Abdominal Pain Of Unknown Origin Research Articles

DUPLICATION OF THE SMALL INTESTINE IN EMERGENCY PEDIATRIC SURGERY

Duplication of the gastrointestinal tract is a rare congenital surgical malformation. The frequency of the anomaly is 1:4500 ofnewborns, the most frequent localization of the duplication is the iliac region of the small intestine – 33%, duplications of the jejunum make up 7-10% of the total number of cases. The complexity of diagnosis and choice of surgical tactics is due to the absence of specifi c symptoms, possible asymptomatic presence for a long time, clinical manifestations characteristic of other diseases. The article presents an example of a clinical case of doubling of the jejunum in a pediatric patient complicated by peptic ulcer and diff use peritonitis. Complaints, features of the diagnostic process at the prehospital stage, selected surgical tactics, and causes of complications were analyzed.Morphologic signs of jejunal duplication are given. The given clinical example proves that the cause of dyspeptic phenomena of long duration and abdominal pain of unknown origin in pediatric patients may be surgical pathology, in particular, doubling of the gastrointestinal tract complicated by infl ammation of the small intestine. Therefore, such patients need the consultation of a pediatric surgeon, search and detection of possible surgical pathology, including doubling of the intestine. The diagnostic methods for detecting this anomaly are radiography, ultrasound, and contrast- enhanced computed tomography (CECT). Perforation in GI duplication is one of the causes of peritonitis that should be considered by emergency pediatric surgeons in their practice. Timely determination of the patient’s gastrointestinal tract duplication allows the emergency surgeon to optimize diagnostic measures, optimal choice of surgical approach, predict the volume of surgical intervention, avoid possible complications, reduce the time and cost of treatment. Since the fi nal confirmation of the diagnosis of gastrointestinal tract duplication is the result of morphological examination, its performance is mandatory.

Couvade Syndrome among partners of women with physiological and complicated pregnancy

Abstract Aim. To assess the prevalence of couvade syndrome and analyze the factors determining the occurrence of this syndrome in the partners of pregnant women. Material and method. The research material was collected by a diagnostic survey, using an author’s survey questionnaire. Results. Couvade Syndrome occurs in 94.3% of partners of women with complicated pregnancies. Among the most common somatic symptoms there are: back pain (56.2%), headaches (53.3%), appetite changes (48.6%), indigestion (34.3%) and abdominal pain of unknown origin (31.4%), while mental ones include: sleep disturbances (37.1%), irritability (34.3%), tension (32.4%), regardless of the course of partner’s pregnancy. Men, who were married, were more likely to have Couvade symptoms than those in an informal relationship, regardless of the course of partner’s pregnancy (p=0.02). Respondents without Couvade Syndrome were more likely to have low levels of involvement in their partner’s current pregnancy than those with symptoms, regardless of the course of this pregnancy (p=0.03). Men with symptoms of the syndrome were more likely to be less involved in their responsibilities at work than those without symptoms, regardless of the course of partner’s pregnancy (p=0.0006). Conclusions. The majority (94.3%) of partners of women with complicated pregnancies have a Couvade Syndrome. The most common somatic symptoms include back pain, headaches, appetite changes, indigestion and abdominal pain of unknown origin, while the mental ones: sleep disturbances, irritability, tension, anxiety and nervousness. Married men are more likely to have Couvade Syndrome than those in an informal relationship. Low levels of involvement in the current pregnancy are shown by men who do not have the syndrome. Men, who have the Couvade Syndrome, are less involved in their work responsibilities.

Role of laparoscopy in the management of chronic abdominal pain: A clinical study in north Indian teaching hospital

Background: Chronic abdominal pain can be diagnostic challenge. These difficult patients are frequently seen by many different physicians and are subjected to myriad of tests without identifying the etiology of pain. Surgical consultation often occurs late after other modalities have failed to provide resolution of their symptoms.Subjects and Methods: This prospective study was conducted in the Department of Surgery, SGT Medical College Hospital & Research Institute, Budhera, Gurugram, Haryana, India. 48 Patients with chronic abdominal pain participate in this study. This study included patients presenting with history of nonspecific abdominal pain for 3 weeks or more who were admitted in surgical wards.Results: The most common site of pain was the periumbilical region (52.08%) followed by the right lower abdominal quadrant (31.25%). Twenty two patients were using either non-steroidal drugs or pain killers to relieve the pain, and five patients were using proton pump inhibitors. Fifteen patients (31.25%) had undergone at least one previous surgical abdominal procedure. All patient characteristics are summarised in table 3. The average length of the operative time was 54.09 minutes with the range from 32 to 116 minutes. There were no cases converted to open procedures. Out the 48 patients with chronic abdominal pain, a definitive diagnosis was established in 46 patients (95.16%), while no identifiable cause could be reached in two patients (4.4%). The most common laparoscopic findings were adhesions (79.16%). Other findings included appendiceal pathology (10.41%), hernia (2.08%), gall bladder pathology (2.08%), and mesenteric lymphadenopathy (2.08%). Table 2 summarises the laparoscopic diagnoses assigned to all patients. Laparoscopic management included adhesiolysis [38], appendectomy [5], hernia repair [1], cholecystectomy [1], and lymph node biopsy [1]. Two patients had no interventions performed. Postoperative hospital stay ranged from two to twelve days with a mean of 3.8 days.Conclusion: Although Chronic abdominal pain of unknown origin represents a significant problem in surgical patients. Due to improvement in instrumentation and greater experience in the laparoscopy, the procedure no longer limited to visualization. This study showed that laparoscopy is an effective approach in the management of patients with chronic abdominal pain in whom conventional methods of investigations have failed to elicit a certain cause.

DIAGNOSTIC LAPAROSCOPY IN CHRONIC AND RECURRENT ABDOMINAL PAIN MANAGEMENT

Background: Chronic abdominal pain is a common condition encountered by many surgeons in their clinic every day. Despite of availability of different tests in maximum cases the reason behind the pain remains unknown. Diagnostic Laparoscopy is a safe technique that can identify the cause of the pain without using any invasive method. In the present study, the use of diagnostic laparoscopy in the diagnosis and management of chronic and recurrent abdominal pain of unknown origin was investigated.
 Material and Methods: All the patients who visited the outpatient department with chronic abdominal pain were included in this study. All the demographic parameters were included and after careful investigation diagnostic laparoscopy were conducted in all these patients. The postoperative outcomes were also recorded in all the patients.
 Result: Total of 51 patients was included in this study. Among these patients 23 patients were male and 28 patients were female. Maximum of the patients were in the 31-40 years of age group. The most common pathology for chronic abdominal pain was chronic appendicitis (n=9, 18%) followed by Koch's abdomen and adhesions (n=8, 16%). There were 4 cases of Carcinoma of the gall bladder and 3 cases of metastatic disease with dissemination in the peritoneal cavity and ascitis. 3 cases of liver cirrhosis and 3 cases of endometriosis were also detected. 2 cases of ovarian cysts which were missed by USG were detected correctly by laparoscopy. There were two unusual cases, one of chronic ectopic pregnancy and another of Crohn's disease. All the above findings were confirmed by direct visualizing (86%), or by biopsy (74%) or by fluid analysis. There were no long term complications in our study.
 Conclusion: The present study concluded that laparoscopy is a safe and effective method for diagnosis of chronic abdominal pain.
 Keywords: Chronic abdominal pain, diagnostic laparoscopy, recurrent abdominal pain

Abdominal pain as first manifestation of lyme neuroborreliosis in children, case report and review of literature

BackgroundLyme neuroborreliosis can cause a variety of neurological manifestations. European children usually present facial nerve palsy, other cranial nerve palsies and aseptic meningitis.Case presentationWe hereby report a case of Lyme neuroborreliosis in a 9-year-old boy with abdominal pain as first symptom and subsequent onset of attention deficit and ataxia. Diagnosis was made by detection of specific antibody in both serum and cerebrospinal fluid with neuro-radiological images suggestive for this infectious disease. A 12-months follow-up was performed during which no relevant neurological sequelae were revealed.ConclusionThis case report shows that abdominal radiculitis, although extremely rare, could be the first manifestation of early Lyme neuroborreliosis in pediatric patients. Pediatricians must consider Lyme disease in the differential diagnosis of abdominal pain of unknown origin in children, especially in countries where the infection is endemic.

3D reconstruction of small bowel lesions using stereo camera-based capsule endoscopy

Three-dimensional (3D) reconstruction of capsule endoscopic images has been attempted for a long time to obtain more information on small bowel structures. Due to the limited hardware resources of capsule size and battery capacity, software approaches have been studied but have mainly exhibited inherent limitations. Recently, stereo camera-based capsule endoscopy, which can perform hardware-enabled 3D reconstruction, has been developed. We aimed to evaluate the feasibility of newly developed 3D capsule endoscopy in clinical practice. This study was a prospective, single-arm, feasibility study conducted at two university-affiliated hospitals in South Korea. Small bowel evaluation was performed using a newly developed 3D capsule endoscope for patients with obscure gastrointestinal bleeding, suspected or established Crohn’s disease, small bowel tumors, and abdominal pain of unknown origin. We assessed the technical limitations, performance, and safety of the new capsule endoscope. Thirty-one patients (20 men and 11 women; mean age: 44.5 years) were enrolled. There was no technical defect preventing adequate visualization of the small bowel. The overall completion rate was 77.4%, the detection rate was 64.5%, and there was no capsule retention. All capsule endoscopic procedures were completed uneventfully. In conclusion, newly developed 3D capsule endoscopy was safe and feasible, showing similar performance as conventional capsule endoscopy. Newly added features of 3D reconstruction and size measurement are expected to be useful in the characterization of subepithelial tumours.

Role of diagnostic laparoscopy in chronic and recurrent pain abdomen

Background: Chronic and recurrent abdominal pain of unknown origin represents a significant problem in surgical patients and poses a diagnostic dilemma. With advances in optics, laparoscopy allows visualisation of entire peritoneal cavity and further makes histological diagnosis possible. The rapidly increasing popularity of laparoscopy may be attributed to several factors including its applicability in both emergency and elective settings, high diagnostic yield, therapeutic management in the same setting, low patient morbidity, reduced hospital stays and expenditure. The objective of the study was to evaluate the role of diagnostic laparoscopy in chronic and recurrent pain abdomen.Methods: We conducted a prospective descriptive study on 50 patients who suffered from chronic and recurrent pain in abdomen for more than 3 months with inconclusive clinical or radiological diagnosis. All patients were subjected to diagnostic laparoscopy and findings were noted down. Therapeutic procedures were conducted at the same setting wherever indicated. Histopathological evaluation reports were followed up.Results: Out of 50 patients, laparoscopy established diagnosis in 44 patients, proving diagnostic efficacy at 88%. The most common finding at diagnostic laparoscopy was appendicitis (28%), followed by adhesions (24%). Other findings were tuberculosis (16%), pelvic inflammatory disease (8%), endometriosis (3%), partial torsion of ovarian cyst (4%), cholecystitis (2%). However, diagnostic laparoscopy showed normal study in 6 patients (12%). Appendicectomy followed by adhesiolysis were the most common procedures performed.Conclusions: Recurrent appendicitis is the most common cause of chronic and recurrent pain abdomen. Diagnostic laparoscopy is a safe and effective modality for both diagnostic and therapeutic management of such patients.

Efficacy of Laparoscopy in Diagnosis and Treatment of Chronic Abdominal Pain of Unknown Origin

Chronic abdominal pain of unknown origin is a challenging diagnosis encountered by clinicians. Patients often undergo an extensive workup and long periods of uncertainty without the establishment of a definitive diagnosis. Diagnostic laparoscopy is a relatively safe procedure that can be used as an effective diagnostic and therapeutic tool in treating this disease. This was a retrospective, single-institution study exploring the efficacy of diagnostic laparoscopy in treating chronic abdominal pain of unknown origin. More than 90 per cent of laparoscopies resulted in a positive finding, with adhesions being the most common. A total of 50 per cent of patients experienced resolution of symptoms on follow-up. Patients were overwhelmingly satisfied with their postoperative outcomes and willing to undergo the procedure again with their outcomes in mind.

Roux Limb Motility in Gastric Bypass Patients with Chronic Abdominal Pain\u2014Is There an Association to Prescribed Opioids?

Background/AimA number of patients continue to suffer from chronic abdominal pain of unknown origin, which may also lead to a prolonged use of opioid analgesics. Symptoms of abdominal pain, nausea and vomiting in this patient group resemble the characteristics of the Roux stasis Syndrome. The aim was to elucidate relationships between chronic abdominal pain, Roux limb motor activity and opioid analgesics.MethodsRoux limb high-resolution manometry and ratings of abdominal pain and quality of life were analysed in 15 gastric bypass patients reporting abdominal pain of unknown origin. Effect of acute opiate administration (morphine i.v.) on fasting Roux limb motor activity was assessed in asymptomatic and morphine-naïve gastric bypass patients (n = 9) and compared with an untreated control group (n = 11).ResultsIn the symptomatic patient group, we found disturbed Roux limb motor patterns in 10 out of 15 examinations, but no signs of Roux stasis syndrome. A high prevalence of prescribed opioid analgesics as well as a high number of reoperations in this group. The worst quality of life and the highest number of pain-killing medications were observed among the patients with distal pacemaker activity in Roux limb. In the morphine-naïve and asymptomatic patients, morphine increased the muscular tone in the Roux limb during phase III-like motor activity.Summary and ConclusionsA majority of the RYGBP patients with chronic abdominal pain had a disturbed Roux limb fasting motility, and there was a high prevalence of prescribed opioid analgesics. In opiate-naïve RYGBP patients, acute morphine intravenously increased the muscular tone of the Roux limb.

Colecistitis aguda alitiásica como manifestación inicial de una granulomatosis eosinofílica con poliangeítis (Churg-Strauss). A propósito de un caso

Eosinophilic granulomatosis with polyangiitis (Churg-Stauss) is a systemic vasculitis with eosinophil-rich and necrotizing granulomatous inflammation and necrotizing vasculitis predominantly affecting small to medium vessels. It often involves the respiratory tract and is associated with asthma and eosinophilia.We describe a case in which acute acalculous cholecystitis was the initial manifestation of the disease.Although acute acalculous cholecystitis rarely appears as an early manifestation in eosinophilic granulomatosis with polyangiitis, this entity should be taken into consideration in the differential diagnosis of patients with abdominal pain of unknown origin and a history of eosinophilia, asthma, or allergic rhinitis.

Early Detection of a Rare Case: Idiopathic Spontaneous Superior Mesenteric Artery Dissection, by Duplex Ultrasonography

Spontaneous dissection of the superior mesenteric artery (SMA) without involvement of the aorta is an extremely rare condition. It could be a surgical emergency because ischaemic intestine due to artery occlusion is life-threatening and the prognosis is time-dependent. We present a 55-year-old man with a 5-day history of progressive abdominal pain. He had a negative laboratory work-up and pan-endoscopy showed multiple gastric ulcers. Despite treatment, he had persistent severe epigastric pain disproportionate to physical findings. Bedside duplex ultrasonography revealed the absence of color signal in the proximal SMA. Angiography confirmed the diagnosis of SMA dissection. Mesenteric vascular emergency including arterial dissection should be taken into consideration in patients who present with severe abdominal pain of unknown origin. Abdominal bruit may be the only vital clue but is usually difficult in the noisy emergency department. Duplex ultrasonography can be helpful to detect blood flow abnormality whenever in doubt. (Hong Kong j. emerg.med. 2015;22:189-193)

Mo1585 Role of Endoscopic Capsule in Patients With Chronic Diarrhea and Abdominal Pain of Unknown Origin

Mo1585 Role of Endoscopic Capsule in Patients With Chronic Diarrhea and Abdominal Pain of Unknown Origin

Gabapentin and venlafaxine reduce pain in a patient with somatic symptom disorder.

To the Editor: Here, a case of abdominal pain of unknown origin is presented. A thorough gastrointestinal workup was negative. The patient was then referred to psychiatry for further workup and management, with the suspicion that he was suffering from somatic symptom disorder. Case report. Mr A is a 58-year-old man with a psychiatric history significant for major depressive disorder, alcohol use disorder, cannabis use disorder, and cocaine use disorder, all in sustained, full remission. He presented to the psychiatry outpatient clinic with anxiety and worsening abdominal pain for a period of 3 months. Review of Mr A’s chart showed an extensive gastrointestinal workup that was negative for structural, infectious, and autoimmune processes. He had been treated with amitriptyline 10 mg at bedtime by a psychiatrist earlier in the month, which did not help the pain. This medication was switched to nortriptyline 25 mg at bedtime, which also did not help the pain. Mr A was desperate for relief and reported that the abdominal pain had remained constant since it began 3 months prior. He rated the pain on a scale of 1 to 10 as a 7 at the time of interview but said that the pain often reaches maximum intensity of a 10. He denied constipation or diarrhea associated with the pain. Following careful review of Mr A’s chart, the most likely diagnosis was somatic symptom disorder, according to DSM-5 criteria. His symptoms had been present for 3 months, which does not exclude the diagnosis of somatic symptom disorder; it only qualifies the diagnosis as atypical. It was decided to discontinue nortriptyline treatment and begin a combined treatment of gabapentin and venlafaxine. Gabapentin was titrated to 300 mg 3 times per day, and venlafaxine extended release was titrated to 150 mg per day. At a 2-week follow-up, he reported improvement in pain symptoms. On a scale of 1 to 10, Mr A said the pain had dropped from a 10 to a 6. Gabapentin was increased to 300 mg 4 times per day to control residual pain. At a 4-week follow-up, Mr A reported the pain to be a 5, with fluctuations up to 7. Mr A is still on the venlafaxine and gabapentin regimen and is being followed closely by psychiatry and primary care. In an animal study, gabapentin inhibited visceral pain when the pain was induced by an inflammatory stimulus or by stress.1 In another small study comparing the use of gabapentin to placebo in 40 patients with irritable bowel syndrome,2 a barostat study was used to determine threshold pressures for bloating, discomfort, and pain. The group given gabapentin showed an increased threshold compared to the placebo group. In a case report, gabapentin 1,800 mg allowed for a remission in somatoform pain disorder in a 48-year-old woman with depression.3 Venlafaxine was used in Mr A to control his depression, as well as to contribute to pain control. Venlafaxine has been shown in several studies to improve pain symptoms that are associated with depression4 as well as peripheral neuropathy.5 In any patient, the differential diagnosis and medical examination must be exhausted before considering a psychogenic cause to the patient’s illness. Mr A meets the criteria for somatic symptom disorder. Irritable bowel syndrome cannot be excluded and has considerable overlap with somatization disorder.6 More research is required to develop treatment modalities for somatic symptom disorder, as well as to differentiate between somatic symptom disorders affecting the gastrointestinal tract and irritable bowel syndrome. Although Mr A is not pain free, the reduction of pain is promising.

Infected urachal sinus presenting as infraumbilical mass- A Case report and review of literature

Urachal sinus is rare congenital urachal anomaly in adults develops from incomplete obliteration of fetal urachus. Usually incidental finding and remain asymptomatic unless a complication occurs. Complications includes infection, abscess, calculus, gas formation, intraperitoneal rupture, peritonitis and malignant transformation. High index of clinical suspicion is required when patient presents with pain abdomen, infraumbilical mass or umbilical discharge. Infected urachal sinus remains a diagnostic challenge due to its rare incidence and variable clinical presentations. We report a case in 37 year old female patient of infected urachal sinus presenting as infraumbilical mass, umbilical discharge and local tenderness. Two months back presented with fever, lower abdominal pain of unknown origin. Clinical suspicion of abdominal wall abscess or omphalitis were made. In our case ultrasonography and magnetic resonance imaging confirmed this rare entity. Brief discussion were made on clinical presentation, differential diagnosis, radiological findings and management options in order to prevent further complications, recurrence and malignant transformation.

Role of diagnostic laparoscopy in chronic and recurrent abdominal pain

Chronic abdominal pain is a very common condition presenting to a general surgeon. It is defined as pain lasting for more than 3 months. Sometimes, the diagnosis cannot be established even with the help of advanced radiological investigations. This study aims to define the role of laparoscopy in diagnosing the cause of chronic abdominal pain and thus enabling a definitive management. The study included 52 patients admitted to the Department of Surgery, Himalayan Institute of Medical Sciences, Dehradun, India for chronic abdominal pain of unknown origin. All patients underwent diagnostic laparoscopy with methodical inspection of the whole abdomen. Diagnosis was established in 86.5% of cases either by direct visualization or histopathological examination. The most common pathology was chronic appendicitis (19%) followed by adhesions (17.3%) and peritoneal tuberculosis (15.3%). A therapeutic procedure was done in 46% of cases during laparoscopy. No major complication was reported during the study. Laparoscopy is a safe and effective method to diagnose the cause of chronic abdominal pain in cases where other non-invasive methods prove unreliable.

Role of diagnostic laparoscopy in chronic and recurrent abdominal pain

Background: Chronic abdominal pain is a very common condition presenting to a general surgeon. It is defined as pain lasting for more than 3 months. Sometimes, the diagnosis cannot be established even with the help of advanced radiological investigations. This study aims to define the role of laparoscopy in diagnosing the cause of chronic abdominal pain and thus enabling a definitive management. Methods: The study included 52 patients admitted to the Department of Surgery, Himalayan Institute of Medical Sciences, Dehradun, India for chronic abdominal pain of unknown origin. All patients underwent diagnostic laparoscopy with methodical inspection of the whole abdomen. Results: Diagnosis was established in 86.5% of cases either by direct visualization or histopathological examination. The most common pathology was chronic appendicitis (19%) followed by adhesions (17.3%) and peritoneal tuberculosis (15.3%). A therapeutic procedure was done in 46% of cases during laparoscopy. No major complication was reported during the study. Conclusions: Laparoscopy is a safe and effective method to diagnose the cause of chronic abdominal pain in cases where other non-invasive methods prove unreliable.

Septic Pylephlebitis as a Rare Complication of Crohn's Disease

Thrombophlebitis of the portal venous system (PVS) with superimposed bacterial infection (septic pylephlebitis) is an extremely rare complication of Crohn's disease (CD), and therefore diagnosis of septic pylephlebitis is difficult without high clinical suspicion. A 16-year old male patient who was diagnosed with CD 3 months earlier was admitted with recurrent fever and abdominal pain. CD activity had been well controlled with conventional medical treatment during a follow-up period. Abdominal contrast-enhanced computed tomography showed massive thrombosis in the PVS without evidence of intra-abdominal infection, and blood cultures were positive for Streptococcus viridians. There was no evidence of deep vein thrombosis or pulmonary thromboembolism, and all laboratory tests for thrombophilia were normal. Based on these findings, the patient was diagnosed with septic pylephlebitis complicated with CD, and was successfully treated with intravenous antibiotic therapy combined with anticoagulation. This case suggests that early comprehensive evaluation is crucial for immediate diagnosis and proper treatment of septic pylephlebitis in patients with CD who present with fever and abdominal pain of unknown origin, even with stable disease activity and absence of other intra-abdominal infections.

Narcotic Bowel Syndrome

BackgroundNarcotic bowel syndrome is characterized by chronic or recurrent abdominal pain associated with escalating doses of narcotic pain medications. It may occur in as many as 4% of all patients taking opiates, and yet few physicians are aware that the syndrome exists. ObjectivesThe objectives of this case report are to raise awareness of narcotic bowel syndrome among emergency physicians, as well as review the clinical features, diagnosis, pathophysiology, and emergency department (ED) management of the syndrome. Case ReportWe report a case of narcotic bowel syndrome diagnosed in a 24-year-old woman after > 1 year of ED visits for recurrent abdominal pain of unknown origin. ConclusionsIt is particularly important for emergency physicians to be familiar with this syndrome, as many patients with narcotic bowel syndrome seek evaluation and treatment in the ED. Although the diagnosis is unlikely to be made in the ED, timely referral for evaluation of this syndrome may help patients to receive definitive treatment for their recurrent and chronic pain.

The association of mast cells and serotonin in children with chronic abdominal pain of unknown etiology

BackgroundAbdominal pain of unknown origin affects up to 20% of school-aged children. Evaluation of children is symptom-based without clear guidelines to investigate molecular mechanisms of abdominal pain. Aberrant molecular mechanisms may increase intestinal permeability leading to interactions between the immune and nervous systems, subclinical inflammation, and visceral pain. This study evaluated the association between interleukin-6 (IL-6), mast cell infiltrates, and serotonin (5-HT) levels in gastrointestinal (GI) biopsies, with perceived abdominal pain in a pediatric cohort.MethodsClinical data and biopsy samples from pediatric patients (n = 48) with chronic abdominal pain, with and without inflammation were included. Formalin-fixed paraffin-embedded GI biopsies were sectioned and immunohistochemistry performed for IL-6 and 5-HT; mast cells were identified with toluidine blue stain. Histological findings were compared to self-reported abdominal pain between groups.ResultsThere was significantly greater IL-6 immunoreactivity in biopsies with confirmed histologic inflammation (p = 0.004). There was a greater number of mast cells per HPF in non-inflammatory biopsies (3.5 ± 2.9) compared to the inflammatory biopsies (2.6 ± 1.8) p = 0.049. The non-inflammatory biopsy group was significantly less likely to respond to standard treatment as evidenced by higher pain reports (p = .018). Mast cells (p = .022) and 5-HT (p = .02) were significantly related to abdominal pain scores.ConclusionsA potential association between self-reported abdominal pain, number of mast cells, and 5-HT levels, which may contribute to perceived GI pain in pediatric patients may exist.

Seltene Ursache

Seltene Ursache