Abdominal Pain In Adolescents Research Articles

Higher Self-perceived Stress Reactivity Is Associated with Increased Odds for the Development of Chronic Pain

Experiencing stress can contribute to unfavorable pain experiences, but outcomes vary across individuals. Evidence suggests that a person's specific reactivity to stressful events may influence pain responses, independent of the type of event. Previous studies measuring physiological markers of stress reactivity such as salivary cortisol and heart rate have found associations with pain both clinically (e.g. recurrent abdominal pain in adolescents, and increased odds of future musculoskeletal pain frequency and severity in young adults) and in the laboratory (i.e. decreased conditioned pain modulation). However, the time and cost required for testing physiological stress reactivity may limit clinical application and reduce external validity. Alternatively, self-reported perception of one's own stress reactivity has been shown to correlate with physiological stress reactivity in relation to health outcomes, and as such may be a valuable tool in predicting pain outcomes. Using data from the Midlife in the United States survey, we selected participants who did not have chronic pain at baseline (n=1512) and who had data at follow-up nine years later. Stress reactivity was assessed using a subscale of the Multidimensional Personality Questionnaire. We conducted a binary logistic regression to determine the odds of developing chronic pain, controlling for demographics and other health related variables (i.e. self-rated physical/mental health, depression, anxiety, BMI, other chronic conditions). Results indicate that higher reported stress reactivity at baseline increased the odds of developing chronic pain at follow-up, OR=1.085, 95% CI [1.021, 1.153], p=0.008, with the only other predictor being number of chronic conditions, OR=1.118, 95% CI [1.045, 1.197], p=.001. Findings provide evidence for the predictive criterion validity of self-reported stress reactivity in the context of chronic pain risk. More generally, with increased need for virtual assessment and care, self-reported stress reactivity may be a useful, time and cost-efficient tool for predicting pain outcomes in research and clinical contexts.

Emergency Department Evaluation of Abdominal Pain in Female Adolescents.

Evaluation of acute abdominal pain in an adolescent female patient should include consideration of all potential sources of pain, including gynecologic etiologies. The goal of our study was to determine the frequency of evaluation of gynecologic causes of abdominal pain in adolescent girls seen in a pediatric emergency department. A retrospective review was performed of girls between 12 and 21 years of age presenting to the emergency department or urgent care centers at a single pediatric institution with the chief complaint of abdominal pain during 2016. Frequency analyses of demographic and clinical characteristics are presented. A total of 1082 girls presented with a chief complaint of abdominal pain. Menarche was documented in 85% of patients, sexual history in 52% of patients, and assessment of contraception use in 28%. Pregnancy testing was performed in 77%. Sexually transmitted infection (STI) testing was performed in 31%, and in only 73% of patients who reported being sexually active. Imaging was performed in 52%. In the subgroup of patients who reported being sexually active and presented with abdominal pain and vaginal discharge, only 37% had a pelvic examination performed. In multivariable modeling, Black patients were significantly more likely than White patients to have STI testing performed (adjusted risk ratio [aRR]=1.39; confidence interval [CI]=1.13-1.70) and to undergo a pelvic examination (aRR=2.45; CI=1.34-4.50), and less likely to undergo imaging (aRR=0.69; CI=0.59-0.81). The assessment of abdominal pain in adolescent girls should include gynecologic etiologies. Our results raise concerns that there are deficiencies in the evaluation of gynecologic sources of abdominal pain in girls treated at pediatric facilities, and evidence of potential racial disparities.

Clinical therapeutic effects of opioid analgesia for acute abdominal pain in children and young adults: A protocol for systematic review and meta-analysis.

Background:Nearly 10% of all patients who visit the emergency department report severe abdominal pain. Out of these, almost one-third are not diagnosed accurately. The conventional practice to care for such inpatients involves actively managed observation and repetitive clinical assessments at regular intervals. The aim of this study is to assess the clinical therapeutic effects of opioid analgesia in the treatment of severe abdominal pain in kids and adolescents.Methods:A comprehensive electronic search will be done on Web of Science, EMBASE, PubMed, WanFang database, Chinese National Knowledge Infrastructure, and the Cochrane Library from their establishment to May 2021. The search will identify and retrieve all randomized controlled trials that describe the clinical therapeutic effects of opioid analgesia to treat severe abdominal pain in adolescents and children. Two independent authors will shortlist studies that meet the inclusion criteria, extract data from selected studies, and evaluate the risk associated with bias in the selected articles. We will use RevMan (v: 5.3) to conduct all the data synthesis.Results:This meta-analysis will conduct a high-quality synthesis on present evidence related to the usage of opioid analgesia to treat severe abdominal pain in both kids and adolescents.Conclusion:Our findings will summarize the present evidence and help judge whether opioid analgesia is an effective and safe line of treatment for severe abdominal pain.Ethics and dissemination:This study will use pre-published data, and as such, it does not require ethics approval.OSF registration number:May 29, 2021.osf.io/fp9ym (https://osf.io/fp9ym/).

Risk factors of recurrent abdominal pain in adolescents

Background Recurrent abdominal pain is 2-4% of all cases encountered by pediatricians. Risk factors vary among countries. There is no data on prevalence and risk factors of recurrent abdominal pain in adolescents in Indonesia.
 Objective To evaluate prevalence and risk factors of recurrent abdominal pain in junior high school students.
 Methods A cross-sectional study was performed among junior high school students in South Jakarta who experienced recurrent abdominal pain according to Roma III criteria. Students allowed by their parents to participate to this study were asked to complete a Roma III questionnaire. Data about sociodemographic and history of recurrent abdominal pain among the parents were also collected using a questionnaire.
 ResultsThree hundred ninety-six adolescents participated in this study, 17.2% among them experiencing recurrentabdominal pain. Irritable bowel syndrome (IBS) was the most common type (42.6%), followed by functional dyspepsia (30.9%), functional abdominal pain syndrome (11.8%), functional abdominal pain (10.3%), and abdominal migraine (4.4%). The risk factor most responsible was anxious personality (OR 3.86; 95%CI 2.05 to 7.29, P<0.001). Other risk factors that contribute were female, age > 13 years, and middle to lower family income.
 Conclusions Prevalence of recurrent abdominal pain in adolescents is 17.2%. Irritable bowel syndrome is the most common type. The risk factors are anxious personality, female, age > 13 years, and middle to lower family income.

A rare cause of hemorrhagic shock

A 16-year-old girl, previously healthy and without a relevant family history, was admitted to Emergency Department for sudden and intense abdominal pain in the lower quadrants with four hours of evolution associated with vomiting and a liquid dejection. She denied fever, dysuria or another symptom. She also denied the onset of sexual activity and her last menstrual period occurred three weeks before admission. She was taken a combined oral contraceptive. On physical examination, she was tachycardic, hypotensive and had a capillary filling time of 4 seconds. The abdomen was painful especially in the right lower quadrant with peritoneal irritation signs. The blood workup revealed: hemoglobin: 10,8 g/dL, leukocytes: 28,850/µL (N:85,3% and L:9%) and a serum hormone human chorionic gonadotropin of 1124,7 mUI/mL. She performed an abdominal-pelvic CT scan that revealed an abundant amount of intraperitoneal fluid with spontaneously dense areas compatible with hemoperitoneum. Extravasation of iodinated contrast in the right adnexal area suggested the diagnosis of ruptured tubal ectopic pregnancy. The patient underwent emergency surgical salpingectomy with good clinical evolution. Ectopic pregnancy is a pregnancy in which the implantation of the blastocyst occurs outside the endometrium. Risk factors include fallopian tube injuries, previous surgeries, previous ectopic pregnancy, the early beginning of sexual activity and multiple sexual partners. The classic triad of ectopic pregnancy includes abdominal pain, amenorrhea, and vaginal bleeding. However, manifestations of the disease may vary considerably from being asymptomatic to haemodynamically compromised. The authors pretend to report a rare cause of abdominal pain in adolescence that should be considered even when sexual activity is denied, in order to prevent a potentially fatal outcome.

Clinical analysis of testicular torsion with the primary symptom of abdominal pain in adolescents and boys

Objective To evaluate the characteristics of the testicular torsion patients with the first symptom of acute abdominal pain. Methods From October 1998 to May 2014, 8 adolescent or boys with testicular torsion presenting acute abdominal pain instead of scrotal pain as their primary symptom were retrospectively reviewed. The average age was 12 (3-16) years. An acute abdominal pain presented firstly in all cases, which accompanied by nausea and vomiting in 4 cases, groin pain in 2 cases, fever in 1 case. In genital examination, the scrotum skin was red and swollen, while the testis was in transverse position and tenderness. The testicular and homolateral abdominal pain got worse when we pulled the involved testis. Doppler ultrasound examination revealed that the blood supply of the involved testis decreased or disappeared. Results In the 8 cases, 5 cases were not examined their testicles or scrotum during the first evaluation, which were found the testicular necrosis during the following exploratory surgery, and orchidectomy was performed. In the other 3 cases, external genital were examined during the first evaluation, and the scrotal and testicular abnormalities were detected. Doppler ultrasonography showed abnormality in testicular blood supply. Testicular torsion was proved during the emergent operation, and the 3 testes were salvaged. The mean duration time from symptom onset to operation was 4 h in the salvaged group, while the average time was 28 h in the orchiectomy group. The mean follow-up time was 18 (10-36) months. In the 3 cases whose testis was saved, 1 affected testis was atrophied, and the blood supply of the other two was good. No severe complications occurred in the other 5 cases. Conclusions Testicular torsion should be considered in adolescents and boys with acute lower abdominal pain. The routine external genital examination should be performed when a boy or adolescent complains of abdominal pain. Key words: Testicular torsion; Adolescent and children; Acute abdominal pain; Acute scrotal pain

Invagination of Meckel’s Diverticulum: A Rare Cause of Recurrent Abdominal Pain in a Young Girl

The invagination of Meckel's diverticulum is a very rare cause of abdominal pain in adolescents and adults. The classic clinical triad of the intussusception consisting abdominal pain, a palpable sausage-shaped mass, and bloody stools is seen infrequently. At the diagnosis, ultrasonography and computed tomography has a significant role with characteristic findings that include the “target” sign and sausage-shaped appearance. In this paper, we report a case of invagination of Meckel’s diverticulum which causes recurrent abdominal pain in a young adolescent. Key Words : Meckel’s Diverticulum; Intussusception; Ultrasonography; Computed Tomography.

Bornholm Disease

Bornholm disease is an uncommon cause of sudden-onset, severe, abdominal pain in adolescents and young adults caused by Coxsackievirus infection. Physicians who care for this patient population should consider Bornholm disease when presented with an acute abdomen or when other serious causes of abdominal pain have been ruled out. Typically, patients with this presentation progress to have pleuritic chest pain associated with a normal chest radiograph. Obtaining Coxsackievirus titers can help confirm the diagnosis. With this case presentation and review of the literature, we demonstrate the varied clinical presentation of Bornholm disease in adolescents and young adults.

Himen imperforado como causa de dolor abdominal en la adolescencia. A propósito de un caso

The imperforate hymen is a congenital anomaly of the female genital development. This is a rare pathology with an estimated incidence of 0.1% in female newborns. In many cases, the diagnosis goes unnoticed until puberty, debuting with cyclical abdominal pain in adolescents who have not submitted menarche. Diagnosis is based on history and physical examination, although additional tests, especially the ultrasound that allows to confirm clinical diagnosis and to exclude other genital malformations. We report a case of a 13-year-old that was diagnosed after consulting several times for recurrent abdominal pain.

Diet and Functional Abdominal Pain in Children and Adolescents

Functional abdominal pain (FAP) is a common complaint among children and adolescents. For many patients, symptoms exacerbate with eating. This review discusses findings concerning the role of diet in FAP. The foods that are discussed are divided into 2 major groups: food allergies or intolerances, which focus on milk, gluten, and fermentable oligosaccharides, disaccharides, monosaccharides, and polyols; and functional foods, which hone in on foods that reduce abdominal pain in adolescents such as fiber, peppermint oil, and probiotics. Lastly, we discuss the role of eating habits in FAP and how the physiology of eating may be the real culprit of symptoms associated with eating.

Recurrent abdominal pain in adolescents with anxiety and depression disorders

Background Anxiety and depression disorders in adolescentsmay affect their academic performances and social functioningat school. Adolescents with these disorders sometimes developrecurrent abdominal pain (RAP).Objective To assess the occurence of recurrent abdominal painamong adolescents with anxiety and depression disordersMethods We conducted a cross-sectional study from Augustto September 2009 in 12-18 year-old adolescents from 3 juniorhigh schools and 3 senior high schools in Secanggang Subdistrict,Langkat District, North Sumatera Province. We screened 960adolescents. Subjects were selected by consecutive samplingand instructed to fill the child behavior checklist (CBCL) andchildren's depression inventory (CDI) forms. Those with suspectedanxiety/depression (CBCL score 2: 12 for boys and 2: 14 for girls)and those with suspected depression (CDI score 2: 13) were thenexamined by a psychiatrist. Adolescents diagnosed with anxiety ordepression disorders were instructed to fill the RAP questionnairebased on Apley and Naish criteria.Results From the CBCL and CDI forms, 250 students weresuspected of having anxiety and/or depression. From these,144 students participated in this study. Of the 84 students withanxiety disorders, 60 (71.4%) students suffered from RAP. Ofthe 60 students with depression disorders, 31 (51 %) sufferedfrom RAP.Conclusion Adolescents with anxiety or depression are morelikely to have recurrent abdominal pain.

Isolated Tubal Torsion in Adolescence: Case Report and Review

Background: Isolated torsion of the fallopian tube is a rare cause of lower abdominal pain in adolescence. Lack of specific clinical signs, images, and laboratory data make preoperative diagnoses difficult. This article presents a case of isolated torsion of the fallopian tube in an adolescent girl. Case: A 15-year-old girl presented with right lower abdominal pain for 6 days, and ultrasonography and magnetic resonance imaging (MRI) revealed a cystic mass on the left side of her uterus. Urgent laparoscopy was carried out according to the diagnosis of torsion of the left ovarian cyst. The procedure revealed torsion of the right fallopian tube with necrosis and swelling, so a laparoscopic salpingectomy was performed. Results: She was discharged, uneventfully, on the third day after surgery. Conclusions: During the reproductive period of life, prompt diagnosis and treatment are needed to preserve fertility for women. On MRI, the coiling-up sign described by Park et al. might be useful for diagnosis, while laparoscopy is also helpful for diagnosis and treatment. (J GYNECOL SURG 29:39)

Recurrent abdominal pain in adolescents with anxiety and depression disorders

Recurrent abdominal pain in adolescents with anxiety and depression disorders

A rare cause of acute abdominal pain in adolescence: Hydrosalpinx leading to isolated torsion of fallopian tube

Torsion of the fallopian tube accompanying hydrosalpinx is a rare occurrence in the pediatric population. This report describes a 13year old sexually inactive girl with isolated tubal torsion due to hydrosalpinx. The girl had lower left abdominal pain for two days. The physical examination revealed left lower quadrant tenderness with a firm round anterior mass on rectal examination. Abdominal ultrasound showed left tubal enlargement with free pelvic peritoneal fluid. Magnetic Resonance Imaging (MRI) showed engorgement and dilatation of the left fallopian tube without contrast enhancement suspicious of tubal torsion. At operation, torsion of the left tube on its longitudinal axis was observed, and a salpingectomy was performed.Although rare, the diagnosis of torsion of the fallopian tube should be considered when evaluating acute abdominal pain. The earlier tubal torsion is diagnosed, the greater the likelihood of salvaging the fallopian tube.

Lansoprazole for recurrent abdominal pain in adolescents

Background Recurrent abdominal pain is common among adolescents. School absenteeism and lower quality of life are associated with severity of symptoms. Lansoprazole has been used to treat recurrent abdominal pain.Objective To investigate the effectiveness of lansoprazole as a treatment for recurrent abdominal pain in adolescents.Methods We conducted a randomized, double-blind, controlled trial from August 2009 to October 2009. Adolescents suffering recurrent abdominal pain were eligible for the study. Simple randomization was done to divide subjects into two groups. Groups received 30 mg of lansoprazole or placebo, once a day for 14 days. Before treatment, we performed laboratory and physical examinations. Pain frequency was measured in number of abdominal pain episodes per month. Duration was measured in minutes and pain intensity was measured by a pain rating scale. Drug efficacy was measured before, during and after intervention. Data was analyzed using Mann-Whitney U-test and t-test.Results One hundred sixteen recurrent abdominal pain patients were randomized into two groups of 58 patients. There were no statistically significant differences in pain frequency before and after treatment for either the lansoprazole group or the placebo group (P=0.083, 95%CI, -0.033 to 0.021 and P=0.096, 95%CI -0.376 to 0.031, respectively). In addition, there were no significant differences in frequency, duration, and degree of abdominal pain at baseline and after 1, 2 and 3 months of treatment between the two groups.Conclusion Lansoprazole was not more effective than the placebo for treatment of recurrent abdominal pain among adolescents.

Recurrent abdominal pain in adolescents: initial evaluation of an interdisciplinary pain rehabilitation program

Recurrent abdominal pain in adolescents: initial evaluation of an interdisciplinary pain rehabilitation program

Childhood predictors of recurrent abdominal pain in adolescence: A 13-year population-based prospective study

Objective To investigate maternal and child emotional symptoms, physical health problems, and negative life events measured at children's age 18 months and 12 years as potential predictors for self-reported recurrent abdominal pain (RAP) in adolescents (14 years). Methods A population-based prospective study conducted at child health clinics (preventive health care) in Norway followed a cohort of 916 mothers with children from children's age 18 months until adolescence. Child self-report was obtained from 12 years of age. Outcome measure was adolescent self-reported RAP. Results Of 456 adolescents, 58 (13%) reported RAP. Of these, 36 (62%) were girls. By multivariate analyses, the following maternal factors predicted RAP in adolescence: psychological distress at children's age 18 months (OR, 2.5; 95% CI, 1.3–4.8) and a maternal history of psychological distress at children's age 12 years (OR, 3.2; 95% CI, 1.7–6.2). The following child factors measured at age 12 years predicted RAP in adolescence: abdominal (OR, 2.5; 95% CI, 1.3–4.9) and extraintestinal pain (OR, 2.3; 95% CI, 1.2–4.4) by maternal report, self-reported frequent extraintestinal pain (OR, 2.9; 95% CI, 1.4–5.9), and self-reported depressive symptoms (OR, 2.4; 95% CI, 1.1–5.1). Negative life events and physical health in mothers and toddlers did not predict RAP. Conclusions This is the first cohort study that finds maternal psychological distress in early childhood to predict RAP in their offspring 13 years later. Our results support that maternal psychological distress and preadolescent children's depressive and somatic symptoms may play a role in the development of RAP.

Unusual presentation of acute ovarian torsion in an adolescent

Ovarian torsion occurs when an ovary twists about its vascular pedicle. The process causes abdominal pain and will result in ovarian tissue loss if not diagnosed and managed expeditiously. Acute ovarian torsion is an uncommon cause of abdominal pain in adolescents, and, as a result, it is often mistaken for other processes. We present a case of ovarian torsion in an adolescent female who presented with abdominal pain and marked abdominal distension, which was initially suggestive of a gravid abdomen. She was ultimately found to have a very large cystic teratoma of the right ovary with concomitant ovarian torsion. There are no reported cases of ovarian cystic teratoma with acute torsion presenting with an abdominal mass suggestive of a gravid abdomen.

Spigelian Hernia as A Cause of Unexplained Lower Abdominal Pain in an Adolescent Girl.

<h3>Background</h3> A Spigelian hernia occurs along the lateral border of the rectus abdominis muscle in the Spigelian fascia between the semilunar and semicircular lines. It represents 1–2% of all abdominal wall hernias and is usually located in the lower quadrants. Diagnosis may be difficult as symptoms are often subtle and nonspecific. A small defect may not always be felt on examination. In some cases the symptoms are even deemed to be psychiatric in origin. Persistent, pinpoint localization of pain to direct palpation is an important clue to identifying this disorder. Serious complications, such as incarceration, may occur if treatment is delayed. The purpose of this report is to heighten awareness among practitioners that Spigelian hernias may occur in adolescents and that a high index of suspicion may be necessary for diagnosis. <h3>Methods</h3> A 15 year old girl was evaluated for a several week history of pain in the right lower quadrant. The pain was desaibed as a constant dull ache which became intermittently sharp and more severe. It remained localized to a small area and did not radiate. The pain was increased with activity and relieved by rest. There was no nausea, vomiting, diarrhea, constipation, change in appetite, weight loss or relationship to meals. The patient had not missed any periods and her menses were described as normal without any relationship to the pain. There were no systemic symptoms or other complaints. She was referred for evaluation after her primary care physician was unable to establish a cause for the pain. <h3>Results</h3> Upon consultation. her physical examination was entirely unremarkable other than the presence of persistent, pinpoint pain to fingertip palpation in the right lower quadrant. This reproduced the pain the patient was experiencing. There also appeared to be a small underlying defect in the same area. These findings raised the possibility of a Spigelian hernia. Sonograms of the abdominal wall and pelvis were negative. The pain was found to completely disappear after injection with a local anesthetic, but not with placebo. An anatomic abnormality in the abdominal wall was strongly suspected in view of the clinical findings. Surgical exploration revealed a 6mm Spigelian hernia which was repaired and the patient became entirely asymptomatic. <h3>Conclusion</h3> This case illustrates the importance of including Spigelian hernias in the differential diagnosis of unexplained lower abdominal pain in adolescents. Signs and symptoms are often subtle which may pose a dilemma for the practitioner and lead to unnecessary tests or referrals. Persistent, reproducible. pinpoint pain to fingertip palpation is an important clue to diagnosis. Failure to recognize a Spigelian hernia not only prolongs pain, but may also result in potentially serious adverse sequelae. Clinicians who care for adolescents must be aware that such defects may occur in this age group so that the diagnosis is established as soon as possible and treattnent initiated in a timely manner.

Recurrent Abdominal Pain in Adolescents: Psychosocial Correlates of Organic and Nonorganic Pain

Recurrent abdominal pain is associated with a host of adverse social and financial consequences. Theoretical models have suggested numerous psychosocial factors that may contribute to the formation and maintenance of recurrent abdominal pain. To date, studies comparing groups with organically and nonorganically based pain on psychosocial variables have yielded inconsistent results. Adolescents diagnosed with organic (n = 25) and nonorganic (n = 24) abdominal pain and a control group of siblings of children with chronic constipation (n = 19) were compared on psychological, behavioral, and familial dimensions. Adolescents with nonorganic abdominal pain reported a significantly higher frequency of related symptoms than both com- parison groups. However, groups did not significantly differ on adolescent or maternal-reported measures of anxiety, locus of control, life events, family environment, or behavior problems. Greater methodological rigor and selection of control group participants who shared the contextual experiences of living in a family with a chronically ill child may account for these findings.