Abstract
BackgroundWe studied whether short-term exposure to air pollution was associated with non-specific abdominal pain in epidemiologic and animal studies.MethodsPatients visiting the emergency department with non-specific abdominal pain were identified in Edmonton (1992 to 2002, n = 95,173) and Montreal (1997 to 2002, n = 25,852). We calculated the daily concentrations for ozone (O3), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), and particles <10 (PM10) or <2.5 (PM2.5) µm. A case crossover study design was used to estimate the odds ratio (OR) and 95% confidence interval (CI) associated with an increase in the interquartile range of the air pollutants. We investigated differential effects by age and sex. Mice were gavaged with urban particle extracts. In animal models, colonic motility was tested, and visceral abdominal pain was measured using a writhing test, and behavioral response to oil of mustard and neostigmine. Motility and pain was measured acutely (1.5 hours after gavage) and chronically (7-days and 21-days after gavage).ResultsEmergency department visits for non-specific abdominal pain were primarily by women between the ages of 15–24 years. Individuals aged 15 to 24 years were at increased risk of non-specific abdominal pain in Edmonton (same day CO: OR = 1.04, 95% CI = 1.02–1.06; and NO2: OR = 1.06, 95% CI = 1.03–1.09). The risk of air pollution among 15–24 year olds in Montreal was significantly positive (same day CO: OR = 1.11, 95% CI = 1.05–1.17; NO2: OR = 1.09, 95% CI = 1.01–1.16; SO2: OR = 1.17, 95% CI = 1.10–1.25; PM2.5: OR = 1.09, 95% CI = 1.04–1.15). Abdominal pain was increased by an acute gavage of pollution extract but not to chronic exposure to pollutants. Colonic transit was delayed following chronic but not acute exposure with the pollutants.ConclusionsEpidemiological and animal data suggest that short-term exposure to air pollution may trigger non-specific abdominal pain in young individuals.
Highlights
Abdominal pain is the second most common diagnosis (4.2%) claimed by emergency department physicians in the USA
In many cases patients are diagnosed with non-specific abdominal pain, which refers to abdominal pain that is not explained during acute assessment. [1,2] While many patients diagnosed with nonspecific abdominal pain are asymptomatic at a later outpatient follow-up [3,4,5], a subset of these patients require recurrent admissions. [6,7,8] non-specific abdominal pain is an important clinical presentation associated with impairment in quality of life for patients and significant costs to the health care system. [7,8]
2/3 of emergency department visits for non-specific abdominal pain were by women and the majority of women presented in adolescence and early adulthood (Figure 1A and 1B; Table S1)
Summary
In many cases patients are diagnosed with non-specific abdominal pain, which refers to abdominal pain that is not explained during acute assessment. Non-specific abdominal pain may be due to gastrointestinal diseases such as Crohn’s [9] and celiac [10] diseases that are diagnosed after the patient is discharged from the emergency department. We investigated whether acute exposure to air pollutants was associated with emergency department visits for non-specific abdominal pain by: 1) evaluating the effect of shortterm ambient air pollution exposure in a human population; 2) replicating this epidemiological study in a second population; and 3) exploring the biological plausibility in in vitro and in vivo models. We studied whether short-term exposure to air pollution was associated with non-specific abdominal pain in epidemiologic and animal studies
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