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Abdelazim O, Hassnine AA, Fathy B, Mgdy A, Semeda N, Mahmoud SR, Saad ZM, Mahmoud HA. The prevalence of functional dyspepsia using Rome IV questionnaire among chronic kidney disease patients. Ren Fail 2024; 46:2344651. [PMID: 38655865 PMCID: PMC11044757 DOI: 10.1080/0886022x.2024.2344651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/14/2024] [Indexed: 04/26/2024] Open
Abstract
Background: Symptoms of dyspepsia are usually encountered by chronic kidney disease patients. Abdominal discomfort is commonly seen in CKD patients with no other causes of organic affection. Aim: to determine the prevalence of functional dyspepsia in CKD patients, and which subtype is predominant in them. Materials and patients: This observational study included 150 CKD patients. Clinical and laboratory data were recorded for every patient. All the patients were interviewed using the ROME IV questionnaire of functional dyspepsia. Patients fulfilling criteria for functional dyspepsia were exposed to upper GI endoscopy. Results: Overall, 73 (48.7%) of CKD patients were males and 77 (51.3%) were females with mean age of (45.71 ± 9.59) and mean BMI (26.58 ± 5.39). The frequency of functional dyspepsia among CKD patients was determined to be 14.7% (22 out of 150 patients). Among those affected by functional dyspepsia, the most prevalent subtype was found to be Epigastric Pain Syndrome (EPS), accounting for 59% (13 out of 22 cases). The most common predictor of FD in CKD patients was chronic HCV infection, hemodialysis, stage of CKD and eGFR as revealed by Univariate regression analysis. Conclusion: The prevalence of FD amongst CKD patients is 14.7% with EPS the predominant subtype. Male patients, HCV patients, patients with higher CKD stages and highly impaired eGFR (low eGFR) are more probable to have FD.
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Affiliation(s)
- Omar Abdelazim
- Department of Tropical Medicine, Minia University, Egypt
| | | | - Basma Fathy
- Department of Internal Medicine, Minia University, Egypt
| | - Ahmed Mgdy
- Department of Tropical Medicine, Minia University, Egypt
| | - Nady Semeda
- Department of Tropical Medicine, Minia University, Egypt
| | | | - Zeinab M. Saad
- Department of Tropical Medicine, Minia University, Egypt
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Ortega PM, Scholtz S, O'Donnell K, Hakky S, Purkayastha S, Tsironis C, Moorthy K, Aggarwal R, Ahmed AR. Risk Factors for Chronic Abdominal Pain After RYGB: Are Patients Adequately Selected Beforehand? Obes Surg 2024; 34:1748-1755. [PMID: 38575742 DOI: 10.1007/s11695-024-07193-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/16/2024] [Accepted: 03/20/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE Chronic abdominal pain after RYGB is a known issue. Identifying the potential patient-related and modifiable risk factors might contribute to diminish the risk for this undesirable outcome. METHODS A single-center retrospective cohort study with prospective data collection was conducted with inclusion of all patients who underwent RYGB surgery between 2015 and 2021. Data from the NBSR and medical records were used. Patients with chronic abdominal pain were defined when pain lasting or recurring for more than 3 to 6 months. RESULTS Six hundred sixty-four patients who underwent RYGB surgery were included with a median follow-up of 60.5 months. Forty-nine patients (7.3%) presented with chronic abdominal pain. Postoperative complications (OR 13.376, p = 0.020) and diagnosis of depression (OR 1.971, p = 0.037) were associated with developing abdominal pain. On the other hand, ex-smokers (OR 0.222, p = 0.040) and older age (0.959, p = 0.004) presented as protective factors. CONCLUSION Postoperative complications and diagnosis of depression are risk factors for chronic pain after RYGB. The role of the bariatric MDT remains crucial to select these patients adequately beforehand.
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Affiliation(s)
- Patricia M Ortega
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK.
| | - Samantha Scholtz
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
- West London NHS Trust, Southall, UK
| | - Karen O'Donnell
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Sherif Hakky
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Sanjay Purkayastha
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Christos Tsironis
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Krishna Moorthy
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
- Department of Surgery and Cancer, Imperial College London, 10th Floor, QEQM Building, London, W2 1NY, UK
| | - Ravi Aggarwal
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
- Department of Surgery and Cancer, Imperial College London, 10th Floor, QEQM Building, London, W2 1NY, UK
| | - Ahmed R Ahmed
- Imperial Weight Centre, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
- Department of Surgery and Cancer, Imperial College London, 10th Floor, QEQM Building, London, W2 1NY, UK
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Celik G, Haney MÖ. The relationship of depressive symptoms with pain and analgesic use in Turkish adolescents. J Child Adolesc Psychiatr Nurs 2024; 37:e12464. [PMID: 38591776 DOI: 10.1111/jcap.12464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/10/2024] [Accepted: 04/01/2024] [Indexed: 04/10/2024]
Abstract
PROBLEM This study aimed to determine the prevalence of depressive symptoms, pain (headache, abdominal pain, back pain) and analgesic use among Turkish adolescents. Additionally, it aimed to examine the association between depressive symptoms and pain and analgesic use in adolescents. METHODS This cross-sectional, correlational study was conducted in Izmir, Turkey with 954 adolescents aged 11-19 years. Data were collected with the "socio-demographic questionnaires" and the "Center for Epidemiologic Studies Depression Scale for Children". Analyzes were performed using descriptive statistics and multiple logistic regression analysis. FINDINGS Of the adolescents, 632 (66.2%) showed depressive symptoms. Of the adolescents, 424 (44.4%) experienced headache, 256 (26.8%) experienced abdominal pain, and 343 (36.0%) experienced back pain. A total of 309 (32.4%) adolescents used analgesics for headaches, 132 (13.8%) abdominal pain, and 47 (4.9%) for back pain. Female gender, high level maternal education, bad economic status, poor health perception, bad school success, pain and analgesic use were the correlated variables with adolescent depression. CONCLUSIONS The depressive symptoms, headache and back pain, and use of analgesics especially for headaches were common among adolescents. The results showed depression in adolescent correlated with pain (headache, abdominal pain, and back pain) and analgesic use. Regular screening is needed to assure early intervention of depression among adolescents.
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Affiliation(s)
| | - Meryem Öztürk Haney
- Public Health Nursing Department, Nursing Faculty, Dokuz Eylul University, İzmir, Türkiye
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Janatolmakan M, Zobeiri M, Rezaeian S, Rostami S, Akbari M, Khatony A. Epidemiology of Celiac Disease in Western Iran during 2019-2021. Biomed Res Int 2024; 2024:1112812. [PMID: 38665986 PMCID: PMC11045285 DOI: 10.1155/2024/1112812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024]
Abstract
Celiac disease is a growing global public health concern. This epidemiological study is aimed at determining the prevalence of celiac disease in Kermanshah, Western Iran, from 2019 to 2021, as well as the frequency of gastrointestinal and nongastrointestinal manifestations associated with the disease. In this cross-sectional study, the medical records of all patients with a confirmed diagnosis of celiac disease between 2019 and 2021 were reviewed. The average population during the study period was 2,058,545. A researcher-developed checklist was used as the data collection tool, and descriptive statistics were employed for data analysis. During the study period, there were 113 patients diagnosed with celiac disease, with a mean age of 29.1 ± 16.6 years. The three-year prevalence of celiac disease was 5.49 (95% CI: 5.17-5.82) per 100,000 population. Among these patients, 70% (n = 78) was female. The most common gastrointestinal manifestations of the disease were abdominal pain (77.8%), constipation (59.3%), and diarrhea (54.9%). Iron-deficiency anemia (64.6%) and vitamin D3 deficiency (46.1%) were the most common nongastrointestinal manifestations. Growth retardation was observed in 39.0% of patients. This study demonstrated a higher prevalence of celiac disease in Kermanshah compared to global statistics. Given the association of celiac disease with other conditions such as diabetes, irritable bowel syndrome, growth retardation, and iron-deficiency anemia, healthcare providers should consider screening patients for celiac disease. Furthermore, community-based education is crucial in raising awareness about the significance of adhering to a proper diet and reducing wheat consumption.
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Affiliation(s)
- Maryam Janatolmakan
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehdi Zobeiri
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahab Rezaeian
- School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shima Rostami
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehnosh Akbari
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Khatony
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Sarkar MAM, Arefin MS, Khan MMR, Saha M, Alam MR, Ghosh CK, Ahmed DS, Masud MH, Roy PK. Demographic and Clinical Characteristics of Functional Dyspepsia and Its Subtypes in Adult Patients: An Experience from a Tertiary Care Centre in Bangladesh. Mymensingh Med J 2024; 33:426-432. [PMID: 38557521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Functional dyspepsia (FD) is a common gastrointestinal problem in the world. The Rome III consensus subdivided functional dyspepsia into two groups: meal-related postprandial distress syndrome (PDS) and meal-unrelated epigastric pain syndrome (EPS). Limited data are available regarding FD in Bangladesh. The aim of this study was to investigate the demographic and clinical characteristics of FD and its sub-types. This cross-sectional study was conducted in which we recruited patients who attended the outpatient department of Gastroenterology of Bangabandhu Sheikh Mujib Medical University, Bangladesh from March 2017 to February 2018. Patients fulfilling Rome III FD criteria and a negative upper GIT endoscopy were included for this study. The patients were then subdivided into 'pure' PDS (i.e. meeting criteria for PDS without EPS symptoms), 'pure' EPS (i.e., meeting criteria for EPS without PDS symptoms), and overlapping PDS-EPS (i.e., symptoms of both PDS and EPS) groups. Total of 368 FD patients (56.0% females, mean age 32.8±8.6 years, BMI: 22.0±2.7), were included in this study. Out of them, 112(30.4%) patients (57.2% females, mean age 33.9±9.3 years, BMI: 22.0±2.7) fulfilled criteria of pure EPS and 64(17.4%) patients (68.8% females, mean age 33.2±7.8 years, BMI: 22.1±2.4) fulfilled criteria of pure PDS. However, the majority of patients [192(52.2%), 52.1% females, mean age 32.0±8.4 years, BMI: 21.9±2.8] had symptoms of overlapping EPS-PDS. More than 40% of patients in our study presented with 3 or more of the four key symptoms of FD. A longer duration of presenting symptoms was seen among patients with overlapping EPS-PDS in comparison to pure EPS and pure PDS (p<0.001). A significant overlap of symptoms of both EPS and PDS was noticed among patients with FD. The value of dividing functional dyspepsia into the subgroups of PDS and EPS is thus questionable. Further research and modification of the diagnostic criteria for FD subtypes are necessary.
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Affiliation(s)
- M A M Sarkar
- Dr Md Abdul Mumit Sarkar, Resident, Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh; E-mail:
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Edholm D, Hofgård JO, Andersson E, Stenberg E, Olbers T. Very low risk of short bowel after Roux-en-Y gastric bypass - a large nationwide Swedish cohort study. Surg Obes Relat Dis 2024; 20:362-366. [PMID: 38114384 DOI: 10.1016/j.soard.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/28/2023] [Accepted: 10/29/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is one of the most common bariatric procedures. Internal herniation may lead to small bowel ischemia requiring small bowel resection, resulting in short bowel syndrome. OBJECTIVE To determine the incidence of extensive small bowel resection in patients operated with RYGB. We also aimed to look for early clinical warning signs among patients requiring extensive small bowel resection. SETTING Cohort from national quality registers. METHODS All patients having undergone RYGB between January 2007 to June 2019 were analyzed in the Scandinavian Obesity Surgery Registry (SOReg). We identified patients with small bowel obstruction (SBO) for whom small bowel resection was necessary. Additionally, we assessed clinical signs in these patients. RESULTS The study included 57,255 patients having undergone RYGB. Closure of the mesenteric openings was performed in 78%. Surgery for SBO was required in 3659 (6%) of patients, and small bowel resection in 188 (.3%). Extensive small bowel resection, resulting in less than 1.5 meters of remaining small bowel, was required in 7 patients (.01%). All patients with extensive small bowel resection presented with abdominal pain and had confirmed internal herniation as the cause of the small bowel resection, and 2 of 7 patients died. Closure of mesenteric defects was not associated with a reduction in overall small bowel resection rates (P = .89) CONCLUSION: Surgery for SBO after RYGB was common (6%). The risk of extensive small bowel resection leading to short bowel was low (.01%). Patients with abdominal pain after RYGB should be assessed for internal hernia, as it can be devastating.
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Affiliation(s)
- David Edholm
- Department of Surgery, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Johan Olsson Hofgård
- Department of Surgery, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ellen Andersson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Torsten Olbers
- Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, Norrköping, Sweden; Department of Biomedical and Clinical Sciences and Wallenberg Centre for Molecular Medicine, Department of Biomedical and Clinical sciences, Linköping University, Linköping, Sweden
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Mineva G, Culleton E, Falusi T, Ryan D. Outcomes of abdominal pain among children presenting to the Emergency Department of a tertiary hospital in the Republic of Ireland before and during the COVID-19 pandemic. Ir J Med Sci 2024; 193:1033-1041. [PMID: 37851331 DOI: 10.1007/s11845-023-03547-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 10/03/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Acute abdominal pain in paediatric patients is a common presentation to the Emergency Department (ED). The COVID-19 pandemic had a significant impact on the health care sector leading to a decline in hospital attendance. AIMS We compare the burden of paediatric abdominal pain 1 year before and after the start of the COVID-19 pandemic in an Irish ED. METHODS A retrospective cohort study was conducted in a tertiary hospital. Ethical approval was obtained. Data was collected from January 1 to June 30, 2019, and 2021. Patients' charts were accessed using Therefore® software. Key variables were extracted and summarised in Microsoft Excel tables. Univariate and multivariate data analysis were conducted in SPSS® software. RESULTS Six hundred sixty-one (2019) and 479 (2021) patient records were evaluated. There was a 28% reduction in case presentations during pandemic months. Age group, sex and attending discipline were similar for both years. Rates of imaging were significantly higher in 2021 (22.5% vs. 10.6%). Overall admission rate was higher in 2021 (37% vs. 25%, p < 0.001). Viral gastroenteritis decreased (13%) and non-specific diagnosis increased (46%) in 2021. Fewer children re-presented in 2021 (13%). CONCLUSIONS The COVID-19 pandemic had an impact on the presentation, investigations and admission rates of abdominal pain in the ED. Our study highlights the need for increased awareness of severe abdominal pain signs and symptoms in paediatric patients and importance for diagnostic accuracy. Improving patient flow through the ED and having clear guidelines for staff and parents can optimise clinical practice and improve patient outcomes.
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Affiliation(s)
- Gabriela Mineva
- University Hospital Limerick, St Nessan's Road, Dooradoyle, Co. Limerick, V94 F858, Ireland.
- School of Medicine, University of Limerick, Limerick, V94 T9PX, Ireland.
| | - Emma Culleton
- University Hospital Limerick, St Nessan's Road, Dooradoyle, Co. Limerick, V94 F858, Ireland
- School of Medicine, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Tolulope Falusi
- School of Medicine, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Damien Ryan
- School of Medicine, University of Limerick, Limerick, V94 T9PX, Ireland
- ALERT, Emergency Department, University Hospital Limerick, St. Nessan's Road, Limerick, Ireland
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Stieler M, Carter G, Spittal MJ, Campbell C, Pockney P. Somatic symptom severity, depression and anxiety associations with pancreatitis and undifferentiated abdominal pain in surgical inpatients. ANZ J Surg 2024; 94:634-639. [PMID: 38156726 DOI: 10.1111/ans.18801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 09/28/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Somatic Symptom Disorder is a psychiatric diagnosis that describes the experience of physical symptoms and associated distress, that is disproportionate to recognized organic pathology. Somatic symptom severity (SSS) may be associated with some surgical diagnoses; particularly the complex pain associated with pancreatitis, or the diagnostic ambiguity of undifferentiated abdominal pain (UAP). We aimed to estimate the prevalence of SSS in different diagnostic groups in surgical inpatients with abdominal pain; and to estimate the magnitude and direction of any association of SSS, anxiety and depression. METHODS Cross sectional analysis (n = 465) of adult admissions with non-traumatic abdominal pain, at a tertiary hospital in Australia. We estimated SSS with the Patient Health Questionnaire-15 (PHQ-15), depression with the Patient Health Questionnaire (PHQ-9) and anxiety with the General Anxiety Disorder (GAD-7), at standard cut-points ≥ 10; comparing acute pancreatitis (n = 20), chronic pancreatitis (n = 18) and UAP (n = 64) versus other causes of abdominal pain. RESULTS Somatic symptoms were common, 52% having moderate and 19.6% severe SSS. There was an association between moderate SSS and pancreatitis (OR 2.11, 95% CI 1.05-4.25) and depressive symptoms and chronic pancreatitis (OR = 3.47, 95% CI 1.31-9.24). There was no significant association between the four mental health categories and UAP. CONCLUSIONS SSS and psychological comorbidity were common in a surgical inpatients admitted for abdominal pain and equally represented across most diagnostic sub-groups. However, the pancreatitis sub-group had greater proportions with clinically significant SSS and depression, suggesting that they have a higher requirement for psychological assessment and intervention.
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Affiliation(s)
- Melissa Stieler
- College of Health, Medicine and Wellbeing, School of Medicine and Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
- Department of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Gregory Carter
- College of Health, Medicine and Wellbeing, School of Medicine and Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
- Department Consultation-Liaison Psychiatry, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Matthew J Spittal
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Cassidy Campbell
- Department of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Peter Pockney
- College of Health, Medicine and Wellbeing, School of Biological Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia
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Aghaie Meybodi M, Shah V, Razdan R, Amer K, Ahlawat S. National Trends and Predictors of Opioid Administration in Patients Presenting With Abdominal Pain to the Emergency Department (2010-2018). Gastroenterol Nurs 2024; 47:122-128. [PMID: 38567855 DOI: 10.1097/sga.0000000000000795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 09/27/2023] [Indexed: 04/05/2024] Open
Abstract
Given the current opioid crisis, in this study, we assess the national trend and factors associated with opioid administration for patients presenting to the emergency department with abdominal pain. This is a retrospective cross-sectional study conducted using the National Hospital Ambulatory Medical Care Survey from 2010 to 2018. Weighted multiple logistic regression was applied to assess the independent factors associated with opioid administration in the emergency department. Trends of opioid administration were evaluated using the linear trend analysis. There were an estimated total of 100,925,982 emergency department visits for abdominal pain. Overall, opioid was administered in 16.8% of visits. Age less than 25 years was associated with lower odds of receiving opioids. Patients living in the Northeast had the lower odds of receiving opioids (odds ratio [OR] = 0.82, p = .006) than patients living in the Midwest. Patients in the West had the highest odds of receiving opioids (OR = 1.16, p = .01). Non-Hispanic White patients had higher odds of opioid administration (OR = 1.29, p < .001). Trend analysis demonstrated a statistically significant reduction in opioid administration. From 2010 to 2018, opioid administration has approximately decreased in half. Living in the West and the non-Hispanic White racial group were the significant factors associated with a higher risk of opioid administration.
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Affiliation(s)
- Mohamad Aghaie Meybodi
- Mohamad Aghaie Meybodi, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Vraj Shah, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Reena Razdan, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Kamal Amer, MD, is at Department of Medicine and Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, New Jersey
- Sushil Ahlawat, MD, is at Department of Medicine and Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Vraj Shah
- Mohamad Aghaie Meybodi, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Vraj Shah, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Reena Razdan, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Kamal Amer, MD, is at Department of Medicine and Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, New Jersey
- Sushil Ahlawat, MD, is at Department of Medicine and Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Reena Razdan
- Mohamad Aghaie Meybodi, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Vraj Shah, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Reena Razdan, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Kamal Amer, MD, is at Department of Medicine and Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, New Jersey
- Sushil Ahlawat, MD, is at Department of Medicine and Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Kamal Amer
- Mohamad Aghaie Meybodi, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Vraj Shah, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Reena Razdan, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Kamal Amer, MD, is at Department of Medicine and Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, New Jersey
- Sushil Ahlawat, MD, is at Department of Medicine and Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Sushil Ahlawat
- Mohamad Aghaie Meybodi, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Vraj Shah, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Reena Razdan, MD, is at Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
- Kamal Amer, MD, is at Department of Medicine and Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, New Jersey
- Sushil Ahlawat, MD, is at Department of Medicine and Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, New Jersey
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Sasankan P, McMichael J, Lyu R, Rouphael C, Baggott B, Vargo J, Garber A. Comparative Effectiveness of Virtual Versus In-person Visits for Abdominal Pain During the COVID-19 Pandemic. Dig Dis Sci 2024; 69:720-727. [PMID: 38300419 DOI: 10.1007/s10620-023-08236-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 07/17/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND AND AIMS The COVID-19 pandemic has highlighted the importance of telemedicine in improving healthcare access and reducing costs. This study aimed to assess order compliance in the virtual versus in-person setting for the initial evaluation of abdominal pain (AP) prior to and during the pandemic. METHODS A retrospective evaluation of virtual and in-person outpatient gastroenterology visits for AP were identified through natural language processing from January 2019 through September 2021 at the Cleveland Clinic main campus and regional hospitals in Ohio. We assessed the number and type of orders placed for patients and measured compliance through order completion. This study received Institutional Review Board approval (IRB 21-514). RESULTS Among 20,356 patients at their initial visit, 79% had orders placed, of which 40% had pandemic in-person visits, 13% had pandemic virtual visits, and 47% had pre-pandemic in-person visits. Patients seen virtually were 65.1% less likely to complete orders compared to patients seen in-person (p < 0.001) during the pandemic. Patients seen in a pandemic virtual setting were 71.0% less likely to complete imaging orders (p < 0.001), 82.6% less likely to complete procedure orders (p < 0.001), and 60.5% less likely to complete lab orders (p < 0.001). CONCLUSION Compared with in-person visits, patients seen virtually for their first presentation of AP were less likely to complete labs, imaging, and endoscopic evaluations. In-person visits were more successful with patient order completion during the pandemic. These findings highlight that virtual visits for AP, despite convenience, may compromise care delivery and warrant additional care coordination to achieve compliance with medical recommendations.
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Affiliation(s)
- Priya Sasankan
- Departments of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| | - John McMichael
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Ruishen Lyu
- Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Carol Rouphael
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Brian Baggott
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - John Vargo
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Ari Garber
- Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
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11
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Hung LY, Margolis KG. Autism spectrum disorders and the gastrointestinal tract: insights into mechanisms and clinical relevance. Nat Rev Gastroenterol Hepatol 2024; 21:142-163. [PMID: 38114585 DOI: 10.1038/s41575-023-00857-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 12/21/2023]
Abstract
Autism spectrum disorders (ASDs) are recognized as central neurodevelopmental disorders diagnosed by impairments in social interactions, communication and repetitive behaviours. The recognition of ASD as a central nervous system (CNS)-mediated neurobehavioural disorder has led most of the research in ASD to be focused on the CNS. However, gastrointestinal function is also likely to be affected owing to the neural mechanistic nature of ASD and the nervous system in the gastrointestinal tract (enteric nervous system). Thus, it is unsurprising that gastrointestinal disorders, particularly constipation, diarrhoea and abdominal pain, are highly comorbid in individuals with ASD. Gastrointestinal problems have also been repeatedly associated with increased severity of the core symptoms diagnostic of ASD and other centrally mediated comorbid conditions, including psychiatric issues, irritability, rigid-compulsive behaviours and aggression. Despite the high prevalence of gastrointestinal dysfunction in ASD and its associated behavioural comorbidities, the specific links between these two conditions have not been clearly delineated, and current data linking ASD to gastrointestinal dysfunction have not been extensively reviewed. This Review outlines the established and emerging clinical and preclinical evidence that emphasizes the gut as a novel mechanistic and potential therapeutic target for individuals with ASD.
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Affiliation(s)
- Lin Y Hung
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY, USA
| | - Kara Gross Margolis
- Department of Molecular Pathobiology, College of Dentistry, New York University, New York, NY, USA.
- Department of Cell Biology, NYU Grossman School of Medicine and Langone Medical Center, New York, NY, USA.
- Department of Pediatrics, NYU Grossman School of Medicine and Langone Medical Center, New York, NY, USA.
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12
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McKenzie YA, French C, Todd C, Burden S. Food intolerance related to gastrointestinal symptoms amongst adults living with bile acid diarrhoea: A cross-sectional study. J Hum Nutr Diet 2024; 37:79-93. [PMID: 37735850 DOI: 10.1111/jhn.13232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/16/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The role of food in managing bile acid diarrhoea (BAD) is poorly understood. The present study explored the prevalence of food intolerance amongst adults with BAD. METHODS The study comprised a cross-sectional survey of adults with BAD determined by the 75 selenium homotaurocholic acid test (SeHCAT) living in the UK. Participants anonymously completed an online questionnaire on 39 food items. Frequency of food in general affecting BAD symptoms, as well as frequencies of diarrhoea, abdominal pain, bloating, flatulence and consequential food avoidance after food item ingestion, were assessed. Food group avoidance was also assessed. RESULTS There were 434 participants who completed the questionnaire between April and May 2021 of whom 80% reported moderate to severe chronic diarrhoea. Food intolerances were reported by 88.0% (95% confidence interval [CI] = 84.6-90.9) of participants. Diarrhoea was reported most frequently after take-away food, fish and chips, creamy sauces, cream and large quantities of fruit (range 41.0%-33.6%). Lowest frequencies were for potato, avocado, mango, watermelon and pear (range 3.7%-7.4%) for the foods listed in the questionnaire. Similar trends were found for abdominal pain, bloating, flatulence and consequential food avoidance. Symptom-triggering within 30 min of ingestion was more prevalence than after 30 min for almost all foods. Food group avoidance was highest for fatty foods (81.2%; 95% CI = 77.8-85.3) followed by dairy (53.9%; 95% CI = 49.1-58.7). CONCLUSIONS Perceived food intolerance amongst adults with BAD and persisting diarrhoeal symptoms is high. Important triggers were meals with a higher fat content and higher-fat dairy products. Diets amongst those with persisting diarrhoeal symptoms may be overly restrictive.
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Affiliation(s)
- Yvonne A McKenzie
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Chloe French
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Sorrel Burden
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Salford Royal Hospital, Northern Care Alliance Foundation Trust, Scott Lane, Salford, UK
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13
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Zuzek R, Potter M, Talley NJ, Agréus L, Andreasson A, Veits L, Vieth M, Walker MM. Prevalence of Histological Gastritis in a Community Population and Association with Epigastric Pain. Dig Dis Sci 2024; 69:528-537. [PMID: 38091176 PMCID: PMC10861608 DOI: 10.1007/s10620-023-08170-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 10/26/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND AND AIMS Gastritis is a common histological diagnosis, although the prevalence is decreasing in developed populations, alongside decreasing prevalence of H. pylori infection. We sought to determine the prevalence of the etiology of gastritis in a Swedish population sample and to analyze any associations with symptoms, an area of clinical uncertainty. METHODS Longitudinal population-based study based in Östhammar, Sweden. A randomly sampled adult population completed a validated gastrointestinal symptom questionnaire (Abdominal Symptom Questionnaire, ASQ) in 2011 (N = 1175). Participants < 80 years of age and who were eligible were invited to undergo esophagogastroduodenoscopy (EGD) (N = 947); 402 accepted and 368 underwent EGD with antral and body biopsies (average 54.1 years, range 20-79 years; 47.8% male) with H. pylori serology. RESULTS Gastritis was found in 40.2% (148/368; 95% CI 35.2-45.2%). By rank, the most common histological subtype was reactive (68/148; 45.9%), then H. pylori (44/148; 29.7%), chronic non-H. pylori (29/148; 19.6%), and autoimmune (4/148; 2.7%). Gastritis was significantly associated with older age and H. pylori status (p < 0.01). Gastritis subjects were divided into three histological categories: chronic inactive inflammation, autoimmune gastritis, and active inflammation; there was no difference in the presence of upper gastrointestinal symptoms when categories were compared to cases with no pathological changes. Functional dyspepsia or gastroesophageal reflux were reported in 25.7% (38/148) of those with gastritis (any type or location) versus 34.1% (75/220) with no pathological changes (p = 0.32). Epigastric pain was more common in chronic H. pylori negative gastritis in the gastric body (OR = 3.22, 95% CI 1.08-9.62). CONCLUSION Gastritis is common in the population with a prevalence of 40% and is usually asymptomatic. Chronic body gastritis may be associated with epigastric pain, but independent validation is required to confirm these findings. Clinicians should not generally ascribe symptoms to histological gastritis.
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Affiliation(s)
- Rachael Zuzek
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
- Department of Medicine, Wollongong Hospital, Wollongong, Australia
| | - Michael Potter
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
- Department of Gastroenterology, John Hunter Hospital, Newcastle, Australia
- NHMRC Centre for Research Excellence in Digestive Health, Newcastle, Australia
| | - Nicholas J Talley
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.
- Department of Gastroenterology, John Hunter Hospital, Newcastle, Australia.
- NHMRC Centre for Research Excellence in Digestive Health, Newcastle, Australia.
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW, 2305, Australia.
| | - L Agréus
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - A Andreasson
- Department of Psychology, Macquarie University, North Ryde, Australia
- Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
- Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - L Veits
- Klinikum Bayreuth, Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Bayreuth, Germany
| | - M Vieth
- Klinikum Bayreuth, Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Bayreuth, Germany
| | - M M Walker
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
- NHMRC Centre for Research Excellence in Digestive Health, Newcastle, Australia
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14
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Bernadá Scarrone MM, Le Pera Garófalo V. [Gastrointestinal symptoms and problems in children cared by pediatric palliative care teams. Observational study]. Andes Pediatr 2024; 95:24-33. [PMID: 38587341 DOI: 10.32641/aodespediatr.v95i1.4813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/16/2023] [Indexed: 04/09/2024]
Abstract
Gastrointestinal symptoms and problems (GI- SP) frequently cause discomfort and suffering in pediatric patients with life-threatening and/or life-limiting illnesses (LTI/LLI). Pediatric palliative care (PPC) professionals should be aware of them and perform a comprehensive approach. OBJECTIVE To determine the prevalence of GI- SP in patients treated in PPC units and to describe the pharmacological and non-pharmacological measures prescribed. PATIENTS AND METHOD Observational, prospective, multicenter, prospective study in patients with LTI/LLI, seen by PPC teams in Uruguay. The variables analyzed included age, sex, origin, type of LTI/LLI, presence of mucositis, vomiting, swallowing disorders, abdominal pain, constipation, diarrhea, digestive bleeding, problems with digestive prosthesis, and prescribed pharmacological and non-pharmacological treatment. RESULTS 10 out of 16 PPC teams participated. 96 out of 436 patients seen presented GI- SP (22%). Median age was 4.2 years (1 month-18 years). LTI/LLI 65% neurological and 7% oncological. The 96 patients had 114 consultations; 50% had 2 or more GI- SP per consultation. GI- SP observed: swallowing disorders (57%), constipation (53%), nausea and/or vomiting (24%), gastrostomy problems (17%), abdominal pain (10%), digestive bleeding (3%), and diarrhea (2%). There were variable prescriptions of pharmacological and non-pharmacological measures; only 50% of those with swallowing disorder received speech and hearing therapy. CONCLUSIONS GI- SP motivated consultations in all PPC settings, frequently due to 2 or more GI- SP. Swallowing disorders and gastrostomy complications are frequent but not very visible problems in PPC. According to the comprehensive approach, pharmacological and non-pharmacological measures were implemented.
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15
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Defert C, Cousin I, Marchand ICL, Burgazzi C, Pabic EL, Arnaud AP. Dysmenorrhea among 12-year-old teenagers from different socioeconomic backgrounds. Arch Pediatr 2024; 31:141-147. [PMID: 38267345 DOI: 10.1016/j.arcped.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/16/2023] [Accepted: 09/17/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND The age of menarche has been gradually declining since the end of the 20th century. Few studies have been carried out about dysmenorrhea in Europe and they mainly included girls over the age of 15 years. METHODS We conducted an observational study among sixth-grade schoolgirls (usually 11-12 years) during the 2020 academic year in 72 randomly selected public schools in a French region (approval number #20.94). RESULTS Among 1712 girls interviewed, 257 (23 %) had reached menarche. Overall, 83 % of these teenagers had dysmenorrhea. Symptoms were reported to occur since the first periods in 59 % of the girls. School absenteeism was positively correlated with severe abdominal pain (p = 0.001). Median age at menarche was 11 years (10.7-11.5). Periods lasted less than 3 days, 3-8 days, and more than 8 days in, respectively, 18 %, 70 %, and 7 % of the girls. Symptoms were significantly more frequent and more severe in the urban group than the rural group (p = 0.005). Symptoms were abdominal pain (70 %), fatigue (48 %), difficulty in concentrating (26 %), headache (25 %), digestive disorders (16 %), and breast discomfort (11 %). Of the girls with dysmenorrhea, 61 % took painkillers; 10 % were uncomfortable despite taking painkillers. Sport exemption was more frequent in the urban group (p = 0.003) and among girls with severe abdominal pain (p = 0.001). CONCLUSIONS The duration of the menstrual cycle was similar between the various socioeconomic groups, but symptoms and ways of coping were significantly different. Dysmenorrhea is definitely an issue that has to be raised with teenagers as soon as menarche occurs or even before that. Easy access to skilled health practitioners should be widespread.
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Affiliation(s)
- Coralie Defert
- Department of Pediatric Surgery, University Hospital of Rennes, Brittany, France.
| | - Ianis Cousin
- Department of Pediatric Surgery, University Hospital of Brest, Brittany, France
| | | | - Catherine Burgazzi
- School Health Service, Board Education of the Academy of Brittany, Rennes, France
| | | | - Alexis P Arnaud
- Department of Pediatric Surgery, University Hospital of Rennes, Brittany, France
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16
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Dadeh AA, Uppakarnnuntakul W. Factors associated with serious abdominal conditions in geriatric patients visiting the emergency department. BMC Emerg Med 2024; 24:16. [PMID: 38273250 PMCID: PMC10809639 DOI: 10.1186/s12873-024-00934-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/14/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Abdominal pain occurs in 20% of geriatric patients who visit the emergency department (ED). Geriatric patients usually have more severe conditions and a higher mortality rate. We aimed to determine the factors associated with serious abdominal conditions in geriatric patients who visit the ED with abdominal pain. METHODS This retrospective cohort study was conducted from January 1, 2017 to June 30, 2021. The inclusion criteria were patients aged ≥ 65 years and presented at the ED with acute abdominal pain. Significantly associated factors for serious abdominal conditions were examined using univariate and multivariate logistic regression analyses. RESULTS A total of 1221 patients were included in this study. Multivariate logistic regression analysis showed that the significant factors associated with serious abdominal conditions were male (adjusted odds ratio [AOR] 2.29, 95% CI:1.3-4.04; p = 0.004), anorexia (AOR 2.16, 95% CI:1.08-4.32; p = 0.03), NEWS 5-6 (AOR 2.96, 95% CI:1.35-6.49; p = 0.007), SBP 100-125 mmHg (AOR 1.5, 95% CI:0.75-2.99; p ≤ 0.001), guarding (AOR 6.92, 95% CI:3.39-14.12; p ≤ 0.001), WBC ≥ 14,000 cells/mm3 (AOR 2.08, 95% CI:1.06-4.09; p = 0.034), ED length of stay (EDLOS) 4-8 h (AOR 2.17, 95% CI:1.08-4.36; p = 0.03), and EDLOS ≥ 8 h (AOR 3.22, 95% CI:1.15-9; p = 0.025). CONCLUSIONS The statistically significant factors associated with serious abdominal conditions in geriatric patients were male, anorexia, NEWS 5-6, SBP 100-125 mmHg, guarding, WBC ≥ 14,000 cells/mm3, EDLOS 4-8 h, and EDLOS ≥ 8 h.
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Affiliation(s)
- Ar-Aishah Dadeh
- Department of Emergency Medicine, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, 90110, Hat Yai, Songkhla, Thailand.
| | - Wasitthee Uppakarnnuntakul
- Department of Emergency Medicine, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, 90110, Hat Yai, Songkhla, Thailand
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Erwander K, Ivarsson K, Olsson ML, Agvall B. Elderly patients with non-specific complaints at the emergency department have a high risk for admission and 30-days mortality. BMC Geriatr 2024; 24:5. [PMID: 38172691 PMCID: PMC10762826 DOI: 10.1186/s12877-023-04621-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Older adults have complex medical needs that causes increased use of resources at the emergency department (ED). The prevalence of non-specific complaint (NSC) as a chief-complaint in the ED is common among older adults and is not prioritized even though possibly having worse clinical outcome. The objective was to study hospital admission and mortality for older adults visiting the ED with NSC compared to specific complaints such as dyspnea, chest pain and abdominal pain. METHODS A retrospective observational study of older adults visiting the ED with NSC and specific complaints; dyspnea, chest pain and abdominal pain was performed. Chief-complaint were collected from electronic medical records. Fatigue, confusion, non-specific complaints, generalized weakness and risk of falling were defined as non-specific complaint (NSC) when registered as chief-complaint at the ED. Admission rate and 30-days mortality were the primary outcomes. RESULTS A total of 4927 patients were included in the study based on chief-complaint; patients with chest pain 1599 (32%), dyspnea 1343 (27%), abdominal pain 1460 (30%) and NSC 525 (11%). Patients with dyspnea and NSC had the highest hospital admission rate 79% vs 70% compared to patients with chest pain (63%) and abdominal pain (61%) (p = < 0.001). Patients with NSC had a mean LOS 4.7 h at the ED which was significantly higher compared to chest pain, dyspnea and abdominal pain. Mean bed-days for the whole population was 4.2 days compared to patients with NSC who had a mean LOS of 5.6 days. NSC and dyspnea were both associated with the highest 30-day mortality. CONCLUSION Older patients who present with NSC at the ED are associated with a high risk for admission and 30-days mortality. In addition, patients with NSC have a longer LOS at the ED, a high admission rate and the highest number of bed-days once admitted. This study indicates that ED staff should be more vigilant when an elderly patient presents with NSC at the ED. Further studies and guidelines are needed to improve the management of these individuals.
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Affiliation(s)
- Karin Erwander
- Department of Clinical Sciences, Lund University, Lund, Sweden.
| | - Kjell Ivarsson
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | | | - Björn Agvall
- Department of Research and Development, Region Halland, Halmstad, Sweden
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18
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Madavi S, Rai A, Kumar M, Sharma S, Mittal S. Yield of coeliac screening in children with non-specific functional abdominal pain: A cross-sectional study from North India. Trop Doct 2024; 54:27-29. [PMID: 37743656 DOI: 10.1177/00494755231202891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
A significant group of children suffer from non-specific functional abdominal pain. We argue that the prevalence of coeliac disease is higher in this group than the general population; thus, screening in this group is justified.
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Affiliation(s)
- Shraddha Madavi
- Post Graduate Student, Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | - Anuradha Rai
- Specialist, Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | - Manish Kumar
- Professor, Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | - Shikha Sharma
- Assistant Professor, Department of Biochemistry, Chacha Nehru Bal Chikitsalaya, Delhi, India
| | - Santosh Mittal
- Visiting Professor, Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Delhi, India
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Karakas HD, Kuloglu Z, Aydin F, Ozdemir S, Avar-Aydin PO, Tuna Kirsaclioglu C, Cakar N, Ozcakar ZB. Evaluation of Gastrointestinal System Complaints and Comorbidities in Pediatric Familial Mediterranean Fever Patients. J Clin Rheumatol 2023; 29:375-380. [PMID: 37723615 DOI: 10.1097/rhu.0000000000002027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
OBJECTIVE Familial Mediterranean fever (FMF) is the most prevalent hereditary autoinflammatory disease among children. Abdominal pain and various gastrointestinal system (GIS) manifestations may arise directly from FMF or concomitantly with FMF. This study aimed to evaluate GIS complaints and findings other than classic peritonitis attacks in patients with FMF and to interpret concomitant GIS and hepatic disorders in these patients. METHODS The medical and genetic findings of patients with FMF who attended our clinic between December 2011 and December 2021 were reviewed. Gastrointestinal system symptoms, liver function tests, abdominal images, and endoscopic and histopathological data were extracted from medical records. RESULTS A total of 576 pediatric patients (female, 52.3%) diagnosed with FMF were included. Among them, almost one-fifth displayed GIS complaints, such as abdominal pain, defecation problems, and dyspepsia, distinct from typical FMF attacks. High serum aminotransferase levels were detected in 18.4% of the patients, with viral infections being the most common cause of moderate/severe hypertransaminasemia. In addition, during follow-up, 26.9% of them were referred to the pediatric gastroenterology department. At least 1 gastroenterological and hepatobiliary disorder was detected in 17.5% of the patients because of organic and functional GIS disorders or hepatobiliary disorders, such as gastroesophageal reflux disease, esophagitis, functional dyspepsia, and inflammatory bowel diseases. CONCLUSION Various GIS and hepatic disorders can be encountered in children with FMF. The spectrum of these complaints and pathologies can range from frequently observed health problems to more severe diseases.
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Affiliation(s)
| | - Zarife Kuloglu
- Pediatric Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Fatma Aydin
- From the Departments of Pediatric Rheumatology
| | - Serpil Ozdemir
- Pediatric Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
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Qiao T, Gao D, Lu G, Yi W, Lv Z. Association of gastrointestinal symptoms and skipping breakfast with anxiety and depressive symptoms in quarantined Chinese college students during the Shanghai 2022 lockdown: a cross sectional survey. BMC Psychiatry 2023; 23:889. [PMID: 38017419 PMCID: PMC10685502 DOI: 10.1186/s12888-023-05317-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 10/27/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the prevalence of anxiety and depressive symptoms among quarantined college students at school in Shanghai 2022 lockdown during the COVID-19 pandemic and investigate the association of gastrointestinal discomfort related-factors and skipping breakfast with anxiety and depressive symptoms. METHODS 384 quarantined college students in Shanghai China were recruited in this cross-sectional study from April 5th to May 29th, 2022. Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) were used to assess anxiety and depressive symptoms, respectively. RESULTS The prevalence of anxiety and depressive symptoms were 56.8% and 62.8%, respectively. Longer quarantine duration, higher education level, skipping breakfast, stomachache or abdominal pain, and nausea or dyspepsia were significantly associated with anxiety symptoms. Moreover, longer quarantine duration, being woman, skipping breakfast, stomachache or abdominal pain, and nausea or dyspepsia were markedly related to depressive symptoms. Notably, regularly physical exercising and taking positive attitude towards COVID-19 were negatively correlated with anxiety and depressive symptoms. CONCLUSIONS More attention should be paid to anxiety and depressive symptoms of quarantined college students and universities should provide timely psychological monitoring and intervention services to mitigate the impact of negative emotions on students. Effectively relieving gastrointestinal symptoms, insisting on eat breakfast, regularly exercising, and taking a positive attitude towards to COVID-19 might contribute to preventing the anxiety and depressive symptoms for those college students experiencing a long-term quarantine.
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Affiliation(s)
- Tingting Qiao
- Department of Nuclear Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301, Middle Yanchang Road, Jing'an District, Shanghai, 200072, China
| | - Dingwei Gao
- Department of Nuclear Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301, Middle Yanchang Road, Jing'an District, Shanghai, 200072, China
| | - Gaixia Lu
- Department of Nuclear Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301, Middle Yanchang Road, Jing'an District, Shanghai, 200072, China
| | - Wanwan Yi
- Department of Nuclear Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301, Middle Yanchang Road, Jing'an District, Shanghai, 200072, China.
| | - Zhongwei Lv
- Department of Nuclear Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301, Middle Yanchang Road, Jing'an District, Shanghai, 200072, China.
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Yuming T, Jiani S, Hefeng C, Ying Z, Weiyan Y, Duowu Z. The Clinical Characteristics and Related Factors of Centrally Mediated Abdominal Pain Syndrome. Clin Transl Gastroenterol 2023; 14:e00624. [PMID: 37467381 PMCID: PMC10684177 DOI: 10.14309/ctg.0000000000000624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION The aim of this study was to explore the clinical characteristics and related factors of centrally mediated abdominal pain syndrome (CAPS). METHODS Our study included 73 patients with CAPS and 132 age-matched and gender-matched healthy controls. The general information of the participants was collected, and the questionnaires were completed including the 7-item Generalized Anxiety Disorder Scale, 9-item Patient Health Questionnaire, Hamilton Anxiety Scale, Hamilton Depression Scale Pittsburgh Sleep Quality Index, Visual Analog Scale, and Short-Form 36. Univariate and forward stepwise regression analyses were performed to explore the influencing factors of CAPS. RESULTS Nonexercise (adjusted odds ration [AOR] 4.53; confidence interval [CI] 1.602-12.809), mild-to-moderate depression (AOR 7.931; CI 3.236-19.438), married status (AOR 3.656; CI 1.317-10.418), and drinking coffee (AOR 0.199; CI 0.051-0.775) were found to be related with centrally mediated abdominal syndrome. The Hamilton Anxiety Scale score (7-13) was significantly related to moderate-to-severe abdominal pain (AOR 7.043; CI 1.319-37.593). Higher Hamilton Depression Scale score was related to lower mental component scale score (β = -0.726, P < 0.01) and physical component scale score (β = -0.706, P < 0.01). DISCUSSION Depression, married status, and nonexercise were the independent risk factors of CAPS. Conversely, coffee intake was an independent protective factor of CAPS. Anxiety was related to the severity of abdominal pain, while depression was related to low health-related quality of life.
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Affiliation(s)
- Tang Yuming
- Department of Gastroenterology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Song Jiani
- Department of Gastroenterology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Chen Hefeng
- Department of Pharmacy, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Zhu Ying
- Department of Gastroenterology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Yao Weiyan
- Department of Gastroenterology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Zou Duowu
- Department of Gastroenterology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
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22
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Safaee M, Malekzadeh M, Motamedi N, Sayadishahraki M, Eizadi-Mood N. Gastrointestinal Manifestations of Lead Poisoning: A Brief Report. Iran J Med Sci 2023; 48:600-605. [PMID: 38094284 PMCID: PMC10715114 DOI: 10.30476/ijms.2023.95824.2749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/26/2022] [Accepted: 12/17/2022] [Indexed: 12/18/2023]
Abstract
Gastrointestinal (GI) manifestations of lead poisoning include abdominal pain, constipation, and diarrhea. Depending on the severity of a symptom, surgical consultation is required. The present study aimed to make a comparison between the mean blood lead levels of patients hospitalized for lead toxicity and the various Gl symptoms. A retrospective cross-sectional study was performed in 2020 at Khorshid Hospital, the main regional referral center for poisoned patients (Isfahan, Iran). A total of 82 patients aged ≥18 years who were hospitalized for lead poisoning during 2017-2018 were included in the study. Patients' information was extracted from hospital medical records, including demographic information, clinical manifestations, blood lead levels, and treatment outcome. The mean age of the patients was 48.18±11.9 years, 91.5% were men, and 62.2% suffered from multiple GI symptoms, with abdominal pain being predominant (31.7%). Blood lead levels in patients with multiple GI symptoms were higher than those with only one symptom (P=0.01). Surgical consultation was required in 14.6% of the patients. Multiple GI symptoms were the main predictive factor for blood lead levels above 70 mg/dL (P=0.03, Odds ratio=3.06, 95% CI=1.09-8.61). Given the prevalence of abdominal pain and its association with elevated blood lead levels, differential diagnosis of abdominal pain should include lead toxicity.
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Affiliation(s)
- Masumeh Safaee
- Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahdi Malekzadeh
- Department of Clinical Toxicology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Narges Motamedi
- Department of Preventive and Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Sayadishahraki
- Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nastaran Eizadi-Mood
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Tong K, Yin S, Yu Y, Yang X, Hu G, Zhang F, Liu Z. Gastrointestinal adverse events of tirzepatide in the treatment of type 2 diabetes mellitus: A meta-analysis and trials sequential analysis. Medicine (Baltimore) 2023; 102:e35488. [PMID: 37904345 PMCID: PMC10615484 DOI: 10.1097/md.0000000000035488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 09/13/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Tirzepatide (TZP) is a novel drug for type 2 diabetes mellitus (T2DM), but the gastrointestinal (GI) adverse events (AEs) is a limiting factor in clinical application. Therefore, this study systematically evaluated the GI AEs of TZP for T2DM. METHODS Clinical trials of TZP for T2DM were retrieved from eight databases published only from the establishment of the database to February 2023. Revman5.3 and TSA0.9.5.10 Beta were used for meta-analysis and trials sequential analysis (TSA). RESULTS Meta-analysis showed that compared with placebo, total GI AEs, nausea, decreased appetite, constipation and vomiting were significantly higher in all dose groups of TZP (P < .05), while abdominal pain and abdominal distension were comparable (P > .05). TSA showed that the differences in total GI AEs, nausea, decreased appetite and constipation were conclusive. Compared with insulin, nausea, diarrhea, vomiting and decreased appetite were significantly increased in all doses of TZP (P < .05), and dyspepsia was significantly increased with TZP 15 mg (P < .05). TSA showed that these differences were all conclusive. Compared with GLP-1 RA, decreased appetite was significantly higher with TZP 5 mg, total GI AEs, decreased appetite and diarrhea were significantly higher with TZP 10 mg (P < .05), while nausea, vomiting, dyspepsia and constipation were significantly different in all dose groups, abdominal pain were not significantly different (P < .05) and TSA showed no conclusive results in this group. CONCLUSION The GI AEs of TZP were significantly higher than those of placebo and insulin, but comparable to GLP-1 RA. Nausea, diarrhea and decreased appetite are very common GI AEs of TZP, and the incidence is positively correlated with dose. GI AEs of TZP decrease gradually over time, so long-term steady medication may be expected to reduce GI AEs.
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Affiliation(s)
- Keke Tong
- Hunan University of Chinese Medicine, Changsha, China
- The Hospital of Hunan University of Traditional Chinese Medicine, Changde, China
| | - Shuang Yin
- Hunan University of Chinese Medicine, Changsha, China
| | - Yunfeng Yu
- Hunan University of Chinese Medicine, Changsha, China
- The First Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Xinyu Yang
- Hunan University of Chinese Medicine, Changsha, China
| | - Gang Hu
- Hunan University of Chinese Medicine, Changsha, China
- The First Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Fei Zhang
- Hunan University of Chinese Medicine, Changsha, China
| | - Zhenjie Liu
- The First Hospital of Hunan University of Chinese Medicine, Changsha, China
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24
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van Olst N, Vink MRA, de Vet SCP, Hutten BA, Gerdes VEA, Tielbeek JAW, Bruin SC, van Weyenberg SJB, van der Peet DL, Acherman YIZ. A Prospective Study on the Diagnoses for Abdominal Pain After Bariatric Surgery: The OPERATE Study. Obes Surg 2023; 33:3017-3027. [PMID: 37563516 PMCID: PMC10514148 DOI: 10.1007/s11695-023-06756-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/06/2023] [Accepted: 07/14/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE Long-term follow-up after bariatric surgery (BS) reveals high numbers of patients with abdominal pain that often remains unexplained. The aim of this prospective study was to give an overview of diagnoses for abdominal pain, percentage of unexplained complaints, number and yield of follow-up visits, and time to establish a diagnosis. MATERIALS AND METHODS Patients who visited the Spaarne Gasthuis Hospital, The Netherlands, between December 2020 and December 2021 for abdominal pain after BS, were eligible and followed throughout the entire episode of abdominal pain. Distinction was made between presumed and definitive diagnoses. RESULTS The study comprised 441 patients with abdominal pain; 401 (90.9%) females, 380 (87.7%) had Roux-en-Y gastric bypass, mean (SD) % total weight loss was 31.4 (10.5), and median (IQR) time after BS was 37.0 (11.0-66.0) months. Most patients had 1-5 follow-up visits. Readmissions and reoperations were present in 212 (48.1%) and 164 (37.2%) patients. At the end of the episode, 88 (20.0%) patients had a presumed diagnosis, 183 (41.5%) a definitive diagnosis, and 170 (38.5%) unexplained complaints. Most common definitive diagnoses were cholelithiasis, ulcers, internal herniations, and presumed diagnoses irritable bowel syndrome (IBS), anterior cutaneous nerve entrapment syndrome, and constipation. Median (IQR) time to presumed diagnoses, definitive diagnoses, or unexplained complaints was 16.0 (3.8-44.5), 2.0 (0.0-31.5), and 13.5 (1.0-53.8) days (p < 0.001). Patients with IBS more often had unexplained complaints (OR 95%CI: 4.457 [1.455-13.654], p = 0.009). At the end, 71 patients (16.1%) still experienced abdominal pain. CONCLUSION Over a third of abdominal complaints after BS remains unexplained. Most common diagnoses were cholelithiasis, ulcers, and internal herniations.
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Affiliation(s)
- Nienke van Olst
- Department of Bariatric Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands.
- Department of Surgery, Amsterdam UMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Marjolein R A Vink
- Department of Bariatric Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - Sterre C P de Vet
- Department of Bariatric Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - Barbara A Hutten
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Diabetes & Metabolism, Amsterdam, The Netherlands
| | - Victor E A Gerdes
- Department of Bariatric Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
- Department of Vascular Medicine Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jeroen A W Tielbeek
- Department of Radiology, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - Sjoerd C Bruin
- Department of Bariatric Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - Stijn J B van Weyenberg
- Department of Gastroenterology, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - Donald L van der Peet
- Department of Surgery, Amsterdam UMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Yair I Z Acherman
- Department of Bariatric Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
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25
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Thunnissen FM, Baars C, Arts R, Latenstein CSS, Drenth JPH, van Laarhoven CJHM, Lantinga MA, de Reuver PR. Persistent and new-onset symptoms after cholecystectomy in patients with uncomplicated symptomatic cholecystolithiasis: A post hoc analysis of 2 prospective clinical trials. Surgery 2023; 174:781-786. [PMID: 37541808 DOI: 10.1016/j.surg.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/14/2023] [Accepted: 06/18/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy is the gold standard for treating biliary colic in patients with gallstones, but post-cholecystectomy abdominal pain is commonly reported. This study investigates which symptoms are likely to persist and which may develop after a cholecystectomy. METHODS Patients from 2 previous prospective trials who underwent laparoscopic cholecystectomy for symptomatic cholecystolithiasis were included. Patients completed questionnaires on pain and gastrointestinal symptoms before surgery and at 6 months follow-up. The prevalence of persistent and new-onset abdominal symptoms was evaluated. RESULTS A total of 820 patients received cholecystectomy and were included, 75.4% female (n = 616/820) mean age 49.4 years (standard deviation 13.7). At baseline, 74.1% (n = 608/820) of patients met all criteria for biliary colic. Cholecystectomy successfully resolved biliary colic in 94.8% (n = 327/345) of patients, but 36.5% (n = 299/820) of patients reported persistent abdominal pain after 6 months of follow-up. The prevalence of most abdominal symptoms reduced significantly. Symptoms such as flatulence (17.8%, n = 146/820) or restricted eating (14.5%, n = 119/820) persisted most often. New-onset symptoms were frequent bowel movements (9.6%, n = 79/820), bowel urgency (8.5%, n = 70/820), and new-onset diarrhea (8.4%, 69/820). CONCLUSION Postcholecystectomy symptoms are mainly flatulence, frequent bowel movements, and restricted eating. Newly reported symptoms are mainly frequent bowel movements, bowel urgency, and diarrhea. The present findings give clinical guidance in informing, managing, and treating patients with symptoms after cholecystectomy.
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Affiliation(s)
- Floris M Thunnissen
- Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Cléo Baars
- Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Rianne Arts
- Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | | | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Cornelis J H M van Laarhoven
- Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marten A Lantinga
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, University Medical Centres Amsterdam, The Netherlands. https://twitter.com/PhilipReuver
| | - Philip R de Reuver
- Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
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Said H, Nee J, Iturrino J, Rangan V, Singh P, Lembo A, Ballou S. Clinical Characteristics of Patients Presenting With Bloating as a Predominant Symptom. J Clin Gastroenterol 2023; 57:830-834. [PMID: 36306181 PMCID: PMC10148919 DOI: 10.1097/mcg.0000000000001767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/23/2022] [Indexed: 12/10/2022]
Abstract
BACKGROUND The estimated prevalence of bloating is 15 to 30% in the adult US population and is even higher in patients with disorders of gut-brain interaction (DGBIs). Despite this frequency, there is little research into patients who endorse bloating as a predominant symptom. The aim of this study was to better characterize these patients. MATERIALS AND METHODS New patients with DGBIs were asked to identify their 3 most predominant symptoms over the preceding 3 months; those who reported bloating were classified as "bloating predominant." Rome IV and symptom-specific questionnaires were administered to assess for the frequency of DGBIs and other predominant symptoms in this patient population. Using univariable and multivariable modeling, we analyzed the associations between bloating predominance, DGBI subtype, and clinical characteristics. RESULTS Of the 586 patients surveyed, 242 (41%) reported predominant bloating. Bloating-predominant patients were more likely to be female, younger, and meet the criteria for IBS-mixed (IBS-M), functional constipation, and functional dyspepsia compared with nonbloating-predominant patients. Bloating-predominant patients were also more likely to endorse concurrently predominant constipation, incomplete evacuation, abdominal pain, belching, and/or nausea. On multivariable logistic regression, constipation and abdominal pain severity were positively associated, although depression was negatively associated with predominant bloating. CONCLUSIONS Patients with predominant bloating are more likely to have constipation-related symptoms than diarrhea-related symptoms. They are also more likely to have more severe abdominal pain than patients without predominant bloating. These findings help characterize patients with bloating as a predominant symptom and suggest that diagnosing and treating constipation should be considered as first-line treatment.
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Affiliation(s)
- Hyder Said
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Judy Nee
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Johanna Iturrino
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Vikram Rangan
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Prashant Singh
- Division of Gastroenterology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Anthony Lembo
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Sarah Ballou
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Yang PL, Kamp KJ, Burr RL, Tang HY(J, Dobra A, Shulman RJ, Heitkemper MH. Age Differences in Core Symptoms and Symptom Relationships in Patients With Irritable Bowel Syndrome: A Network Analysis. Am J Gastroenterol 2023; 118:1648-1655. [PMID: 37040543 PMCID: PMC10524048 DOI: 10.14309/ajg.0000000000002280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 04/04/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION Irritable bowel syndrome (IBS) is a common disorder of gut-brain interaction, characterized by symptoms of abdominal pain and changes in bowel habits. It often co-occurs with extraintestinal somatic and psychological symptoms. However, the nature of the interrelationships among these symptoms is unclear. Although previous studies have noted age differences in IBS prevalence and specific symptom severity, it remains unknown whether specific symptoms and symptom relationships may differ by age. METHODS Symptom data were collected in 355 adults with IBS (mean age 41.4 years, 86.2% female). Network analysis was used to examine the interrelationships among 28 symptoms and to identify the core symptoms driving the symptom structure between young (≤45 years) vs older (>45 years) adults with IBS. We evaluated 3 network properties between the 2 age groups: network structure, edge (connection) strength, and global strength. RESULTS In both age groups, fatigue was the top core symptom. Anxiety was a second core symptom in the younger age group, but not the older age group. Intestinal gas and/or bloating symptoms also exerted considerable influences in both age groups. The overall symptom structure and connectivity were found to be similar regardless of age. DISCUSSION Network analysis suggests fatigue is a critical target for symptom management in adults with IBS, regardless of age. Comorbid anxiety is likely an important treatment focus for young adults with IBS. Rome V criteria update could consider the importance of intestinal gas and bloating symptoms. Additional replication with larger diverse IBS cohorts is warranted to verify our results.
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Affiliation(s)
- Pei-Lin Yang
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Kendra J Kamp
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Robert L Burr
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Hsin-Yi (Jean) Tang
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Adrian Dobra
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
- Department of Statistics, University of Washington, Seattle, WA, USA
| | - Robert J Shulman
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Children’s Nutrition Research Center, Houston, Texas, USA
| | - Margaret H Heitkemper
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
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Thapa R, Pokharel M, Paudel S, Khadka T, Sapkota P, Rana R, Pokharel M, Chhetri D. Acid Peptic Disease among Patients with Acute Abdomen Visiting the Department of Emergency Medicine in a Tertiary Care Centre. JNMA J Nepal Med Assoc 2023; 61:636-638. [PMID: 38289821 PMCID: PMC10566611 DOI: 10.31729/jnma.8228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Acid peptic disease is caused by excessive acid secretion or weakened mucosal defense. Symptoms include epigastric pain, bloating, and nausea. Factors like gastric acid, Helicobacter pylori infection, alcohol consumption, smoking, and stress contribute to peptic ulcers. Imbalances between offensive and defensive factors can lead to ulcers. Acid-related disorders impact the quality of life and mortality. Accurate diagnosis and prompt treatment are vital. This study aimed to find out the prevalence of acid peptic disease among patients with acute abdomen in the Department of Emergency Medicine in a tertiary care centre. Methods A descriptive cross-sectional study was conducted from 2 April 2022 and 2 April 2023 among the patients presented in the Department of Emergency Medicine in a tertiary care centre. Ethical approval was obtained from the Institutional Review Committee. All patients presenting with acute abdominal pain in the Emergency Department were included in the study. Patients not giving consent were excluded from the study. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results Out of the 400 patients with acute abdomen, the prevalence of acid peptic disease was found to be 87 (21.75%) (17.71-25.79, 95% Confidence Interval). Conclusions The prevalence of acid peptic disease among patients with acute abdomen was found to be lower than in other studies performed in similar settings. Keywords acute abdomen; gastroenteritis; Helicobacter pylori; peptic ulcer.
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Affiliation(s)
- Rashmi Thapa
- Department of Emergency Medicine, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Mohir Pokharel
- Department of Emergency Medicine, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Saroj Paudel
- Department of Emergency Medicine, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Tunam Khadka
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Priyanka Sapkota
- Universal College of Medical Sciences, Bhairahawa, Rupandehi, Nepal
| | - Rohit Rana
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Moneec Pokharel
- Birat Medical College and Teaching Hospital, Biratnagar, Morang, Nepal
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Chahal-Kummen M, Våge V, Kristinsson JA, Mala T. Chronic abdominal pain and quality of life after Roux-en-Y gastric bypass and sleeve gastrectomy - a cross-cohort analysis of two prospective longitudinal observational studies. Surg Obes Relat Dis 2023; 19:819-829. [PMID: 36870870 DOI: 10.1016/j.soard.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/20/2023] [Accepted: 01/21/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Chronic abdominal pain (CAP) after bariatric surgery is not extensively explored and may impact the postoperative outcomes. OBJECTIVE To compare the prevalence of patient-reported chronic abdominal pain (CAP) after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Secondarily, we compared other abdominal and psychological symptoms and quality of life (QoL). Preoperative predictors of postoperative CAP were also explored. SETTING Tertiary referral centers for bariatric surgery in Norway. METHODS Analyses of 2 separate prospective longitudinal cohort studies evaluating CAP, abdominal and psychological symptoms and QoL before and 2 years after RYGB and SG. RESULTS Follow-ups were attended by 416 patients (85.8%), 300/416 (72.1%) were females and 209/416 (50.2%) were RYGB procedures. At follow-up, the mean age was 44.9 (10.0) years, BMI 29.5 (5.4) kg/m2, and total weight loss 31.6 (10.3) %. The prevalence of CAP was 28/236 (11.9%) before and 60/209 (28.7%) after RYGB (P < .001) and 32/223 (14.3%) before and 50/186 (26.9%) after SG (P < .001). Gastrointestinal symptom rating scale scores showed greater deterioration of diarrhea and indigestion after RYGB and reflux after SG. The improvement in depression symptoms was greater after SG, as well as several QoL scores improved more after SG. Patients with CAP after RYGB experienced deterioration in several QoL scores, while these scores improved in patients with CAP after SG. Preoperative hypertension, bothersome reflux symptoms, and CAP predicted postoperative CAP. CONCLUSIONS The prevalence of CAP increased comparably after RYGB and SG, with worsening of gastroesophageal reflux after SG and greater deterioration of diarrhea and indigestion after RYGB. In patients with CAP at follow-up, several QoL scores improved more after SG than RYGB.
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Affiliation(s)
- Monica Chahal-Kummen
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Villy Våge
- Scandinavian Obesity Surgery Registry, Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
| | - Jon A Kristinsson
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Tom Mala
- Department of Endocrinology, Morbid Obesity and Preventive Medicine and Department of Pediatric and Gastrointestinal Surgery, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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30
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Madsen KM, Holstein BE, Madsen KR. Recurrent headache, stomachache, and backpain among adolescents: association with exposure to bullying and parents' socioeconomic status. Scand J Pain 2023; 23:563-570. [PMID: 37277906 DOI: 10.1515/sjpain-2022-0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 05/09/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Recurrent pain is a prevalent and severe public health problem among adolescents and is associated with several negative health outcomes. In a representative sample of adolescents this study examined 1) whether exposure to bullying and low socioeconomic status (SES) were associated with recurrent headache, stomachache and backpain, 2) the combined effect of exposure to bullying and low SES on recurrent pain and 3) whether SES modified the association between bullying and recurrent pain. METHODS Data derived from the Danish contribution to the international collaborative study Health Behaviour in School-aged Children (HBSC). The study population was students in three age groups, 11-, 13- and 15-year-olds from nationally representative samples of schools. We pooled participants from the surveys in 2010, 2014 and 2018, n=10,738. RESULTS The prevalence of recurrent pain defined as pain 'more than once a week' was high: 11.7 % reported recurrent headache, 6.1 % stomachache, and 12.1 % backpain. The proportion who reported at least one of these pains 'almost every day' was 9.8 %. Pain was significantly associated with exposure to bullying at school and low parental SES. The adjusted odds ratio (AOR, 95 % CI) for recurrent headache when exposed to both bullying and low SES was 2.69 (1.75-4.10). Equivalent estimates for recurrent stomachache were 5.80 (3.69-9.12), for backpain 3.79 (2.58-5.55), and for any recurrent pain 4.81 (3.25-7.11). CONCLUSIONS Recurrent pain increased with exposure to bullying in all socioeconomic strata. Students with double exposure, i.e., to bullying and low SES, had the highest OR for recurrent pain. SES did not modify the association between bullying and recurrent pain.
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Affiliation(s)
- Klara Merrild Madsen
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| | - Bjørn E Holstein
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
| | - Katrine Rich Madsen
- University of Southern Denmark, National Institute of Public Health, Copenhagen, Denmark
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Bao X, Yu W, Chu Z, Gao J, Zhou M, Gu Y. Functional abdominal pain disorders in children in southern Anhui Province, China are related to academic stress rather than academic performance. BMC Pediatr 2023; 23:333. [PMID: 37386380 PMCID: PMC10308753 DOI: 10.1186/s12887-023-04154-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/24/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Functional abdominal pain disorders (FAPDs) are one of the most common gastrointestinal disorders in children. The aim of this study was to investigate the prevalence of FAPDs in children in southern Anhui Province, China and their association with academic stress. METHODS In this cross-sectional survey, we randomly selected children aged 6-17 years from 11 public schools in southern Anhui Province. FAPDs were diagnosed according to the Rome IV criteria, and a custom-designed questionnaire was used to investigate the association between academic stress and FAPDs in children. RESULTS A total of 2,344 children aged 6-17 years were enrolled. The mean age was 12.4 ± 3.0 years. Of these children, 335 (14.3%) were diagnosed with FAPDs according to the Rome IV criteria. Among the children with FAPDs, 156 (46.6%) were boys, and 179 (53.4%) were girls. The prevalence was higher in girls than in boys. The most common disorder was irritable bowel syndrome (IBS) (n = 182 (7.8%)). Other types of FAPDs included functional abdominal pain-not otherwise specified (FAPNOS) (n = 70 (3.0%)), functional dyspepsia (FD) (n = 55 (2.3%)), and abdominal migraine (AM) (n = 28 (1.2%)). Academic stress, not meeting parental expectations, poor relationships with parents, and sleep disturbances were independent risk factors for FAPDs in children; academic performance was not associated with the development of FAPDs. CONCLUSION There was a high prevalence of FAPDs among children in southern Anhui Province, China, and IBS was the most common subtype of functional abdominal pain. Academic stress, rather than academic performance, was associated with FAPDs in children.
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Affiliation(s)
- Xiaoshuang Bao
- Department of Paediatrics, Graduate School, Wannan Medical College, Wuhu, Anhui, China
| | - Wenchao Yu
- Department of Paediatrics, Yijishan Hospital of Wannan Medical College, No. 2, Zheshan Road, Wuhu, 241000, Anhui Province, People's Republic of China
| | - Ziyan Chu
- Department of Paediatrics, Yijishan Hospital of Wannan Medical College, No. 2, Zheshan Road, Wuhu, 241000, Anhui Province, People's Republic of China
| | - Jie Gao
- Department of Paediatrics, Graduate School, Wannan Medical College, Wuhu, Anhui, China
| | - Meimei Zhou
- Department of Paediatrics, Graduate School, Wannan Medical College, Wuhu, Anhui, China
| | - Yong Gu
- Department of Paediatrics, Yijishan Hospital of Wannan Medical College, No. 2, Zheshan Road, Wuhu, 241000, Anhui Province, People's Republic of China.
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Azadbakht S, Parvaee R, Darabian S. An epidemiological investigation of gallstone disease among patients admitted to Shahid Rahimi teaching hospital in Khorramabad in 2016-2020. Afr Health Sci 2023; 23:435-441. [PMID: 38223601 PMCID: PMC10782301 DOI: 10.4314/ahs.v23i2.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Background Gallstones are a significant global health issue, imposing enormous costs to patients and the healthcare system, annually. Objectives This epidemiological study aimed to explore the prevalence of gallstones among inpatients who were admitted to Shahid Rahimi Hospital in Khorramabad City, Iran, from 2016 to 2020. Methods This was a retrospective and descriptive-analytical study. The study population included patients who were admitted to Shahid Rahimi Hospital in Khorramabad City, Iran, who underwent abdominal ultrasounds from 2016 to 2020. The required data were collected using a checklist and patients' records. The logistic regression analysis method was used to analyse the obtained data in SPSS at the significance level of P<0.05. Results Of the 927 explored subjects, 232(25%) presented gallstones. The mean age of the patients with gallstones was 62.9 years. The most frequent symptom in individuals with gallstones was right upper quadriceps abdominal pain (63%). There was a significant relationship between gallstone and age, gender, epigastric pain, upper quadrant pain, hypertension, anemia, and family history. Conclusion The present study findings indicated that increasing age, female gender, the lack of epigastric pain, upper quadrant pain, anemia, hypertension, and a family history of this disease increased the risk of generating gallstone disease.
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Affiliation(s)
- Saleh Azadbakht
- Department of Internal Medicine, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Raziyeh Parvaee
- Student Research Committee, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Samad Darabian
- Department of Statistics and Epidemiology, School of Health, Lorestan University of Medical Sciences, Khorramabad, Iran
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Vujasinovic M, Asplund E, Kourie M, Guliaieva M, Dugic A, Waldthaler A, Baldaque-Silva F, Löhr JM, Ghorbani P. Painless chronic pancreatitis: experiences from a high-volume center. Scand J Gastroenterol 2023; 58:417-421. [PMID: 36300843 DOI: 10.1080/00365521.2022.2137692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Although abdominal pain is the most prevalent and disabling symptom in patients with chronic pancreatitis (CP), there are also patients who have painless CP. PATIENTS AND METHODS We performed a retrospective analysis of patients with a diagnosis of CP. A total of 279 patients with definite CP with completed demographic and clinical data were included in the final analysis. RESULTS There were 75 (26.9%) patients with painless CP. These patients had a significantly higher mean age at diagnosis, 61.7 years, than the 52.5 years of patients with pain (p < 0.001). Painless and painful CP had similar rates of diabetes mellitus (DM) (28.4% vs. 31.6%) and pancreatic exocrine insufficiency (PEI) (50.0% vs. 52.3%). Painless CP had lower rates of alcoholic etiology, 36.0%, than the 52.5% in painful CP (p < 0.05). Patients older than 55 at the time of CP diagnosis were associated with painless CP with an adjusted odds ratio (aOR) of 3.27 [95% confidence interval (CI): 1.62-6.60]. Alcoholic etiologies were not associated with painless CP, aOR of 0.51 (95% CI: 0.25-0.91). CONCLUSION Patients with painless CP had a significantly higher mean age than patients with painful CP and increased aOR for those older than 55 at CP diagnosis. Painless and painful CP patients had similar rates of DM and PEI, confirming the necessity of routine follow up in all patients with CP.
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Affiliation(s)
- Miroslav Vujasinovic
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Ebba Asplund
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Mourad Kourie
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Margaryta Guliaieva
- Alby Health Centre, Health Care Services Stockholm County, Stockholm, Sweden
| | - Ana Dugic
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Alexander Waldthaler
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Francisco Baldaque-Silva
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Gastroenterology Department, Advanced Endoscopy Center Carlos Moreira da Silva, Hospital Pedro Hispano, ULS Matosinhos, Porto, Portugal
| | - J Matthias Löhr
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Poya Ghorbani
- Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
- Alby Health Centre, Health Care Services Stockholm County, Stockholm, Sweden
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Moshiree B, Freeman AJ, Vu PT, Khan U, Ufret-Vincenty C, Heltshe SL, Goss CH, Schwarzenberg SJ, Freedman SD, Borowitz D, Sathe M. Multicenter prospective study showing a high gastrointestinal symptom burden in cystic fibrosis. J Cyst Fibros 2023; 22:266-274. [PMID: 36319569 PMCID: PMC10147845 DOI: 10.1016/j.jcf.2022.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 10/15/2022] [Accepted: 10/16/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND AIMS People with cystic fibrosis (PwCF) suffer from gastrointestinal (GI) symptoms affecting their quality of life (QOL). Despite the relevance of GI symptoms to the overall health of PwCF, a paucity of studies only have comprehensively assessed the prevalence, severity and QOL of GI symptoms in both children and adults with Cystic Fibrosis (CF). METHODS Eligible participants ≥2 years of age across 26 US CF centers were followed for 4 weeks. Three validated GI electronic patient-reported outcome measures (ePROMs) with a recall period of 2 weeks and a stool-specific questionnaire were administered weekly over four weeks. Total and domain scores of ePROMs were evaluated overall and in subgroups using linear mixed-effect models. RESULTS Of 402 enrolled, 58% were ≥ 18 years of age (52% male). The mean (SD) of the total score for PAC-SYM was 0.52 (0.55), for PAGI-SYM was 0.63 (0.67), and for PAC-QOL was 0.67 (0.55). For specific ePROM questions, prevalence of moderate to very severe symptoms were as follows: straining (20.3%), fullness (18.3%), incomplete bowel movements (17.1%), bloating (16.4%), distension (16.4%), abdominal pain (upper-5.1%, lower-7.5%). Comparing participants ≥18 versus <18, a higher prevalence of bloating (63.7% versus 27.3%), lower abdominal pain (39.8% vs 26.2%), stomach fullness (75.6% versus 56.2%), and abdominal distension (60.2% versus 34.9%) was found. Both age groups reported high treatment dissatisfaction as measured with PAC-QOL, mean 1.39 (95% CI: 1.30, 1.47). CONCLUSION GI symptoms were reported in all age ranges irrespective of gender, with higher prevalence observed amongst older and female subgroups. Dissatisfaction with GI targeted treatments were reported in a large proportion of participants despite therapy, highlighting an unmet need for clinical interventions. CLINICALTRIALS GOV: NCT03801993.
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Affiliation(s)
- Baha Moshiree
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Atrium Health, Charlotte, NC, United States.
| | - A Jay Freeman
- Division of Pediatric Gastroenterology, Nationwide Children's Hospital/The Ohio State University, Columbus, OH, United States
| | - Phuong T Vu
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle WA, United States
| | - Umer Khan
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle WA, United States
| | - Carmen Ufret-Vincenty
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle WA, United States
| | - Sonya L Heltshe
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle WA, United States; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| | - Christopher H Goss
- Cystic Fibrosis Foundation Therapeutics Development Network Coordinating Center, Seattle Children's Research Institute, Seattle WA, United States; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States; Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Sarah Jane Schwarzenberg
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Minnesota Masonic Children's Hospital, Minneapolis, MN, United States
| | - Steven D Freedman
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Drucy Borowitz
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| | - Meghana Sathe
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Texas Southwestern/Children's Health, Dallas, TX, United States
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Tanaka H, Matsusaki S, Asakawa H, Tsuruga S, Nose K, Kumazawa H, Sakuno T, Isono Y, Sase T, Okano H, Saito T, Mukai K, Nishimura A. A Novel Scoring System to Improve the Detection Efficiency of Pancreatic Cystic Lesions in the General Population. Intern Med 2023; 62:335-344. [PMID: 35831108 PMCID: PMC9970811 DOI: 10.2169/internalmedicine.9104-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 06/01/2022] [Indexed: 02/04/2023] Open
Abstract
Objective Pancreatic cystic lesions (PCLs) are known risk factors for pancreatic cancer. Therefore, this study explored the predictors identifying PCLs in a general population and developed a scoring system to help more efficiently diagnose these entities during medical checkups. Methods We reviewed 9,369 examinees of abdominal ultrasound (AUS) during medical checkups between January 2013 and November 2019. Predictors of PCLs were identified using a multivariate logistic regression analysis, and we constructed a scoring system based on these predictors. Results PCLs were detected in 118 (1.3%). Age 50-59 years old [odds ratio (OR) 2.52, 95% confidence interval (CI) 1.18-5.35], 60-69 years old (OR 3.91, 95% CI 1.86-8.26), and ≥70 years old (OR 10.5, 95% CI 5.03-21.7) as well as abdominal pain (OR 1.85, 95% CI 1.14-3.00), alcohol consumption (OR 1.72, 95% CI 1.03-2.89), a family history of pancreatic cancer (OR 2.41, 95% CI 1.09-5.34), and pre-diabetes or diabetes (OR 1.78, 95% CI 1.05-3.00) were predictors of PCLs. The following scores were assigned according to regression coefficients: age (50-59 years old, 1 point; 60-69 years old, 1.5 points; ≥70 years old, 2.5 points); abdominal pain, 1 point, alcohol consumption, 1 point; a family history of pancreatic cancer, 1 point; and pre-diabetes, 1 point. The PCL detection rate increased with the total score: 0.2% for total score 0 point, 5.4% for ≥4.0 points. The area under the curve of the scoring system was 0.75 (95% CI 0.70-0.79). Conclusion Our scoring system allows the risk of PCLs to be determined and may help more efficiently diagnose these entities.
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Affiliation(s)
- Hiroki Tanaka
- Department of Gastroenterology, Suzuka General Hospital, Japan
| | | | - Hiroki Asakawa
- Department of Gastroenterology, Suzuka General Hospital, Japan
| | - Satomi Tsuruga
- Department of Gastroenterology, Suzuka General Hospital, Japan
| | - Kenji Nose
- Department of Gastroenterology, Suzuka General Hospital, Japan
| | | | - Takashi Sakuno
- Department of Gastroenterology, Suzuka General Hospital, Japan
| | - Yoshiaki Isono
- Department of Gastroenterology, Suzuka General Hospital, Japan
| | - Tomohiro Sase
- Department of Gastroenterology, Suzuka General Hospital, Japan
| | - Hiroshi Okano
- Department of Gastroenterology, Suzuka General Hospital, Japan
| | - Tomonori Saito
- Department of Gastroenterology, Suzuka General Hospital, Japan
| | - Katsumi Mukai
- Department of Gastroenterology, Suzuka General Hospital, Japan
| | - Akira Nishimura
- Department of Gastroenterology, Suzuka General Hospital, Japan
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Kılıççeker R, Yurdakul M. A retrospective evaluation of pregnant adolescents presenting to an emergency department. Afr J Reprod Health 2023; 27:26-33. [PMID: 37584936 DOI: 10.29063/ajrh2023/v27i2.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
The purpose of this study was to evaluate demographic features, presenting complaints and outcomes of adolescent pregnancies admitted to the emergency department of a Turkish State hospital. The study sample included 1187 pregnant adolescents admitted to the emergency department of a state hospital. Data were collected with a form created by the researchers from the emergency department records and forensic records of the hospital. The pregnant adolescents presented to hospital with a wide range of complaints. The most frequent three reasons of presenting to the emergency department were abdominal pain, supervision of normal pregnancy and vaginal bleeding. More than half of them were discharged after their evaluation in the emergency department. In the study, it was determined that the use of the emergency department for non-emergency indications is widespread among adolescent pregnant women. These findings indicate that pregnant adolescents have unmet needs for reproductive health, especially antenatal care.
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Affiliation(s)
- Raziye Kılıççeker
- Department of Emergency, Yakacık Maternity and Child Hospital, Istanbul / Turkey
| | - Mine Yurdakul
- Department of Midwifery, Mersin University İçel School of Health, 33343, Mersin / Turkey
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Liu T, Liu J, Wang C, Zou D, Wang C, Xu T, Ci Y, Guo X, Qi X. Prevalence of gastrointestinal symptoms and their association with psychological problems in youths. Ann Palliat Med 2023; 12:311-323. [PMID: 37019640 DOI: 10.21037/apm-22-1316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/04/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Gastrointestinal symptoms and psychological problems are common in youths, which can negatively affect their lives on physical, mental, and social levels. This cross-sectional study aimed to determine the prevalence of gastrointestinal symptoms in youths and further explore their association with psychological problems. METHODS Self-reported data on gastrointestinal symptoms and psychological problems in 692 sophomores who majored in education in a high vocational school and 310 recruits who were undergoing basic training in an army in China were retrospectively collected. The self-reported data included demographics, gastrointestinal symptoms, and Symptom Checklist 90 (SCL-90) used for the assessment of psychological problems. Gastrointestinal symptoms surveyed included nausea, emesis, abdominal pain, acid regurgitation, eructation, heartburn, anorexia, abdominal bloating, diarrhea, constipation, hematemesis, and hematochezia. Logistic regression analysis was performed to identify the independent risk factors associated with gastrointestinal symptoms. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated. RESULTS The prevalence of gastrointestinal symptoms was 36.7% (n=254) and 15.5% (n=48) in the sophomores and recruits, respectively. Participants with gastrointestinal symptoms had a significantly higher prevalence of total SCL-90 score beyond 160 than those without gastrointestinal symptoms in both sophomores (19.7% vs. 3.2%, P<0.001) and recruits (10.4% vs. 1.1%, P<0.001). Total SCL-90 score beyond 160 was independently associated with gastrointestinal symptoms in both sophomores (OR =5.467; 95% CI: 2.855-10.470; P<0.001) and recruits (OR =6.734; 95% CI: 1.226-36.999; P=0.028). CONCLUSIONS Gastrointestinal symptoms may be common and strongly associated with psychological problems in youths. Prospective studies should be required to explore the impact of the correction of psychological problems on the improvement of gastrointestinal symptoms.
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Affiliation(s)
- Tingwei Liu
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China; Graduate School, Jinzhou Medical University, Jinzhou, China
| | - Jun Liu
- Military Joint Teaching and Research Office, the 32684 Troop of Chinese PLA, Shenyang, China
| | - Cong Wang
- School of Nursing, Panjin Vocational and Technical College, Panjin, China
| | - Deli Zou
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Chunmei Wang
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China; Department of Gastroenterology, General Hospital of Fuxin Mining Industry Group of Liaoning Health Industry Group, Fuxin, China
| | - Tianchao Xu
- Department of Psychology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yihong Ci
- Department of Psychology, General Hospital of Northern Theater Command, Shenyang, China
| | - Xiaozhong Guo
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China; Graduate School, Jinzhou Medical University, Jinzhou, China
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Stone AL, Epstein I, Bruehl S, Garber J, Smith CA, Walker LS. Twenty-year Outcomes of a Pediatric Chronic Abdominal Pain Cohort: Early Adulthood Health Status and Offspring Physical and Behavioral Health. J Pain 2023; 24:145-156. [PMID: 36126817 PMCID: PMC9789180 DOI: 10.1016/j.jpain.2022.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/16/2022] [Accepted: 09/01/2022] [Indexed: 02/08/2023]
Abstract
Chronic abdominal pain (CAP) represents a common pediatric primary pain disorder that can have long-term effects on physical and mental health into adulthood. Pediatric CAP and Control cohorts recruited in childhood (∼11 years old, T1) and then assessed in emerging adulthood (∼20 years old, T2) were evaluated again for health outcomes in early adulthood (∼30 years old, T3) for the current study. Further, the study evaluated the mental and physical health of offspring of participants who had become parents. Participants who agreed to enroll at T3 (CAP: n = 90, Control: n = 55) completed measures regarding current health, health-related quality of life (HRQoL), and their child's health when applicable. Results indicated close to 20% of the CAP cohort reported recurrent CAP across all 3 timepoints. Participants with current CAP reported poorer HRQoL compared to participants with remitted CAP who reported poorer HRQoL compared to Control participants. The CAP cohort reported higher health-related anxiety compared to the Control cohort regardless of current pain status. CAP compared to Control participants reported greater emotional problems and fewer conduct problems in their children. Longitudinal studies are needed to assess the developmental course of pediatric chronic pain and intergenerational pathways of risk and resilience. Perspective: This article evaluates patterns of chronic abdominal pain from childhood into early adulthood. Patients with pediatric chronic abdominal pain continue to present with health-related anxiety in adulthood and report greater emotional problems in offspring.
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Affiliation(s)
- Amanda L Stone
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Isabel Epstein
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Medicine, Health, and Society, Vanderbilt University, Nashville, Tennessee
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Judy Garber
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee
| | - Craig A Smith
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee
| | - Lynn S Walker
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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Smedbråten K, Grotle M, Jahre H, Richardsen KR, Côté P, Steingrímsdóttir ÓA, Storheim K, Nielsen CS, Øiestad BE. Accumulation of health complaints is associated with persistent musculoskeletal pain two years later in adolescents: The Fit Futures study. PLoS One 2022; 17:e0278906. [PMID: 36580469 PMCID: PMC9799295 DOI: 10.1371/journal.pone.0278906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/27/2022] [Indexed: 12/30/2022] Open
Abstract
There is limited knowledge on the association between different health complaints and the development of persistent musculoskeletal pain in adolescents. The aims of this study were to assess whether specific health complaints, and an accumulation of health complaints, in the first year of upper-secondary school, were associated with persistent musculoskeletal pain 2 years later. We used data from a population-based cohort study (the Fit Futures Study in Norway), including 551 adolescents without persistent musculoskeletal pain at baseline. The outcome was persistent musculoskeletal pain (≥3 months) 2 years after inclusion. The following self-reported health complaints were investigated as individual exposures at baseline: asthma, allergic rhinitis, atopic eczema, headache, abdominal pain and psychological distress. We also investigated the association between the accumulated number of self-reported health complaints and persistent musculoskeletal pain 2 years later. Logistic regression analyses estimated adjusted odds ratios (ORs) with 95% confidence intervals (CIs). At the 2-year follow-up, 13.8% (95% CI [11.2-16.9]) reported persistent musculoskeletal pain. Baseline abdominal pain was associated with persistent musculoskeletal pain 2 years later (OR 2.33, 95% CI [1.29-4.19], p = 0.01). Our analyses showed no statistically significant associations between asthma, allergic rhinitis, atopic eczema, headache or psychological distress and persistent musculoskeletal pain at the 2-year follow-up. For the accumulated number of health complaints, a higher odds of persistent musculoskeletal pain at the 2-year follow-up was observed for each additional health complaint at baseline (OR 1.33, 95% CI [1.07-1.66], p = 0.01). Health care providers might need to take preventive actions in adolescents with abdominal pain and in adolescents with an accumulation of health complaints to prevent development of persistent musculoskeletal pain. The potential multimorbidity perspective of adolescent musculoskeletal pain is an important topic for future research to understand the underlying patterns of persistent pain conditions in adolescents.
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Affiliation(s)
- Kaja Smedbråten
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
- * E-mail:
| | - Margreth Grotle
- Department of Rehabilitation Science and Health Technology, Centre for Intelligent Musculoskeletal Health, Oslo Metropolitan University, Oslo, Norway
- Division of Clinical Neuroscience, Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
| | - Henriette Jahre
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
- Department of Rehabilitation Science and Health Technology, Centre for Intelligent Musculoskeletal Health, Oslo Metropolitan University, Oslo, Norway
| | - Kåre Rønn Richardsen
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
- Department of Rehabilitation Science and Health Technology, Centre for Intelligent Musculoskeletal Health, Oslo Metropolitan University, Oslo, Norway
| | - Pierre Côté
- Faculty of Health Sciences and Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Canada
| | - Ólöf Anna Steingrímsdóttir
- Division of Mental and Physical Health, Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway
| | - Kjersti Storheim
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
- Division of Clinical Neuroscience, Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
| | - Christopher Sivert Nielsen
- Division of Mental and Physical Health, Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
- Division of Emergencies and Critical Care, Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Britt Elin Øiestad
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
- Department of Rehabilitation Science and Health Technology, Centre for Intelligent Musculoskeletal Health, Oslo Metropolitan University, Oslo, Norway
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Cheng S, Yu E, Garacci Z, Erwin AL, Venkatesan T. Prevalence of Undiagnosed Acute Hepatic Porphyria in Cyclic Vomiting Syndrome and Overlap in Clinical Symptoms. Dig Dis Sci 2022; 68:2107-2114. [PMID: 36380150 DOI: 10.1007/s10620-022-07756-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Acute hepatic porphyria (AHP) presents with nausea and vomiting and can mimic cyclic vomiting syndrome (CVS). The prevalence of AHP in CVS and overlap in clinical symptomatology is not known. We thus sought to determine the prevalence of pathogenic variants for AHP and characterize symptom overlap between CVS and AHP. METHODS We conducted a cross-sectional study of 234 CVS patients using Rome criteria. Patients were eligible for AHP genetic testing if they had recurrent episodes of severe, diffuse abdominal pain with ≥ 2 of the following-peripheral nervous system (muscle weakness/aching, numbness, tingling), central nervous system (confusion, anxiety, seizures, hallucinations), autonomic nervous system (hyponatremia, tachycardia, hypertension, constipation) symptoms, red/brownish urine, or blistering skin lesions on sun-exposed areas. A family history of AHP or elevated urinary porphobilinogen (PBG)/aminolaevulinic acid (ALA) were also criteria for genetic testing and was performed using a 4-gene panel. RESULTS Mean age was 38.7 ± 14.5 years, 180 (76.9%) were female and 200 (85.5%) were Caucasian. During a CVS attack, 173 (92%) reported abdominal pain, 166 (87.2%) had peripheral nervous system, 164 (86.8%) had central nervous system and 173 (92) % had autonomic symptoms. Ninety-one eligible patients completed genetic testing. None were positive for AHP but two had variants of uncertain significance (VUS) in the HMBS gene. CONCLUSIONS There is a high prevalence of non-gastrointestinal symptoms in CVS, like AHP, which is important for clinicians to recognize. AHP was not detected in this study and larger studies are warranted to ascertain its prevalence.
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Affiliation(s)
- Shanna Cheng
- Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Elliot Yu
- Gastroenterology and Hepatology Fellow, Division of Gastroenterology and Hepatology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Zhuping Garacci
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Angelika L Erwin
- Department of Pediatrics, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Center for Personalized Genetic Healthcare, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Thangam Venkatesan
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University College of Medicine, 395 W 12th Avenue, Columbus, OH, 43210, USA.
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Karunanayake A, Devanarayana NM, Rajindrajith S. Early life events in functional abdominal pain disorders in children. PLoS One 2022; 17:e0275419. [PMID: 36322579 PMCID: PMC9629606 DOI: 10.1371/journal.pone.0275419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/18/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives Functional abdominal pain disorders (FAPDs) are common gastrointestinal problems in children, and the pathophysiology is thought to be multifactorial. Adverse early life events (ELE) induce alterations in the central nervous system, perhaps predisposing individuals to develop FAPDs. We aimed to study the potential adverse ELE that are associated with FAPDs. Methods We steered a school-based survey involving 1000 children from 4 randomly selected schools. FAPDs were assessed using the translated Rome III questionnaire, and ELE were identified using a pre-tested, parental questionnaire. FAPDs were diagnosed using the Rome III criteria. Results Hundred and eighty-two (182) children had FAPDs (62.1% girls, mean age 8.5, SD 2.1). ELE of them were compared with 571 children without FAPDs (51.1% girls, mean age 8.8, SD 1.9). According to the binary logistic regression analysis, family members with abdominal pain, family member with chronic pain other than abdominal pain, prenatal maternal complications and interventional deliveries, were recognized as potential risk factors for the development of FAPDs. Breast feeding over two years has shown to reduce the prevalence of FAPDs.a. Conclusions Prenatal maternal medical problems are associated a with higher prevalence of FAPDs later in life. Prolonged breastfeeding and normal vaginal delivery could be considered as factors that reduce the vulnerability of developing FAPDs in children. Therefore, minimizing pregnancy-related complications, encouraging vaginal deliveries, and encouraging breastfeeding are potentially valuable measures to prevent FAPDs during childhood.
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Kralicek SE, Sitaraman LM, Kuprys PV, Harrington AT, Ramakrishna B, Osman M, Hecht GA. Clinical Manifestations and Stool Load of Atypical Enteropathogenic Escherichia coli Infections in United States Children and Adults. Gastroenterology 2022; 163:1321-1333. [PMID: 35948108 PMCID: PMC9613550 DOI: 10.1053/j.gastro.2022.07.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS There is debate whether atypical enteropathogenic Escherichia coli (aEPEC) causes disease in adults. aEPEC is commonly detected in symptomatic and asymptomatic individuals. aEPEC, in contrast to typical EPEC, lacks bundle-forming pili, altering its pathogenicity. Here, we define for the first time the clinical manifestations of sporadic aEPEC infection in United States children and adults and determine whether EPEC load correlates with disease. METHODS This is a retrospective case-control study of 380 inpatients/outpatients of all ages. EPEC load in stools was determined by quantitative polymerase chain reaction. RESULTS Diarrhea, vomiting, abdominal pain, and fever were more prevalent in EPEC-positive cases than in EPEC-negative controls. aEPEC infection caused mostly acute, mild diarrhea lasting for 6 to 13 days. However, some had severe diarrhea with 10 to 40 bowel movements per day or had persistent/chronic diarrhea. Fever, vomiting, and abnormal serum sodium levels were more common in children. Adults more often reported abdominal pain and longer duration of diarrhea. Symptomatic aEPEC infection was associated with leukocytosis in 24% of patients. EPEC load >0.1% was associated with symptomatic infection; however, loads varied greatly. Co-infecting pathogens did not alter diarrhea severity or EPEC load. Longitudinal data reveal that some are colonized for months to years or are repeatedly infected. CONCLUSIONS aEPEC is associated with a wide array of symptoms in adults, ranging from asymptomatic carriage to severe diarrhea. Higher EPEC loads are associated with presence of symptoms, but bacterial load does not predict disease or severity. Future studies are needed to understand bacterial and host factors that contribute to aEPEC pathogenicity to improve diagnostic tools and clinical care.
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Affiliation(s)
- Sarah E Kralicek
- Department of Biochemistry and Molecular Biology, Loyola University Chicago, Maywood, Illinois
| | - Lalitha M Sitaraman
- Division of Gastroenterology, Department of Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Paulius V Kuprys
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Amanda T Harrington
- Clinical Microbiology Laboratory, Loyola University Medical Center, Maywood, Illinois; Pathology and Laboratory Medicine, Loyola University Chicago, Maywood, Illinois
| | | | | | - Gail A Hecht
- Division of Gastroenterology, Department of Medicine, Loyola University Medical Center, Maywood, Illinois; Department of Microbiology and Immunology, Loyola University Chicago, Maywood, Illinois.
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Wright M, Pienaar F. Whakarongorau abdominal pain review. N Z Med J 2022; 135:56-64. [PMID: 36049790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
AIMS The purpose of this study was to compare the frequency and profile of abdominal pain calls to Healthline with that from other national healthcare providers; to evaluate the outcomes for this symptom against international telehealth providers; and to explore any inter-clinician variation in the response to abdominal pain that could be part of a quality improvement cycle. METHODS Data routinely collected about abdominal pain calls to Healthline from 2017 to 2019 were extracted, analysed; and compared to the literature, hospital, and ambulance data and international telehealth providers. A specialist group was convened to review the profile of Healthline callers and outcome data. Variation in outcome changes and acuity grouping was evaluated at an individual level. RESULTS Approximately 50,000 abdominal pain calls to Healthline over three years were analysed, with three-quarters from women, mostly of childbearing age. The majority call afterhours, with NZ European and, to a lesser extent, Māori, and callers from smaller geographical areas are over-represented. One quarter of patients had a hospital outcome (including 4% receiving an ambulance), which was found to be less acute than comparable health systems. Whakarongorau's Clinical Governance Committee and the Specialist Group both supported the relative distribution of outcomes given by Healthline for abdominal pain. There was found to be variation in the outcomes given to abdominal pain callers at an individual clinician level. This was both in their changes to the disposition given by the Odyssey decision support tool and in their overall outcome distribution. CONCLUSION Healthline should be considered a key part of New Zealand's healthcare system, as illustrated by the volume of calls that it receives and the fact that presentation types are similar to general practice and emergency departments. Given that abdominal pain is a difficult symptom to accurately address without in-person examination and investigation, the findings support Healthline's outcomes as appropriate with hospitalisation rates lower than comparable healthcare systems. Whakarongorau's (the organisation which runs Healthline) ability to identify individual clinician behaviours gives it a unique opportunity to improve care through decreasing variation.
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Affiliation(s)
- Matt Wright
- Clinical Lead, Urgent Care, Whakarongorau Aotearoa New Zealand
| | - Fiona Pienaar
- Senior Clinical Advisor, Whakarongorau Aotearoa New Zealand
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Freire GC, Diong C, Gandhi S, Saunders N, Neuman MI, Freedman SB, Friedman JN, Cohen E. Variation in low-value radiograph use for children in the emergency department: a cross-sectional study of administrative databases. CMAJ Open 2022; 10:E889-E899. [PMID: 36220182 PMCID: PMC9578750 DOI: 10.9778/cmajo.20210140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Radiograph use contributes to low-value care for children in emergency departments (EDs), but little is known about systemic factors associated with their use. This study compares low-value radiograph use across ED settings by hospital type, pediatric volumes and physician specialty. METHODS This is a cross-sectional study of routinely collected administrative data. We included children (age 0-18 yr) discharged from EDs in Ontario, Canada, between 2010 and 2019 with diagnoses of bronchiolitis, asthma, abdominal pain and constipation. Multiple clinical practice guidelines recommend against routine radiograph use in these conditions. Logistic regression evaluated odds of low-value radiograph by ED setting (pediatric academic [referent], adult academic, community with or without pediatric consultation services), pediatric volume and physician specialty (pediatric emergency medicine [PEM, referent], emergency medicine [EM], family medicine with EM training, pediatrics, family medicine), adjusting for demographic, clinical and provider characteristics. We used generalized estimating equations to account for clustering by ED. RESULTS Of the total 9 862 787 eligible pediatric ED discharges in Ontario, 60 914 children had bronchiolitis, 141 921 asthma, 333 332 abdominal pain and 110 514 constipation; 26.0% received low-value radiographs. Compared with pediatric EDs and PEM physicians (referents), patients with bronchiolitis were most likely to have a chest radiograph in adult academic EDs (adjusted odds ratio [OR] 5.1 [95% confidence interval (CI) 4.6-5.6]) and by family physicians with EM training (adjusted OR 4.8 [95% CI 4.5-5.1]). Patients with asthma were more likely to have a chest radiograph in adult academic EDs (adjusted OR 3.0 [95% CI 2.8-3.2]) and by EM physicians (adjusted OR 2.8 [95% CI 2.6-3.0]). Patients with abdominal pain and constipation were more likely to have abdominal radiographs in community hospitals with pediatric consultation (adjusted OR 1.6 [95% CI 1.6-1.7] and 2.3 [95% CI 2.3-2.4], respectively) and by family physicians with EM training (adjusted OR 1.6 [95% CI 1.6-1.7] and 2.1 [95% CI 2.0-2.2], respectively). INTERPRETATION Over the decade-long study period, low-value radiograph use was frequent for children with 4 common conditions seen in Ontario EDs. Quality improvement initiatives aimed at reducing unnecessary radiographs in children should focus on EM physicians practising in EDs that primarily treat adult patients.
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Affiliation(s)
- Gabrielle C Freire
- Division of Emergency Medicine (Freire), Division of Pediatric Medicine (Saunders, Friedman, Cohen), Department of Pediatrics (Freire, Saunders, Friedman, Cohen), The Hospital for Sick Children, University of Toronto; Child Health Evaluative Sciences (Saunders, Cohen), Hospital for Sick Children Research Institute; ICES (Diong, Gandhi, Saunders, Cohen); Institute of Health Policy, Management, and Evaluation (Saunders, Cohen), University of Toronto; Edwin S.H. Leong Centre for Healthy Children (Cohen), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Neuman), Boston Children's Hospital, Department of Pediatrics (Neuman), Harvard Medical School, Boston, Mass.; Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine (Freedman), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Christina Diong
- Division of Emergency Medicine (Freire), Division of Pediatric Medicine (Saunders, Friedman, Cohen), Department of Pediatrics (Freire, Saunders, Friedman, Cohen), The Hospital for Sick Children, University of Toronto; Child Health Evaluative Sciences (Saunders, Cohen), Hospital for Sick Children Research Institute; ICES (Diong, Gandhi, Saunders, Cohen); Institute of Health Policy, Management, and Evaluation (Saunders, Cohen), University of Toronto; Edwin S.H. Leong Centre for Healthy Children (Cohen), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Neuman), Boston Children's Hospital, Department of Pediatrics (Neuman), Harvard Medical School, Boston, Mass.; Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine (Freedman), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Sima Gandhi
- Division of Emergency Medicine (Freire), Division of Pediatric Medicine (Saunders, Friedman, Cohen), Department of Pediatrics (Freire, Saunders, Friedman, Cohen), The Hospital for Sick Children, University of Toronto; Child Health Evaluative Sciences (Saunders, Cohen), Hospital for Sick Children Research Institute; ICES (Diong, Gandhi, Saunders, Cohen); Institute of Health Policy, Management, and Evaluation (Saunders, Cohen), University of Toronto; Edwin S.H. Leong Centre for Healthy Children (Cohen), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Neuman), Boston Children's Hospital, Department of Pediatrics (Neuman), Harvard Medical School, Boston, Mass.; Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine (Freedman), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Natasha Saunders
- Division of Emergency Medicine (Freire), Division of Pediatric Medicine (Saunders, Friedman, Cohen), Department of Pediatrics (Freire, Saunders, Friedman, Cohen), The Hospital for Sick Children, University of Toronto; Child Health Evaluative Sciences (Saunders, Cohen), Hospital for Sick Children Research Institute; ICES (Diong, Gandhi, Saunders, Cohen); Institute of Health Policy, Management, and Evaluation (Saunders, Cohen), University of Toronto; Edwin S.H. Leong Centre for Healthy Children (Cohen), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Neuman), Boston Children's Hospital, Department of Pediatrics (Neuman), Harvard Medical School, Boston, Mass.; Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine (Freedman), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Mark I Neuman
- Division of Emergency Medicine (Freire), Division of Pediatric Medicine (Saunders, Friedman, Cohen), Department of Pediatrics (Freire, Saunders, Friedman, Cohen), The Hospital for Sick Children, University of Toronto; Child Health Evaluative Sciences (Saunders, Cohen), Hospital for Sick Children Research Institute; ICES (Diong, Gandhi, Saunders, Cohen); Institute of Health Policy, Management, and Evaluation (Saunders, Cohen), University of Toronto; Edwin S.H. Leong Centre for Healthy Children (Cohen), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Neuman), Boston Children's Hospital, Department of Pediatrics (Neuman), Harvard Medical School, Boston, Mass.; Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine (Freedman), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Stephen B Freedman
- Division of Emergency Medicine (Freire), Division of Pediatric Medicine (Saunders, Friedman, Cohen), Department of Pediatrics (Freire, Saunders, Friedman, Cohen), The Hospital for Sick Children, University of Toronto; Child Health Evaluative Sciences (Saunders, Cohen), Hospital for Sick Children Research Institute; ICES (Diong, Gandhi, Saunders, Cohen); Institute of Health Policy, Management, and Evaluation (Saunders, Cohen), University of Toronto; Edwin S.H. Leong Centre for Healthy Children (Cohen), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Neuman), Boston Children's Hospital, Department of Pediatrics (Neuman), Harvard Medical School, Boston, Mass.; Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine (Freedman), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Jeremy N Friedman
- Division of Emergency Medicine (Freire), Division of Pediatric Medicine (Saunders, Friedman, Cohen), Department of Pediatrics (Freire, Saunders, Friedman, Cohen), The Hospital for Sick Children, University of Toronto; Child Health Evaluative Sciences (Saunders, Cohen), Hospital for Sick Children Research Institute; ICES (Diong, Gandhi, Saunders, Cohen); Institute of Health Policy, Management, and Evaluation (Saunders, Cohen), University of Toronto; Edwin S.H. Leong Centre for Healthy Children (Cohen), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Neuman), Boston Children's Hospital, Department of Pediatrics (Neuman), Harvard Medical School, Boston, Mass.; Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine (Freedman), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Eyal Cohen
- Division of Emergency Medicine (Freire), Division of Pediatric Medicine (Saunders, Friedman, Cohen), Department of Pediatrics (Freire, Saunders, Friedman, Cohen), The Hospital for Sick Children, University of Toronto; Child Health Evaluative Sciences (Saunders, Cohen), Hospital for Sick Children Research Institute; ICES (Diong, Gandhi, Saunders, Cohen); Institute of Health Policy, Management, and Evaluation (Saunders, Cohen), University of Toronto; Edwin S.H. Leong Centre for Healthy Children (Cohen), University of Toronto, Toronto, Ont.; Division of Emergency Medicine (Neuman), Boston Children's Hospital, Department of Pediatrics (Neuman), Harvard Medical School, Boston, Mass.; Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine (Freedman), Cumming School of Medicine, University of Calgary, Calgary, Alta.
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Yousaf A, Mutalib M. Burden of Pediatric Functional Gastrointestinal Disorder in an Emergency Department-A Single-Center Experience. Pediatr Emerg Care 2022; 38:e1512-e1516. [PMID: 35969269 DOI: 10.1097/pec.0000000000002807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Functional gastrointestinal disorders (FGIDs) are recurrent or chronic gastrointestinal signs and symptoms in the absence of anatomical or biochemical alterations. They are commonly treated in outpatient setting but often present to emergency departments. We aimed to estimate the burden of pediatric FGID on a busy accident and emergency (A&E) department. METHODS Electronic patient records were used to retrospectively analyze the A&E attendances of 3866 patients presenting with either constipation or abdominal pain. Those found not to have a surgical/organic cause were assessed in terms of various parameters, that is, arrival times, wait times, and investigations performed. RESULTS A total of 91.31% of the attendances relating to constipation or nonsurgical, nonorganic causes of abdominal pain were self-referred with only 3.64% arriving via ambulance, an average wait time ranging between 138 and 156 minutes, and a total of 1008 investigations carried out on patients presenting with these symptoms. A total of 63.65% of the patients were discharged without follow-up. CONCLUSIONS Functional gastrointestinal disorders place considerable burden on the A&E, in terms of resource usage, time of clinicians, and financial strain. More education should be provided to families of those experiencing FGID in an outpatient setting to minimize A&E resource utilization. More research is needed to ascertain the true burden of FGIDs, both financially and in terms of time and resource.
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Affiliation(s)
- Afroze Yousaf
- From the Faculty of Life Science and Medicine, King's College London
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Mubiru IS, Kasirye PG, Hume H, Ndeezi G. Prevalence and factors associated with Helicobacter Pylori infection among children with sickle cell anemia attending Mulago hospital, in Uganda. Afr Health Sci 2022; 22:135-145. [PMID: 36407337 PMCID: PMC9652666 DOI: 10.4314/ahs.v22i2.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Children with sickle cell anemia (SCA) have a high predisposition to a range of infections and gastrointestinal disorders. Studies of children living in low income countries have shown high levels of infection with Helicobacter Pylori (H. pylori), however, there are no reports in Ugandan children with SCA. Objectives We aimed to describe the prevalence and factors associated with H. pylori infection among children with SCA at Mulago Hospital. Methods A cross-sectional study was conducted on 340 children with SCA aged 5–18 years. Assessments included recurrent abdominal pain(RAP), dyspeptic symptoms, relevant medical and social histories. Stool samples were collected and an antigen test carried out to determine H. pylori infection. H. pylori prevalence and its associated factors were determined. Results Helicobacter pylori infection was detected in 49%(168/340); (95%Confidence interval (CI): 44.1, 54.7) of the study subjects. Having epigastric pain was independently associated with H. pylori infection; (Adjusted odds ratio [aOR] = 1.89; 95%CI: 1.1, 3.6; p= 0.048). Pneumococcal vaccination; (aOR=0.425; 95%CI: 0.2, 0.9; p=0.019) and appetite loss; (aOR=0.588; 95%CI: 0.3, 0.9; p=0.046) were negatively associated with H. pylori infection. RAP was not associated with H. pylori infection. Conclusions H. pylori infection was common among children with SCA and independently associated with epigastric pain but not recurrent abdominal pain. Pneumococcal vaccination and appetite loss were protective against the infection. Screening for H. pylori should be carried out in SCA children with epigastric pain.
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Affiliation(s)
- Idris Swaleh Mubiru
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences
| | - Phillip G Kasirye
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences
- Department of Paediatrics, Mulago National Referral Hospital
| | - Heather Hume
- Dept of Paediatrics, Universite de Montreal, Canada
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences
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Polhemus S, Pickett ML, Liu XJ, Fraser R, Ferguson CC, Drendel AL. Racial Disparities in the Emergency Department Evaluation of Adolescent Girls. Pediatr Emerg Care 2022; 38:307-311. [PMID: 35353799 DOI: 10.1097/pec.0000000000002675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Racial disparities and differences exist in emergency care. Obtaining a sexual history is standard of care for adolescents with abdominal pain. Testing for sexually transmitted infections (STIs) and pregnancy should be based on historical findings. The objective of this study was to determine whether differential care was provided to adolescent female patients with abdominal pain based on patient race or healthcare provider characteristics by evaluating the documentation of sexual history, STI testing, and pregnancy testing. METHODS This was a retrospective chart review of female patients between the ages of 14 and 18 years with abdominal pain presenting to a pediatric emergency department. Patient and provider characteristics, sexual history documentation, STI, and pregnancy testing were abstracted. Data were analyzed using χ 2 test and logistic regression model. RESULTS Eight hundred eighty-six encounters were included in the analysis. Median patient age was 16 years (range, 14-18 years); 359 (40.5%) were non-White. Differential care was provided. Non-White patients compared with White patients were more likely to have a documented sexual history (59.9% vs 44.0%, P < 0.001), STI testing (24.8% vs 7.8%, P < 0.001), and pregnancy testing (76.6% vs 66.2%, P < 0.001). Among sexually active female patients, the racial disparity for STI testing persisted ( P = 0.010). Provider type and sex did not result in differences in sexual history documentation, STI, or pregnancy testing for non-White compared with White patients ( P > 0.05). CONCLUSIONS Differential care was provided to non-White adolescents with abdominal pain compared with White adolescents. They were more likely to have a documented sexual history, STI testing, and pregnancy testing. Healthcare provider characteristics did not impact patient care. This racial disparity resulted in better medical care for non-White adolescents, but this may be the consequence of underlying implicit bias.
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Affiliation(s)
| | - Michelle L Pickett
- From the Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Xuerong Joy Liu
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Raphael Fraser
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | | | - Amy L Drendel
- From the Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
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Agah S, Aminianfar A, Hassanzadeh Keshteli A, Bitarafan V, Adibi P, Esmaillzadeh A, Feinle-Bisset C. Association between Dietary Macronutrient Intake and Symptoms in Uninvestigated Dyspepsia: Evidence from a Population-Based, Cross-Sectional Study. Nutrients 2022; 14:nu14132577. [PMID: 35807757 PMCID: PMC9268281 DOI: 10.3390/nu14132577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/18/2022] [Accepted: 06/20/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: Limited evidence from laboratory-based studies suggests that specific dietary macronutrients, particularly fat, can induce dyspeptic symptoms. Through a population-based study, we investigated the relationship between dietary macronutrients and dyspeptic symptoms and sought to determine macronutrient intake thresholds to predict or prevent dyspepsia and reduce symptoms in patients with dyspepsia. (2) Methods: A total of 4763 Iranian people were enrolled in this population-based, cross-sectional study. Uninvestigated dyspepsia (UD) and its symptoms, including postprandial fullness, early satiation, and epigastric pain, were evaluated using a modified Persian version of the Rome III criteria. The dietary intakes of participants were evaluated using a validated food−frequency questionnaire. Receiver operating characteristic (ROC) curve analysis was used to calculate threshold intakes of dietary macronutrients to prevent UD in the general population. The analysis was then repeated in those with UD to calculate intake thresholds for reducing UD symptoms. (3) Results: Early satiation occurred in 6.3% (n = 302), postprandial fullness in 8.0% (n = 384) and epigastric pain in 7.8% (n = 371) of participants. The prevalence of UD was 15.2%. Compared with individuals without UD, those with UD had a lower intake of carbohydrates (48.2% vs. 49.1%) and a higher intake of fats (38.3% vs. 37.4%), while protein and energy intakes did not differ. Higher dietary fat and protein intakes were associated with a higher prevalence of postprandial fullness and epigastric pain, respectively. Macronutrient intakes to predict UD in the general population were <49% of energy from carbohydrates, >14.7% from protein, and >37.7% from fats. Carbohydrate, protein, and fat intakes to prevent symptoms among those with UD were calculated to be >48.2%, <14.6%, and <38.6%, respectively. (4) Conclusion: Higher carbohydrate intake and lower fat or protein intakes were associated with a lower likelihood of UD. Prospective studies carefully manipulating dietary macronutrient composition are warranted to investigate the value of dietary changes to improve symptoms in people with UD.
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Affiliation(s)
- Shahram Agah
- Colorectal Research Centre, Iran University of Medical Sciences, Tehran 1445613131, Iran;
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia;
| | - Azadeh Aminianfar
- Research Centre for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan 8715988141, Iran;
| | - Ammar Hassanzadeh Keshteli
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2P5, Canada;
- Integrative Functional Gastroenterology Research Centre, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
| | - Vida Bitarafan
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia;
- Centre of Research Excellence in Translating Nutritional Sciences to Good Health, University of Adelaide, Adelaide, SA 5005, Australia
| | - Peyman Adibi
- Gastroenterology and Hepatology Research Centre, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran;
| | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran 1416634793, Iran
- Obesity and Eating Habits Research Centre, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran 1416634793, Iran
- Department of Community Nutrition, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
- Correspondence: (A.E.); (C.F.-B.)
| | - Christine Feinle-Bisset
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia;
- Centre of Research Excellence in Translating Nutritional Sciences to Good Health, University of Adelaide, Adelaide, SA 5005, Australia
- Correspondence: (A.E.); (C.F.-B.)
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Li PC, Lin WY, Ding DC. Risk factors and clinical characteristics associated with a ruptured ectopic pregnancy: A 19-year retrospective observational study. Medicine (Baltimore) 2022; 101:e29514. [PMID: 35713461 PMCID: PMC9276220 DOI: 10.1097/md.0000000000029514] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 05/06/2022] [Indexed: 11/25/2022] Open
Abstract
Ectopic pregnancy is the most common cause of maternal mortality in the first trimester of pregnancy. The aim of this study was to find risk factors and clinical characteristics associated with ruptured ectopic pregnancies at a medical center in eastern Taiwan in a 19-year period. This was a retrospective observational study that included patients diagnosed with ectopic pregnancy between August 1999 and December 2018. Data about the demographic variables, initial presentation, pre-treatment beta-human chorionic gonadotropin levels, treatment routes (laparoscopy or laparotomy), surgical methods (salpingostomy or salpingectomy), operation time, blood loss amount, the status of ectopic pregnancy (ruptured or unruptured), the requirement for transfusion, and duration of hospital stay were collected. The categorical and continuous variables were analyzed using the correlation coefficients. This study included 225 women who were diagnosed as having an ectopic pregnancy. There were 49 and 176 women with unruptured and ruptured ectopic pregnancies, respectively. The beta-human chorionic gonadotropin levels, history of previous ectopic pregnancy, pelvic inflammatory disease, tubal surgery, abdominal history, and vaginal bleeding were not significantly different between the 2 groups. The ratio of women with abdominal pain was significantly higher in the ruptured ectopic pregnancy group than in the unruptured group (89.1% vs. 63.8%, respectively, P < .001). Preoperative hemoglobin was lower in the ruptured group compared with the unruptured group (P < .001). Blood loss, postoperative hemoglobin, and blood transfusion were significantly higher in the ruptured group than in the unruptured group (P = .000 and P = .001 for blood loss and blood transfusion, respectively). Multiple logistic regression analysis revealed that abdominal pain and blood loss were associated with ruptured tubal pregnancies (adjusted odds ratio [95% confidence intervals]: 3.42 {1.40, 8.40}; 1.01 {1.005, 1.014}, respectively). In conclusion, early pregnancy with abdominal pain, more parity, and lower preoperative hemoglobin should be aware of the possibility of ruptured ectopic pregnancy. More blood loss, transfusion and lower postoperative hemoglobin were also noted with ruptured ectopic pregnancy.
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Affiliation(s)
- Pei-Chen Li
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, and Tzu Chi University, Hualien, Taiwan
| | - Wen-Yu Lin
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, and Tzu Chi University, Hualien, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, and Tzu Chi University, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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50
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Liu Y, Jiang Y, Wu M, Muheyat S, Yao D, Jin X. Short-term effects of ambient air pollution on daily emergency room visits for abdominal pain: a time-series study in Wuhan, China. Environ Sci Pollut Res Int 2022; 29:40643-40653. [PMID: 35084676 DOI: 10.1007/s11356-021-18200-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Abstract
Short-term exposure to ambient air pollution has been proven to result in respiratory, cardiovascular, and digestive diseases, leading to increased emergency room visits (ERVs). Abdominal pain complaints provide a large proportion of the ERVs, as yet few studies have focused on the correlations between ambient air pollution and abdominal pain, especially in emergency departments within China. Daily data for daily ERVs were collected in Wuhan, China (from January 1, 2016 to December 31, 2018), including air pollution concentration (SO2, NO2, PM2.5, PM10, CO, and O3), and meteorological variables. We conducted a time-series study to investigate the potential correlation between six ambient air pollutants and ERVs for abdominal pain and their effects, in different genders, ages, and seasons. A total of 16,318 abdominal pain ERVs were identified during the study period. A 10-μg/m3 increase in concentration of SO2, NO2, PM2.5, PM10, CO, and O3 corresponded respectively to incremental increases in abdominal pain of 4.89% (95% confidence interval [CI]: - 1.50-11.70), 1.85% (95% CI: - 0.29-4.03), 0.83% (95% CI: - 0.05-1.72), - 0.22% (95% CI: - 0.73-0.30), 0.24% (95% CI: 0.08-0.40), and 0.86% (95% CI: 0.04 - 1.69). We observed significant correlations between CO and O3 and increases in daily abdominal pain ERVs and positive but insignificant correlations between the other pollutants and ERVs (except PM10). The effects were stronger for females (especially SO2 and O3: 13.53% vs. - 2.46%; 1.20% vs. 0.47%, respectively) and younger people (especially CO and O3: 0.25% vs. 0.01%; 1.36% vs. 0.15%, respectively). Males (1.38% vs. 0.87%) and elders (1.27% vs. 0.99%) were more likely to be affected by PM2.5. The correlations with PM2.5 were stronger in cool seasons (1.25% vs. - 0.07%) while the correlation with CO was stronger in warm seasons (0.47% vs. 0.14%). Our time-series study suggests that short-term exposure to air pollution (especially CO and O3) was positively correlated with ERVs for abdominal pain in Wuhan, China, and that the effects varied by season, gender and age. These data can add evidence on how air pollutants affect the human body and may prompt hospitals to take specific precautions on polluted days and maintain order in emergency departments made busier due to the pollution.
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Affiliation(s)
- Yaqi Liu
- The Emergency Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
- The Second Clinical School of Wuhan University, Wuhan, 430071, Hubei, China
| | - Yi Jiang
- The Second Clinical School of Wuhan University, Wuhan, 430071, Hubei, China
| | - Manyi Wu
- The Second Clinical School of Wuhan University, Wuhan, 430071, Hubei, China
| | - Sunghar Muheyat
- The Second Clinical School of Wuhan University, Wuhan, 430071, Hubei, China
| | - Dongai Yao
- Physical Examination Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Xiaoqing Jin
- The Emergency Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
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