Idiopathic Abdominal Pain Research Articles

Igg Food Antibody Guided Elimination-Rotation Diet Was More Effective than FODMAP Diet and Control Diet in the Treatment of Women with Mixed IBS—Results from an Open Label Study

Irritable bowel syndrome (IBS) is a chronic disease with recurrent abdominal pain, disturbed bowel emptying, and changes in stool consistency. We compared the effectiveness of three different dietary treatment plans (G1-FM-low FODMAP diet, G2-IP IgG based elimination-rotation-diet, and as control group, the G3-K control diet recommended by an attending gastroenterologist) in treating patients diagnosed with mixed irritable bowel syndrome. A total of seventy-three female patients diagnosed with a mixed form of irritable bowel syndrome (IBS-M) were enrolled in the study. The diet of each patient in Group 1 (G1-FM) and 2 (G2-IP) was determined individually during a meeting with a dietitian. Patients from Group 3 (G3-K) received nutrition advice from a gastroenterologist. Significant differences in the reduction of IBS symptoms were found between the groups. IBS symptoms as well as comorbid symptoms significantly improved or disappeared completely in the G2-IP group (idiopathic abdominal pain, p < 0.001; abdominal pain after a meal, p < 0.001; abdominal pain during defecation, p = 0.008), while in the G1-FM group, some of the IBS symptoms significantly improved (mucus in stool, p = 0.031; bloating, p < 0.001). In group G3-K no significant improvement was seen. Based on the results of this open-label study, it was concluded that various dietary interventions in the treatment of IBS-M patients do not uniformly affect the course and outcomes of disease management. Rotation diets based on IgG show significantly better results compared to other diets.

A rare case of peritoneal Xanthogranuloma in a 23-year-old woman

Xanthogranuloma is a very rare tumor when it comes to abdomen. Macroscopically, it is characterized by formation of multiple, golden yellow or bright yellow nodules, whereas histologically, the lesion is predominantly composed of foamy cells mixed with acute and chronic inflammatory cells. We report a case of 23-year-old woman presented to the hospital with chronic constipation, colic abdominal pain and recurrent vomiting. The patient had a history of sigmoid colon volvulus. Radiological investigations showed sigmoid colon elongation, multi-density formations in the left iliac region and pelvis and a small amount of pelvic fluid. Laparoscopy followed by excisional biopsy of the formations were made, and pathological examination showed Xanthogranuloma with no ovarian parenchyma. Hence, Xanthogranuloma should be considered as a differential diagnosis for idiopathic abdominal pain. Laparoscopy and excisional biopsy are suggested procedures when short-term therapy is concerned.

Possible Sulfamethoxazole/Trimethoprim-Induced Pancreatitis in a Complicated Adolescent Patient Posttraumatic Injury

Introduction: Multiple medications have been associated with pancreatitis, however, data in the pediatric population are scarce secondary to the nonspecific presentation and infrequent diagnosis. The aim of this report is to characterize drug-induced pancreatitis in an adolescent patient. Case Presentation: A 16-year-old African-American female presented with a surgical site infection 8 weeks after a motor vehicle accident with multiple traumas. Two weeks prior to the admission, the patient was hospitalized for a urinary tract infection (UTI) and was initiated on sulfamethoxazole/trimethoprim (TMP/SMX) daily for UTI prophylaxis. On day 13, the patient was diagnosed with acute pancreatitis with an amylase level of 187 units/L (normal = 30-110) and a lipase level of 987 units/L (normal = 23-208). TMP/SMX was discontinued, and pancreatic enzyme levels decreased but did not reach normal. The patient was asymptomatic at discharge. Discussion: TMP/SMX was identified as the likely etiology of pancreatitis by the medical team. Evaluation with the Naranjo algorithm indicated a “possible” adverse drug reaction. Conclusion: Acute pancreatitis can have significant morbidity and mortality in the pediatric population but can go undiagnosed due to its lower incidence. Pediatric patients presenting with idiopathic abdominal pain should be evaluated for pancreatitis and drug therapy should be reviewed for potential causative agents.

Anterior herniation of lumbar disc induces persistent visceral pain: discogenic visceral pain

Background Visceral pain is a common cause for seeking medical attention. Afferent fibers innervating viscera project to the central nervous system via sympathetic nerves. The lumbar sympathetic nerve trunk lies in front of the lumbar spine. Thus, it is possible for patients to suffer visceral pain originating from sympathetic nerve irritation induced by anterior herniation of the lumbar disc. This study aimed to evaluate lumbar discogenic visceral pain and its treatment. Methods Twelve consecutive patients with a median age of 56.4 years were enrolled for investigation between June 2012 and December 2012. These patients suffered from long-term abdominal pain unresponsive to current treatment options. Apart from obvious anterior herniation of the lumbar discs and high signal intensity anterior to the herniated disc on magnetic resonance imaging, no significant pathology was noted on gastroscopy, vascular ultrasound, or abdominal computed tomography (CT). To prove that their visceral pain originated from the anteriorly protruding disc, we evaluated whether pain was relieved by sympathetic block at the level of the anteriorly protruding disc. If the block was effective, CT-guided continuous lumbar sympathetic nerve block was finally performed. Results All patients were positive for pain relief by sympathetic block. Furthermore, the average Visual Analog Scale of visceral pain significantly improved after treatment in all patients (P &lt;0.05). Up to 11/12 patients had satisfactory pain relief at 1 week after discharge, 8/12 at 4 weeks, 7/12 at 8 weeks, 6/12 at 12 weeks, and 5/12 at 24 weeks. Conclusions It is important to consider the possibility of discogenic visceral pain secondary to anterior herniation of the lumbar disc when forming a differential diagnosis for seemingly idiopathic abdominal pain. Continuous lumbar sympathetic nerve block is an effective and safe therapy for patients with discogenic visceral pain.

Idiopathic Abdominal Pain in Children May Be Migraine

Idiopathic Abdominal Pain in Children May Be Migraine

Dolor originado en la pared abdominal: una alternativa diagnóstica olvidada

Chronic abdominal pain is a common clinical problem in primary care, and is usually referred to gastroenterologists or general surgeons. Although up to 20% of cases of idiopathic abdominal pain arise in structures of the abdominal wall, this is frequently overlooked as a possible cause. It includes pain arising from structures of the abdominal wall including skin, parietal peritoneum, cellular subcutaneous tissue, aponeuroses, abdominal muscles and somatosensorial innervation from lower dorsal roots. The diagnosis is based on anamnesis and physical examination. Carnett's sign is a simple maneuver that discriminates between parietal and visceral pain. Management with topical anesthesia is effective in a majority of patients and can help to confirm the diagnosis.

Mechanically restricted regional blood flow might explain gastrointestinal pain

Idiopathic abdominal pain and chest pain of presumed digestive tract origin accounts for a considerable number of hospital admissions each year. The underlying causes of this pain remain unknown. In this Viewpoint the authors propose a novel mechanism for this undefined pain suggesting that ischemic events could be responsible.

Chronic abdominal wall pain: a frequently overlooked problem. Practical approach to diagnosis and management.

Chronic abdominal wall pain is frequently misdiagnosed as arising from a visceral source, often resulting in inappropriate diagnostic testing, unsatisfactory treatment, and considerable cost. Its prevalence in general medical practice is unknown, although it may account for about 10% of patients with chronic idiopathic abdominal pain seen in gastroenterological practices. The most common cause appears to be entrapment of an anterior cutaneous branch of one or more thoracic intercostal nerves; myofascial pain and radiculopathy are less frequent. Sharply localized pain and superficial tenderness are suggestive of abdominal wall origin. Carnett's test (accentuated localized tenderness with abdominal wall tensing) is a helpful diagnostic sign, especially when incorporated with other findings. Early exclusion of a parietal source should increase diagnostic accuracy when evaluating patients with chronic abdominal pain. Reassurance of patients by the correct diagnosis and avoidance of precipitating causes is often sufficient treatment. However, accurately placed anesthetic/corticosteroid injections give substantial pain relief to more than 75% of patients, often for prolonged periods, and may be confirmatory for the source of the complaint. The probability of missing visceral disease is small (probably less than 7%) with strict adherence to diagnostic criteria and diligent observation of patients.

Idiopathic abdominal pain in children: results, deficits and perspectives of empirical research

Recurrent abdominal pain (RAP) is one of the most common pain syndromes in childhood, with prevalence rates ranging from 10 to 20% in all school-age children. In nearly 50% the complaints persist over many years of their life-span to adolescence or adulthood. Although the empirical findings have increased in the last decade, our knowledge about the etiology, pathogenesis, and pathophysiology is still very limited. Current approaches suggest that we understand recurrent pain syndromes as a complex and multidimensional disturbance (biopsychosocial paradigm). In this respect there is strong evidence for the major importance of psychosocial causes (daily hassles, specific life events), psychopathological factors (anxiety, depression, somatization disorder), and social environmental influences (mother's psychopathology, social modelling, reinforcement) in the pathogenesis of functional abdominal pain. The noticeable correlation with other pain syndromes and functional disturbances indicates that recurrent pain may possibly be a manifestation of a basic somatization disorder. The unfavourable long-term prognosis supports the need for early and specific interventions. Psychological treatment requires a medical examination to exclude organic origins. Some of these invasive diagnostic procedures can be very difficult, expensive and distressing for the child. Behavioural medicine is based upon having an extensive family history and symptom analysis. The psychological interventions applied in clinical practice include prophylaxis, reduction of pain symptoms and environmental modification. In recent years there has been an increasing trend to create more complex and multidimensional behavioural treatment programs for children. Although preliminary data on the use of these behavioural medicine programs have shown some promise, further investigations are needed to examine the applicability and effectiveness of specific interventions in the treatment of abdominal pain symptoms.

The effect of mianserin in chronic idiopathic abdominal pain A pilot study

Mianserin is a tetracyclic antidepressant that has gained popularity in Europe owing to lack of anticholinergic side effects and good tolerability. Being a histamine-1 and -2 receptor antagonist and an alpha-2 receptor blocker suggests that it should be of particular value in somatoform gastrointestinal disorders. In an open trial mianserin was given for 6 weeks to 24 patients with chronic idiopathic abdominal pain of more than 2 years' duration. Patients with a diagnosis of depressive or anxiety disorders were excluded. Daily dosage varied from 90 to 120 mg. Other psychopharmacologic or analgesic medication was not allowed during the trial. Pain response was measured by means of the Clinical Global Improvement Scale and daily self-reporting. Five patients dropped out. Of 19 completers, 15 reported significantly reduced pain. Placebo-controlled studies are needed to validate these encouraging results.