physiotherapists. This list is inclusive but not exhaustive of all the rare or less well-known diseases potentially associated with PAP.

CONCLUSIONS

Persistent abdominal pain (PAP) is a challenging condition to diagnose and treat. Many patients undergo repeated diagnostic testing and treatment, including surgery, without achieving symptom relief. Increasing physician awareness of the various causes of PAP, especially of rare diseases that are less well known, may improve patient outcomes.

Abdominal pain and cirrhosis at diagnosis of hemochromatosis: Analysis of 219 referred probands with HFE p.C282Y homozygosity and a literature review

BACKGROUND

In hemochromatosis, causes of abdominal pain and its associations with cirrhosis are poorly understood.

METHODS

We retrospectively compared characteristics of referred hemochromatosis probands with HFE p.C282Y homozygosity with/without biopsy-proven cirrhosis: sex, age, diabetes, heavy alcohol consumption, abdominal pain/tenderness, hepatomegaly, splenomegaly, non-alcoholic fatty liver disease, chronic viral hepatitis, ascites, transferrin saturation (TS), serum ferritin (SF), and iron removed by phlebotomy (QFe). We performed logistic regression on cirrhosis using characteristics identified in univariate comparisons. We performed computerized and manual searches to identify hemochromatosis case series and compiled prevalence data on cirrhosis and abdominal pain and causes of abdominal pain.

RESULTS

Of 219 probands, 57.1% were men. Mean age was 48±13 y. In 22 probands with cirrhosis, proportions of men, mean age, prevalences of heavy alcohol consumption, abdominal pain, abdominal tenderness, hepatomegaly, splenomegaly, and chronic viral hepatitis, and median TS, SF, and QFe were significantly greater than in probands without cirrhosis. Regression analysis revealed three associations with cirrhosis: abdominal pain (p = 0.0292; odds ratio 9.8 (95% CI: 1.2, 76.9)); chronic viral hepatitis (p = 0.0153; 11.5 (95% CI: 1.6, 83.3)); and QFe (p = 0.0009; 1.2 (95% CI: 1.1, 1.3)). Of eight probands with abdominal pain, five had cirrhosis and four had diabetes. One proband each with abdominal pain had heavy alcohol consumption, chronic viral hepatitis B, hepatic sarcoidosis, hepatocellular carcinoma, and chronic cholecystitis, cholelithiasis, and sigmoid diverticulitis. Abdominal pain was alleviated after phlebotomy alone in four probands. In 12 previous reports (1935-2011), there was a negative correlation of cirrhosis prevalence and publication year (p = 0.0033). In 11 previous reports (1935-1996), a positive association of abdominal pain prevalence and publication year was not significant (p = 0.0802).

CONCLUSIONS

Abdominal pain, chronic viral hepatitis, and QFe are significantly associated with cirrhosis in referred hemochromatosis probands with HFE p.C282Y homozygosity. Iron-related and non-iron-related factors contribute to the occurrence of abdominal pain.

Abdominal Pain in Young Adults

Aim. A study of abdominal pain incidence in young adults in relation to dietary habits and psychological profile for advancement of health-promoting technologies.

Materials and methods. An anonymous quiz survey covered 3,634 students enrolled at Omsk State Medical University in higher and secondary vocational education programmes via online use of the GSRS and WHO CINDI programme questionnaires to assess eating patterns and dietary preferences, as well as a brief multifactor personality inventory scale. Respondents with abdominal pain were divided into subcohorts by pain severity according to GSRS scores (mild, moderate or severe pain).

Results. Abdominal pain was reported by 2,300 (63.29%) respondents, of whom 1,243 (54.0%) rated symptoms as mild, 996 (43.3%) and 61 (2.7%) — as moderate to severe. Abdominal pain complaints were more frequent in women (2I = 33.96, p <0.001), but gender had no effect on pain intensity. Pain associated with abdominal bloating and distention (57.65%), gastroesophageal reflux symptoms (38.75%), constipation (30.54%) or diarrhoea (28.4%). The presence and severity of abdominal pain was distinctive of individuals spending the most of average monthly income on food purchase and those actively consuming tea, coffee, added sugar, extra salt in cooked food, while having low intake of fruit and vegetables. A typical personality in severe abdominal pain is hypothymic depressive, hypochondriac in moderate and psychasthenic in mild pain.

Conclusion. Abdominal pain is common among medical students predominating in females, associates with the eating pattern, dietary habits and psychological profile.

Chronic Abdominal Pain in General Practice

Background and Summary: Chronic abdominal pain is a challenging complaint for both primary care providers and gastroenterologists alike, due to a broad differential diagnosis and sometimes extensive and negative workup. In the absence of red flag features that herald more acute conditions, the majority of patients with chronic abdominal pain have a benign cause or a functional disorder (e.g., irritable bowel syndrome). The costs associated with a diagnostic workup are an expensive burden to health care. A systematic approach for evaluating patients and initiating a management plan are recommended in the primary care setting. Undiagnosed abdominal pain should be investigated starting with a detailed history and physical examination. Diagnostic investigations should be limited and adapted according to the clinical features, the alarm symptoms, and the symptom severity. This review will focus on the diagnostic tools which general practitioners utilize in the evaluation of chronic abdominal pain. Key Messages: The primary role of the general practitioner is to differentiate an organic disease from a functional one, to refer to a specialist, or to provide treatment for the underlying cause of pain. The functional disorders should be considered after the organic pathology has been confidently excluded. Once a diagnosis of functional pain is established, repetitive testing is not recommended and the patient should be referred to receive psychological support (e.g., cognitive therapy) associated with available pharmacological therapeutic options.

[Upper abdominal pain: a frequent and multifaceted leading symptom in primary care internal medicine]

Upper gastrointestinal symptoms are among the most common reasons for medical consultation and represent a challenge for general practitioners in the outpatient care setting. History taking, symptom evaluation and physical examination are the crucial steps toward establishing an initial working diagnosis. The subsequent abdominal ultrasound and laboratory analyses are essential tools for the differential diagnosis.