Recurrent Abdominal Pain Research Articles

Takayasu arteritis masquerading as recurrent abdominal pain

Takayasu arteritis (TA) is a rare granulomatous inflammation of large arteries, specifically the aorta and its branches. It is more prevalent in young Asian women with the highest incidence in Japan. There is a delay in diagnosis due to nonspecific early symptoms and unfamiliarity with this disease. We present a case of a young female who presented with recurrent abdominal pain suggestive of mesenteric angina and constitutional symptoms over one-year. Her radial pulses were absent, and she had multiple bruits on examination over the right subclavian and carotid arteries and the epigastrium, along with high inflammatory markers. Her CT angiography of large vessels confirmed the diagnosis of TA and she was treated with high-dose steroids with good clinical remission confirmed by a reduction in inflammatory markers and improvement in symptoms.

Clinical Features and Decision making of Congenital Vaginal Agenesis Combined with Cervical Aplasia: Case Report and Literature Review

Objective: To present the case of a teenage girl with vaginal agenesis and review current literature on recommended courses of action. A 12-year-old girl with KBG genetic syndrome was admitted to the Pediatric Unit with recurrent acute abdominal pain, vomiting, dehydration, and primary amenorrhea. Physical examination revealed advanced pubertal development, and a negative swab test. Magnetic Resonance Imaging (MRI) showed complete vaginal agenesis, septated uterus with cervical aplasia, hematometra, and hematosalpinx. Open hysterectomy was decided upon due to acute abdominal pain and the risk of endometriosis and infection. She progressed favorably and was discharged two days after surgery. Conclusion: Congenital complete vaginal agenesis with cervical aplasia is a rare obstructive malformation of the genital tract. Generally, hysterectomy is recommended due to the high risk of stenosis, infection, and adhesions. Vaginoplasty is an option when the patient is mature enough to undergo the procedure. Attempts to preserve the uterus and fertility in patients with complete cervical atresia have a small sample size. In this case, the decision to perform a hysterectomy was considered the most appropriate to suit her social circumstances.

Etiological Spectrum of Recurrent Abdominal Pain in Preschool Children: A One-Year Comprehensive Investigation Reveals a Predominance of Non-Organic Causes

Background: Recurrent abdominal pain (RAP) is a common concern affecting preschool children, impacting their daily activities. This one-year study, conducted from March 2017 to February 2018, aimed to explore the etiological spectrum of RAP in this age group, with a specific focus on differentiating between organic and non-organic causes. Methods: Eighty preschool children presenting with RAP were enrolled in the study. A comprehensive investigation included thorough interviews, physical examinations, and initial blood, urine, and stool evaluations. Additional diagnostic modalities, such as abdominal ultrasonography, radiography, and endoscopy, were employed. Data analysis involved both descriptive and inferential statistics to categorize and understand the distribution of organic and non-organic causes. Results: Among the 80 preschool children investigated, 37.5% exhibited organic causes, with urinary tract infections (UTIs) being the most prevalent (20%), either alone or coexisting with other parasitic infections. Non-organic causes dominated, comprising 62.5% of cases. Psychosocial factors, including school phobia, sibling rivalry, and familial discord, were identified as significant contributors to RAP. Conclusion: This comprehensive one-year study reveals a notable predominance of non-organic causes of recurrent abdominal pain in preschool children. UTIs were the leading organic cause, while psychosocial factors emerged as significant influencers. These findings underscore the importance of considering both medical and psychosocial aspects in the evaluation and management of RAP in this age group. Further research and instrumental support are warranted to enhance our understanding and refine therapeutic approaches for preschool children with recurrent abdominal pain.

Role of endoscopic ultrasound in gallbladder and biliary system diseases in patients with normal transabdominal ultrasonography

BackgroundThe clinical management of patients experiencing recurrent abdominal pain resembling biliary-type, but with negative findings on conventional transabdominal ultrasound (TUS), poses a challenge. In recent years, endoscopic ultrasound (EUS) has emerged as a valuable tool for diagnosing gallbladder diseases. This study aims to assess the role of EUS in the evaluation of gallbladder and biliary system diseases specifically in patients with normal transabdominal ultrasonography results.MethodsThis study was a cross-sectional analytic study that enrolled 150 patients with any complaints related to the gallbladder and biliary system necessitating transabdominal ultrasound and endosonography in the period between February 2021 and December 2021.ResultsThe mean age of the studied patients was 46.1 ± 10.3 years; 46.7% were males and 53.3% were females. The main complaint was right abdominal pain in 78.0%; meanwhile, 74.7% had a picture of obstructive jaundice. EUS revealed gallbladder wall thickening in 15 patients (10%), mud and/or small stones inside the gallbladder in 73 patients (48.7%), positive GB mass and/or polyp findings in 30 patients (20%), and biliary lesions such as duct strictures and/or dilatations were detected in 48 patients (32%), while transabdominal ultrasound was normal in all those patients.ConclusionEndoscopic ultrasound (EUS) proves to be a valuable diagnostic modality in patients experiencing biliary-type abdominal pain, despite normal transabdominal ultrasonography results. It not only aids in the accurate diagnosis of underlying conditions but also has the potential to impact the management plan for these patients.

Pain site persistence and changes from childhood to adolescence: a prospective cohort study.

Pain is a complex experience that interferes with the well-being of youth who experience it. We aimed to assess whether recurrent pain sites in childhood can predict later recurrent pain sites prospectively. Pain was assessed using the Luebeck Pain Screening Questionnaire at ages 7, 10, and 13 from the Generation XXI cohort. We used multinomial regression to assess the association of recurrent pain sites at ages 7 and 10 with those at age 13. We included 3833 participants. Boys with recurrent abdominal/pelvic pain at age 7 were more likely to report headaches (OR 2.81; 95%CI 1.48-5.34), abdominal/pelvic (OR 2.92; 95%CI 1.46-5.84), and musculoskeletal pain (OR 1.55; 95%CI 1.02-2.34) at age 13. Girls with recurrent abdominal/pelvic pain at age 7 were more likely to report both musculoskeletal (OR 1.62; 95%CI 1.10-2.40) and abdominal/pelvic pain (OR 1.74; 95%CI 1.15-2.65). At age 10, all pain sites were associated with pain in the same site at age 13. Recurrent abdominal/pelvic pain at age 7 may be related to the development of various pains in adolescence. Pain at a given site at age 10 can be associated with pain at that same site at age 13. Recurrent abdominal or pelvic pain during childhood was distinctively associated with an increased risk of recurrent pain in other sites during adolescence. Recurrent pain during childhood was associated with pain in the same sites at age 13, and this persistence seemed to emerge between the ages of 7 and 10 for both boys and girls. Studying early pain sites may add to the understanding of the etiology of chronic pain.

Enteric Duplication Cyst –A Rare Congenital Anomaly in Adolescence Presenting as Recurrent Pain Abdomen

Case Report: Presented by Dr. Harleen Bawa and Dr. Parthasarathi Hota, this case involves an 18-year-old male with recurrent abdominal pain, nausea, and fever. Initially suspected of congenital gastrointestinal malformation at 1 year, the patient underwent conservative management until symptoms reappeared. Imaging revealed blind-ended tubular structures attached to the small bowel, prompting further investigation for a definitive diagnosis. Management: An exploratory laparotomy revealed an enteric duplication cyst in the ileal region, 50 cm from the ileocecal junction. Resection of the involved ileum with end-to-end anastomosis was performed. Mesenteric lymphadenopathy and an inflamed appendix were also addressed. Biopsy results indicated changes consistent with chronic appendicitis. In Radiological findings CT images displayed well-defined blind-ended tubular structures arising from the distal ileum, suggesting Meckel’s diverticulum. Fluid density cystic lesions near the duodenum and pancreas raised the possibility of an enteric duplication cyst. Discussion: Enteric duplication cysts, though rare, can manifest with varied symptoms, including recurrent abdominal pain and intestinal obstruction. Imaging techniques such as CT, USG, and technetium pertechnetate scanning aid in diagnosis. Resection of the cyst and adjacent intestine with end-to-end anastomosis is a common surgical approach. The prognosis is excellent when complete excision is possible without compromising intestinal length. Conclusion: Enteric duplication cysts, located along the gastrointestinal tract, may present challenges in diagnosis and management. Surgical intervention, guided by imaging and clinical findings, often leads to favorable outcomes. Awareness of potential complications, such as bowel obstruction and bleeding, is crucial for timely intervention.

Gut microbiota and intestinal immunity-A crosstalk in irritable bowel syndrome.

Irritable bowel syndrome (IBS), one of the most prevalent functional gastrointestinal disorders, is characterized by recurrent abdominal pain and abnormal defecation habits, resulting in a severe healthcare burden worldwide. The pathophysiological mechanisms of IBS are multi-factorially involved, including food antigens, visceral hypersensitivity reactions, and the brain-gut axis. Numerous studies have found that gut microbiota and intestinal mucosal immunity play an important role in the development of IBS in crosstalk with multiple mechanisms. Therefore, based on existing evidence, this paper elaborates that the damage and activation of intestinal mucosal immunity and the disturbance of gut microbiota are closely related to the progression of IBS. Combined with the application prospect, it also provides references for further in-depth exploration and clinical practice.

Функциональные расстройства желудочно- кишечного тракта у детей дошкольного возраста: современные подходы к терапии

Recurrent abdominal pain (RAP) syndrome is a common pathology of childhood, which is often encountered in pediatric outpatient practice. Currently, pharmacological options are insufficiently developed, in this regard, we decided to use the drug trimebutin in the form of powder for preparation of suspension for oral administration for the treatment of this group of patients. Objective. To evaluate the effect of trimebutine therapy in the form of powder for preparation of oral suspension on the course of pain syndrome and a number of associated symptoms in preschool patients with functional RAP syndrome. Patients and methods. The study included 84 children aged 3 to 5 years who applied to the consultative and diagnostic clinic "Gastroenterological Center" (Ufa, Republic of Bashkortostan). The diagnosis of functional gastrointestinal disorders (FGD) was established in 53 patients (63.1%) of the total number of patients aged 3 to 5 years with RAP. Results. Complete disappearance of symptoms occurred in 48 (90.5%) outpatients. Commitment to treatment was high in the majority of patients (73.6%, 39 children), which, among other things, ensured high efficacy of the therapy. Conclusion. Trimebutin in the form of powder for suspension preparation in our study showed excellent efficacy in the management of RAP syndrome and associated symptoms, which is extremely valuable for determining the tactics of therapy of this pathology in preschool children in pediatric practice. The drug was well tolerated by patients, which ensured high adherence to treatment. Key words: recurrent abdominal pain, functional gastrointestinal disorders, functional dyspepsia, irritable bowel syndrome, functional gallbladder disorder, sphincter of Oddi dysfunction, functional abdominal pain, trimebutin, Trimedate

Роль генетически детерминированного дефицита лектинового пути активации комплемента при хронической инфекции Helicobacter pylori у детей

Aim. To study the association of six polymorphic regions of MBL2 (rs11003125, rs7096206, rs7095891, rs1800450, rs1800451, rs5030737), two regions of FCN2 (rs7851696, rs17549193) and one region of MASP2 (rs72550870) with Helicobacter pylori infection and the severity of neutrophilic inflammation in gastric mucosa among children with recurrent abdominal pain. Design. Genetic association study of single nucleotide polymorphisms, case — control type. Materials and methods. 96 adolescents aged 12–17 years with recurrent abdominal pain were examined. Medical history, general clinical methods and fibrogastroscopy with a biopsy of the gastric mucosa were included in the medical testing. Biopsy samples were recorded and processed to assess the neutrophil infiltration and the presence of H. pylori. The results were interpreted according to the Sydney System of Gastritis Classification. Genotyping of allelic gene variants was carried out using real-time polymerase chain reaction (MBL2, MASP2), as well as the restriction analysis of amplification products of specific genome regions (MBL2, FCN2). Results. A high rate of H. pylori colonization was associated with a high frequency of the L allele of the rs11003125 gene polymorphism of the MBL2 gene and with a decrease in the proportion of high MBL — expressing genotypes. Carriage of the Q allele of the rs7095891 gene polymorphism of the MBL2 gene was associated with less pronounced neutrophilic infiltration, and a high frequency of the T allele of the rs7851696 gene polymorphism of the FCN2 gene was associated with severe neutrophilic inflammation in gastric mucosa. No differences in the distribution of MASP2 genotypes were found. Conclusion. The results obtained suggest that genetic defects in the production of MBL and ficolin-2 may cause chronic helicobacteriosis in children and more severe inflammation of gastric mucosa. Further study of these proteins seems to be promising for new approaches to the treatment and prevention of H. pylori complications in children to be identified. Keywords: Helicobacter pylori, mannose-binding lectin, ficolin, MASP, gene polymorphism.

Childhood primary stabbing headache: A double center study.

Primary stabbing headache (PSH) is an idiopathic headache disorder characterized by head pain occurring as a transient and localized single stab or a series of stabs. The present study aimed to examine the characteristics of childhood PSH and whether they fit the International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria. We also investigated the association with migraine and episodic syndromes. In this retrospective study, we included 60 patients seen at two headache clinics (Rome and Bari) between 2016 and 2022. A headache-focused history was obtained. All patients had normal neurological examination. PSH was defined according to ICHD-3 criteria. Twenty-three patients were male (38%) and median (range) age at disease onset was 8 (3-17) years. Stabs recurred with irregular frequency and their duration varied from a few seconds up to 30 minutes. Stabs were located in different head regions. Twenty-five patients (42%) underwent neuroimaging exams. Five children reported a limitation of daily activities and none had a chronic pattern. Forty-seven patients (78%) reported a family history of primary headache, especially migraine, and forty-three had episodic syndromes (i.e. infantile colic, benign paroxysmal vertigo, motion sickness, recurrent abdominal pain, cyclic vomiting). Twenty patients had an associated primary headache: 16 suffered from migraine and four suffered from tension type-headache. According to ICHD-3 criteria, thirty-one patients had a diagnosis of probable PSH as a result of a duration of stabs longer than a few seconds (>3 seconds). Features of childhood PSH can vary widely. As seen in previous studies, several patients reported a stab duration longer than a few seconds and this might suggest that current ICHD-3 criteria may need adjustments to be suitable for children. High frequency of associated migraine and episodic syndromes could suggest a common pathophysiological mechanism between PSH and migraine. We can hypothesize that PSH and migraine attacks may be part of a spectrum of the same disease, although further evidence is needed. Larger studies with long-term follow-up are needed to improve understanding of this condition.

New Frontiers in IBS Gut Pain Treatments

Irritable Bowel Syndrome (IBS) is a common functional gastrointestinal disorder, characterized by recurrent abdominal pain or discomfort in combination with disturbed bowel habits in the absence of identifiable organic cause. It is considered a functional disorder where complex neuroimmune and brain-gut interactions occur. IBS affects about 10% of the world’s population and shows a similar prevalence in Canada.1 IBS typically is diagnosed by the Rome IV set of diagnostic criteria, which includes abdominal pain associated with defecation (≥1 day per week for ≥3 months) associated with change in bowel habit for at least three months and can be further subtyped by stool consistency. Treatment strategies existing for IBS are largely focused on symptom amelioration and although beneficial, are rarely curative.

Postbariatric hypoglycemia, abdominal pain and gastrointestinal symptoms after Roux-en-Y gastric bypass explored by continuous glucose monitoring.

BackgroundAbdominal pain and postbariatric hypoglycemia (PBH) are common after bariatric surgery. ObjectivesThis study aimed to explore the potential relationship between abdominal pain, gastrointestinal symptoms, and PBH more than a decade after Roux-en-Y gastric bypass (RYGB) and whether continuous glucose monitoring (CGM) with dietary intervention has an educational role in reducing symptoms. SubjectsAt two public hospitals in Norway (one University Hospital) 22 of 46 invited patients who reported abdominal pain more than weekly took part. Recruited from a prospective follow-up study of 546 patients 14.5 years after RYGB. MethodsThey used a CGM for two 14-day periods, with a dietary intervention between periods. The Gastrointestinal Symptom Rating Scale (GSRS) and the Dumping Severity Score (DSS) questionnaires were completed at the start and end of the study. ResultsThe 22 women had preoperative age 39.6 ± 7.7 years and body mass index (BMI) 42.0 ± 4.0 kg/m2, present age 54.6 ± 7.7 years and BMI 29.8 ± 4.8 kg/m2. The total GSRS score and DSS of early dumping decreased after the diet intervention. The number of events with Level 1 (<3.9 mmol/L) or Level 2 (<3.0 mmol/L) hypoglycemia did not change in the second period. Half of the patients had fewer, three had unchanged, and eight had more frequent events with Level 1 hypoglycemia after the intervention. Ten patients had Level 2 hypoglycemia. ConclusionThough inconclusive findings, a personalized dietary intervention reduces GSRS. This intervention was accompanied by lower mean absolute glucose in patients with recurrent abdominal pain after bariatric surgery. However, further studies are needed to explore the benefits of CGM in this setting.

A personalized approach to recurrent abdominal pain syndrome based on clinical and laboratory algorithms

To optimize the diagnosis of abdominal pain syndrome occurring under the «mask» of acute pancreatitis via algorithms for clinical and laboratory examination. We have retrospectively and prospectively analyzed patients with abdominal pain syndrome. We selected all patients with acute pancreatitis who repeatedly applied with abdominal pain syndrome to polyclinics and hospitals between 2017 and 2021. A personalized algorithm for patients with abdominal pain syndrome occurring under the «mask» of acute pancreatitis has been developed. This algorithm underlies an information system for decision-making support. An optimal diagnostic algorithm is needed in reception departments of hospitals and polyclinics. This one depends on equipment of hospitals and needs to be constantly improved. When refusing hospitalization and discharging patients with recurrent pain syndromes, physicians should orient the doctors of general network to use more informative methods. Indeed, the last ones may be unavailable in reception departments and various districts due to technical, qualification and organizational shortcomings. Advanced clinical and laboratory diagnostic methods based on the above-described algorithm are necessary for recurrent abdominal pain syndrome occurring under the «mask» of acute pancreatitis.

DOMINO trial post hoc analysis: evaluation of the diet effects on symptoms in IBS subtypes.

Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction characterized by recurrent abdominal pain related to defecation and/or associated to a change in bowel habits. According to the stool type, four different IBS subtypes can be recognized, constipation predominant (IBS-C), diarrhea predominant (IBS-D), mixed (IBS-M), and undefined (IBS-U). Patients report that their IBS symptoms are exacerbated by food. Thus, it is important to find a nutritional approach that could be effective in reducing IBS symptoms. The present work is a post hoc analysis of the previously published DOMINO trial. It aimed to evaluate the effects of a self-instructed FODMAP-lowering diet smartphone application on symptoms and psychosocial aspects in primary care IBS stratifying the results for each IBS subtypes. Post hoc analysis. Two hundred twenty-two primary care IBS patients followed a FODMAP-lowering diet for 8 weeks with the support of a smartphone application. Two follow-up visits were scheduled after 16 and 24 weeks. IBS-Symptoms Severity Score (IBS-SSS), quality of life (QoL), and adherence and dietary satisfaction were evaluated. After 8 weeks, IBS-SSS improved in all IBS subtypes (p < 0.0001). Physician Health Questiionnaire (PHQ-15) improved only in IBS-D (p = 0.0006), whereas QoL improved both in IBS-D (p = 0.01) and IBS-M (p = 0.005). This post hoc analysis showed that the app is useful in all IBS subtypes; thus, it could be used as an effective tool by both general practitioners and patients to manage symptoms in primary care. Ethical Commission University Hospital of Leuven reference number: S59482. Clinicaltrial.gov reference number: NCT04270487.

CryptoImperforate Hymen with a Huge Abdominal Mass and Massive Hematocolpometra in a 15-Year-Old Girlmenorrhea with a Huge Abdominal Mass and Massive Hematocolpometra in a 15-Year-Old Girl

Background: Imperforate hymen is one of the commonest embryological defects of the lower genital tract which occurs due to failure of canalization of the sinovaginal bulb. Its incidence is 1 in 2000 girls. Case Presentation: This case is of a 15-year-old nullipara who presented on account of a 2-month history of recurrent abdominal pain, hesitancy, and primary amenorrhea. Her physical examination reveals a huge abdominopelvic mass about the size of a 26 weeks intra-uterine gestation, and a vagina examination revealed an imperforate hymen. A pelvic ultrasound confirmed a massive hematometra and hemaltocolpos leading to a diagnosis of imperforate hymen. She had a hymenotomy with a cruciate incision to drain the menstrum. Conclusion: Pediatricians and gynaecologists need a high index of suspicion to diagnose this defect for earlier treatment and reduced morbidity due to late diagnosis.

An Unexpected Delivery

Background: Intraductal Papillary Mucinous Neoplasms of the Bile Duct (IPNBs) are rare biliary tumors. We present an unusual case with its management. Case Presentation: A 58-year-old man with a history of metastatic TCC presented with recurrent biliary abdominal pain and pruritus. Imaging revealed a dilated common biliary duct with a stone-like filling defect. ERCP revealed a grape-like polycystic mass, subsequently diagnosed as IPNB. Conclusion: IPNBs, though rare, should be considered in the differential for atypical biliary lesions. Timely diagnosis and management are essential due to their malignant potential.

Recurrent abdominal pain in children: a review

Recurrent tummy (abdominal) pain (RAP) is among the most prevalent symptoms where children experience frequent stomach pain over an extended period. RAP is prevalent in children, affecting 10-20% of school aged children. There is no consensus regarding this widespread issue's genesis, investigation, and management. This review touches on a few concerns about children's recurrent abdominal pain.

An Innovative Therapy by Changing the Gut Microbiome for the Dual Post-Operative Complications of the Recurrent Methicillin-Resistant Staphylococcus aureus (MRSA) Infections in the Residual Type II First Branchial Cyst and Facial Nerve Palsy

A very unusual, interesting, and challenging case of a 24-year-old female who was born with three openings in the neck. The patient had chronic abdominal gaseous distention, recurrent abdominal pain, and constipation since early infancy. The patient presented in emergency with acute painful red, hot, and tender swelling in the left upper cervical area. Laboratory studies showed high inflammatory markers and a provisional diagnosis of abscess with a sinus was made. The patient underwent an emergency incision and drainage. Sinus recurred and a sinogram showed it to be a residual cyst in the left submandibular salivary gland. The total cyst excision was attempted with resultant recurrence and grade IV facial nerve palsy. Post-operatively recurrent infections caused by Methicillin-resistant Staphylococcus aureus (MRSA) required several courses of oral and intravenous broad-spectrum antibiotics with several hospital admissions with no resolution in sight. Subsequent ultrasound and magnetic resonance imaging showed a residual infected cyst, cutaneous sinus, and a fistula opening in the left ear canal. A diagnosis of branchial cyst type II of the first brachial cleft remnant with a fistula was established with bilateral branchial fistulas of the second branchial remnants and the associated colorectal hypoganglionosis based on radiological studies. The patient refused any further operative interventions. Therefore, the option of conservative treatment of hypoganglionosis with holobiotics consisting of prebiotics, probiotics and postbiotics, laxatives, dietary changes, lifestyle modifications, and dietary supplements started. All antibiotics were stopped. These therapies resulted in the resolution of residual first branchial remnants and recurrent MRSA infections with the improvement in the facial nerve palsy from grade IV to grade III-IV together with an excellent cosmetic and functional result. The patient is doing well at follow-ups being infection-free for 18 months and repeat contrast-enhanced computed tomogram (CECT) has shown complete resolution of the residual cyst, sinus, and fistula with fibrosis.

The Role of IgA and IgG anti-transglutaminase antibodies in the diagnosis of celiac disease in children

Aims: Diagnosing celiac disease in children presents various challenges for pediatricians in the various clinical stages. Thus, the diagnosis of cases increased significantly, although children did not always present symptoms or clinical signs of the disease. In support of the diagnosis, several factors come into play: screening, serological tests, awareness of the presence of celiac disease and the factors that favor its occurrence. Material and methods: We performed a retrospective study at the Pediatric Clinical Hospital "St. Ioan " Galati between January 1, 2014 and October 2022. In this study we included 2640 children with suggestive symptoms of celiac disease. Results: A number of 102 patients were diagnosed with celiac disease, recurrent abdominal pain being the most common symptom.

Man With Recurrent Abdominal Pain.

Man With Recurrent Abdominal Pain.