Diagnosis Of Chronic Abdominal Pain Research Articles

Familial autoinflammatory syndromes in the differential diagnosis of chronic abdominal pain

Familial autoinflammatory syndromes, including familial Mediterranean fever, are recently recognized group of disorders characterized by seemingly unprovoked inflammation but lacking high-titer autoantibodies. Genetic and clinical tools are improving the ability of the clinician to better approach patients with periodic fever and inflammation. The pathogeneses of many of these diseases are now understood to involve different aspects of a common pathway, largely affecting inflammatory cascades related to IL-1 or tumor necrosis factor-alpha (TNF-alpha). Here we report two cases, where patients were presented with periodic abdominal pain, fever, signs of polyserositis and arthritis. IBD, malignancy, porphyria, systemic autoimmune diseases, infection and lead intoxication were excluded. Both patients formerly underwent cholecystectomy and appendectomy during an acute phase without any effect on recurrent complaints. Erythrocyte sedimentation rate, serum CRP and TNF-alpha levels were found to be increased during acute phase. We have found familiality in one case where the patient's daughter developed the same symptoms. MEFV (Mediterranean fever) gene mutation was found to be positive in 70–80% of the cases, however, our patients presented were negative for the syndrome. We propose an algorithm for the evaluation of a patient with periodic fever, taking into account the patient's age, ethnicity, symptoms and signs, and results of laboratory and genetic testing.

Gastrointestinal leukocytoclastic vasculitis: An adverse effect of sirolimus

An 18-yr-old Hispanic female with end-stage renal disease secondary to chronic glomerulonephritis of unknown etiology underwent cadaveric renal transplantation. She was placed on a steroid-free protocol with tacrolimus and mycophenolate mofetil (MMF) for maintenance immunosuppression. Approximately 8 months post-transplantation, MMF was replaced by sirolimus (SRL) because of persistent leukopenia. Four months after the initiation of SRL, the patient began to experience chronic, constant periumbilical abdominal pain in the absence of vomiting, diarrhea or melena. Esophagogastroduodenoscopy and CT scans revealed significant diffuse mucosal thickening of the antrum, duodenum, and jejunum; leukocytoclastic vasculitis was identified on antral biopsy. A repeat biopsy after reduction of sirolimus dose by 50% over 6 months showed mild chronic inflammation of stomach and duodenum with some improvement in abdominal pain. Discontinuation of SRL and replacement with low dose MMF resulted in complete resolution of pain and normalization of gastrointestinal anatomy by imaging studies within 2 months. In light of this report, drug-induced leukocytoclastic vasculitis caused by SRL should be considered in the differential diagnosis of chronic abdominal pain in a patient with organ transplantation.

Six of the Best, General 24

Aims: Patients in whom extensive investigations have failed to identify the cause of abdominal pain present a challenge to surgeons. We present our initial experience of using laparoscopy under local anaesthetic and sedation in the diagnosis of chronic abdominal pain. Methods: Nine patients with chronic abdominal pain and multiple normal investigations underwent laparoscopy under local anaesthetic and sedation. By touching and grasping intra-abdominal viscera and peritoneum, an attempt was made to reproduce the patient's pain. Results: Two patients were found to have pain arising from the gall bladder and subsequently underwent laparoscopic cholecystectomy with resolution of their symptoms. A third patient had a clinical presentation of chronic acalculous cholecystitis and a normal laparoscopy. She decided to undergo laparoscopic cholecystectomy, which cured her pain. Another patient had pain arising from the appendix, which resolved after an appendicectomy. Another patient had pelvic adhesions and after adhesiolysis is pain free. One patient declined surgery for adhesions, which produced chronic pain and another patient had adhesions secondary to an appendicectomy but did not cause any pain at the time of her laparoscopy. Another patient awaits a repeat laparoscopic adhesiolysis. One patient had a normal laparoscopy and a gastroenterologist has made a diagnosis of irritable bowel syndrome. Conclusion: Laparoscopy can be carried out in the awake patient, who is then usually able to differentiate the type of pain experienced during conscious pain mapping. Long-term effectiveness and diagnostic accuracy has not yet been established.

Rome II criteria exceeds urine porphyrins in the diagnosis of chronic abdominal pain

Rome II criteria exceeds urine porphyrins in the diagnosis of chronic abdominal pain

Flexible sigmoidoscopy for the diagnosis of chronic abdominal pain: an unnecessary procedure

Flexible sigmoidoscopy for the diagnosis of chronic abdominal pain: an unnecessary procedure

Helicobacter pylori

Approximately one in ten children are seen by a health care professional for a complaint of chronic recurrent abdominal pain. In most cases these complaints are non-organic. Organic causes of abdominal pain may include gastroesophageal reflux, peptic ulcer disease, gallbladder, pancreatic or kidney disease. In addition, infection of the gastric antrum with Helicobacter pylori is now included in the differential diagnosis of chronic abdominal pain in children. H. pylori are "S" or "C" shaped, gram negative bacilli with a smooth outer coat and two to four unipolar flagella. There is no known natural reservoir for H. pylori in the environment. The mode of transmission is also unknown. Multiple drug therapy is necessary to maintain long-term eradication of the organism. Until epidemiologic data are determined, universal precautions should be employed in cases of suspected H. pylori infection.