Showing papers on "Abdominal pain published in 1995"

The Irritable Bowel Syndrome: Long-Term Prognosis and the Physician-Patient Interaction

Abstract: Objective: To evaluate the long-term course and prognosis associated with the irritable bowel syndrome (IBS) and to determine the influence of an effective physician–patient relationship on subsequ...

Irritable Bowel Syndrome in a Community: Symptom Subgroups, Risk Factors, and Health Care Utilization

Abstract: The clinical relevance of subdividing the irritable bowel syndrome (IBS) into subgroups based on bowel habit is largely unknown. We therefore obtained an age- and sex-stratified random sample of Olmsted County, Minnesota, residents aged 20-95 years. All subjects were mailed a valid self-report questionnaire during the years 1988-1993; the response rate was 74% (n = 3,022). Among subjects with IBS (n = 536), four symptom-based subgroups of similar size were identified: constipation predominant, diarrhea predominant, alternating constipation and diarrhea, and neither. The prevalence of IBS was significantly greater in females, primarily because of a higher prevalence of constipation-predominant IBS in women. Of persons > or = 60 years of age, 23% reported the initial onset of IBS in the previous year compared with 10% in younger subjects; the age at onset of IBS was similar among the subgroups. Marital status, education level, smoking, and alcohol use were not significantly different among the subgroups. Of those with IBS, 25% reported visiting a physician for abdominal pain or disturbed defecation in the prior year compared with only 8% of persons without IBS. Female sex, an increased number of Manning's symptom criteria, and the individual IBS subgroups were not associated with higher rates of physician visits. We conclude that the onset of IBS may not be limited to early adulthood and that subgroups of IBS based on bowel patterns may not identify clinically distinct entities.

“Natural History” of Unresected Cholangiocarcinoma: Patient Outcome After Noncurative Intervention

Abstract: Objective To clarify the "natural history" of unresected cholangiocarcinoma. Design We reviewed the outcome in 103 patients with biopsy-proven cholangiocarcinoma managed at our institution during a 5-year period (1980 through 1984) who did not undergo curative resection. Material and Methods The study group of 56 men and 47 women had initial manifestations of jaundice (71 %), abdominal pain (49 %), and weight loss (44 %). The histopathologic features were confirmed by operation in 73 patients, percutaneous biopsy in 16, endoscopy in 3, or autopsy in 11. The primary tumor site was the common hepatic duct in 270/0, the hepatic bifurcation in 27%, the common bile duct in 26%, the liver in 13%, and the right or left hepatic duct in 6%. Biopsy-proven metastatic lesions were identified in 70 patients, including 18 with proven nodal involvement. Surgical intervention (N = 57) most commonly consisted of biliary decompression (26%), biliary bypass (16%), or cholecystectomy (11 %). Results The operative mortality was 4% (N = 2). The hospital mortality of medically managed patients was 12%. The survival after the onset of symptoms was 53% at 1 year, 19% at 2 years, and 9% at 3 years. Only four patients (4%) lived more than 5 years. Univariate analysis of all hospitalized patients (N = 90) revealed a survival advantage for women, patients 62 years of age or younger, those with blood group A or O, surgical patients, patients who did not require biliary decompression, and those who received further palliative treatment after any type of biliary decompression. Multivariate analysis showed a survival advantage for patients who underwent surgical exploration and those who had further palliative treatment after either operative or percutaneous biliary decompression. Conclusion Unresected cholangiocarcinoma is a rapidly fatal process, but early intervention affects the course of the disease and likely prolongs patient survival.

Hepatolithiasis associated with cholangiocarcinoma.

Abstract: Hepatolithiasis is a risk factor for cholangiocarcinoma. It is difficult to make an accurate diagnosis before treatment. In a retrospective study, we identified characteristic clinical features of 103 patients with hepatolithiasis (group H) and 10 patients with hepatolithiasis associated with cholangiocarcinoma (group HC), and examined the methods for diagnosis and treatment. The main symptoms were abdominal pain, fever, and jaundice, although few patients in group HC had jaundice. The incidence of abnormal serum levels of carcinoembryonic antigen (CEA) in group HC was higher than in group H. The incidence of cholangiocarcinoma in cases in which most of the stones were present in the intrahepatic ducts of the left lobe (type I-L) was higher than the incidence in the other patients. Of the patients who underwent portography in group HC, portal veins in the portion of the liver containing the cholangiocarcinoma were not seen, and this region was atrophic in the operative specimens. The incidence of portal obstruction in portograms in group HC was higher than that in group H. The possibility of carcinoma should be kept in mind if there are high levels of CEA, if the location of the stones is classified as type I-L, or if portal veins cannot be seen on portograms. In such patients, liver resection should be considered because there may be undiagnosed cholangiocarcinoma.

Long-Term Health Outcomes in Patients with Recurrent Abdominal Pain

Abstract: Investigated somatic and emotional symptoms, functional disability, and health service utilization in 31 former RAP patients and 31 former well patients who had originally been interviewed 5 to 6 years earlier. Both former patients and their mothers were interviewed for this follow-up study. Medical records were obtained for those patients who reported receiving new diagnoses for abdominal pain since their initial assessment. Results indicated that only one of the former RAP patients was later diagnosed with organic disease that clearly accounted for his earlier abdominal pain. Nonetheless, at follow-up former RAP patients reported significantly higher levels of abdominal pain, other somatic symptoms, and functional disability (including school/work absence) than did former well patients. Mothers reported higher levels of internalizing emotional symptoms in former RAP patients than in former well patients.

Effect of octreotide and erythromycin on idiopathic and scleroderma-associated intestinal pseudoobstruction.

Abstract: Treatment of chronic intestinal pseudoobstruction with prokinetic agents has been disappointing. Our study was designed to determine if octreotide and erythromycin would provide sustained relief from nausea, abdominal pain, and bloating in pseudoobstruction. Using gastrointestinal manometry, quantitative parameters of the activity front of the migrating motor complex at baseline and after prokinetic therapy with erythromycin and octreotide were determined in 14 patients with intestinal pseudoobstruction who had nausea, abdominal pain, and bloating. Patients were treated with erythromycin and octreotide for 20–33 weeks. Octreotide increased the frequency, duration, and motility index of activity fronts (AFs) from 1.2±0.3 AFs/4hr, 2.7±0.7 min, and 85±23 min mm Hg to 4.1±0.8 AFs/4 hr, 5.5±0.7 min, and 152±24 min mm Hg, respectively (P<0.05). Antral activity was decreased from 63±14 to 23±8% by octreotide (P<0.05). Erythromycin induced antral activity; however, small intestinal motor activity was suppressed. While on erythromycin and octreotide, five patients had long-term improvement of nausea and abdominal pain. All responders had at least 5 AFs/4 hr induced by octreotide. We conclude that octreotide and erythromycin relieve abdominal pain and nausea in pseudoobstruction. Patients who have at least 5 AFs/4 hr after octreotide administration are most likely to clinically respond.

Abdominal pain in the ED: Stability and change over 20 years

Abstract: Abdominal pain (AP) is a common presenting complaint in emergency department (ED) patients A 1972 study reported that unsupervised surgical residents in a university hospital ED were unable to make a specific diagnosis in 41% of 1,000 AP patients In the intervening time, ED availability of diagnostic technology has increased, and the reference hospital acquired full-time emergency medicine (EM) faculty To assess what changes occurred in the evaluation and epidemiology of AP, a similar study was done at the same hospital The study design was a review of records of 1,000 consecutive ED patients with AP seen in 1993 at a 58,000-visit public Level I trauma center ED The percentage of ED patients (4% to 5%) with AP was unchanged Frequency of hospital admission dropped from 274% (1972) to 183% (1993) There was marked increase in the specificity of diagnoses, with only 249% in 1993 diagnosed as undifferentiated abdominal pain (UDAP) There were eight cases of missed appendicitis in 1972 and none in 1993 One 1993 patient with acute cholecystitis was initially misdiagnosed as having UDAP Advances in technology and EM faculty presence were temporally associated with improved diagnostic accuracy in patients with AP in a university hospital ED As compared with 20 years ago, fewer patients required hospitalization, more were assigned a specific diagnosis, and there were fewer cases of missed surgical disease

Etiologic factors and clinical presentation of hepatocellular carcinoma. Differences between cirrhotic and noncirrhotic Italian patients.

Abstract: Background. It is not known whether the prevalence of hepatocarcinogenic factors differs between cirrhotic and noncirrhotic patients with hepatocellular carcinoma (HCC) or whether the clinical presentation of HCC in these two groups differs. Methods. The prevalence of the putative etiologic factors of HCC and its clinical presentation in 373 patients with cirrhosis and 102 without cirrhosis seen from 1981 to 1992 were evaluated. Results. Hepatitis C virus infection (76 vs. 48%, P = 0.003) and both current (22.5 vs. 10%, P = 0.007) and past (50.5 vs. 34.5%, P = 0.045) hepatitis B virus infections were more common in cirrhotic than in noncirrhotic patients with HCC. The absence of exposure to both viruses was much less frequent in the former (7 vs. 40%, P 400 ng/ml) levels did not differ significantly (24 vs. 17%) between the two groups. Extrahepatic extension of HCC was more common in noncirrhotic patients (20.5 vs. 6.5%, P < 0.001) and its independent predictors were poor cancer differentiation and absence of cirrhosis. Asymptomatic cancers were more frequently encountered with cirrhosis. Abdominal pain was the most common presenting symptom in both groups. Signs of hepatic decompensation prevailed in cirrhotic patients, whereas a toxic syndrome dominated the clinical picture of the noncirrhotic patients. Conclusions. Hepatitis viruses are associated more with carcinogenesis of the cirrhotic than of the noncirrhotic liver. Alpha-fetoprotein is not a sensitive neoplastic marker, particularly in noncirrhotic patients. In the latter, HCC appears more advanced at diagnosis and symptoms of neoplastic toxicity are prominent. Cancer 1995 ;75 :2220-32.

Treatment of functional somatic symptoms

Abstract: Introduction 1. Historical review of management of nervous and somatic disorder 2. Overview of epidemiology, classification and aetiology 3. Overview of treatment Treatment Methods 4. How to engage the patient in treatment 5. The use of antidepressants and other drug treatments 6. Cognitive behavioural treatment 7. Psychodynamic treatment Clinical Syndromes 9. Patients with multiple symptoms 10. Chronic pain 11. Treatment of dysmorphophobia Specific symptoms 12. Irritable bowel and abdominal pain 13. Pre-menstrual tension 14. Chronic fatigue 15. Low back pain 16. Pelvic pain Special populations 17. Treatment of somatic symptoms in the elderly 18. Management of somatic symptoms in children Organisation of care 19. Management in primary care 20. Management in general hospitals

Efficacy of peripheral kappa agonist fedotozine versus placebo in treatment of irritable bowel syndrome. A multicenter dose-response study.

Abstract: The efficacy and safety of the peripheral kappa agonist fedotozine was evaluated in a double-blind, multicenter study involving 238 patients with the irritable bowel syndrome. After a two-week washout, patients were assigned to one of four groups to receive either placebo or fedotozine three times a day at doses of 3.5, 15, or 30 mg for six weeks. Patient assessment of mean symptom intensity indicated that the 30-mg dose of fedotozine was superior to placebo in relieving maximal daily abdominal pain (P=0.01), mean daily pain (P=0.007), and abdominal bloating (P=0.02). Changes in bowel function and defecation disorders could not be evaluated reliably. According to the investigators, the highest dose of fedotozine markedly reduced overall disease severity (P=0.003) and the pain component of the symptomatic profile (P=0.009). Clinical and laboratory safety was very good. Fedotozine 30 mg three times a day therefore appears to be effective and safe in the treatment of the abdominal pain and bloating associated with IBS.

Prevalence and clinical features of abdominal migraine compared with those of migraine headache.

Abstract: The prevalence and clinical features of migraine headache and abdominal migraine were studied in the well defined population of Aberdeen schoolchildren. Ten per cent of all children (2165) aged 5-15 years were given a questionnaire inquiring, among other symptoms, about the history of headache and abdominal pain over the past year. A total of 1754 children (81%) responded. Children with at least two episodes of severe headache and/or sever abdominal pain, attributed by the parents either to unknown causes or to migraine, were invited to attend for clinical interview and examination. After interview, 159 children fulfilled the International Headache Society's criteria for the diagnosis of migraine and 58 children had abdominal migraine giving estimated prevalence rates of 10.6% and 4.1% respectively. Children with abdominal migraine had demographic and social characteristics similar to those of children with migraine. They also had similar patterns of associated recurrent painful conditions, trigger and relieving factors, and associated symptoms during attacks. The similarities between the two conditions are so close as to suggest that they have a common pathogenesis.

Choledochal cysts: lessons from a 20 year experience.

Abstract: Cystic dilatation of the biliary tree is a rare congenital anomaly. To determine mode of presentation, diagnostic pitfalls, and long term outcome after surgery, 78 children (57 girls, 21 boys) with choledochal cyst treated between 1974 and 1994 were reviewed. Anatomical types were: Ic (n = 44), If (n = 28), IVa (n = 4), and V (n = 2); a common pancreaticobiliary channel was identified in 76% patients. Age at presentation ranged from 0-16 (median 2.2) years, six patients being diagnosed by prenatal ultrasonography. Of the 72 patients diagnosed postnatally, 50 (69%) presented with jaundice, associated with abdominal pain in 25 or a palpable mass in three, 13 (18%) presented with pain alone, and two (3%) with a palpable mass. The classic triad of jaundice, pain, and a right hypochondrial mass was present in only four (6%). Four children presented acutely after spontaneous perforation of a choledochal cyst, two presented with ascites and one cyst was discovered incidentally. Plasma and/or biliary amylase values were raised in 30 of 31 patients investigated for abdominal pain; seven had evidence of pancreatitis at operation. In 35 of 67 (52%) patients referred without previous surgery, symptoms had been present for more than one month, and in 14 of them for more than one year, before diagnosis. Delayed referral was due to misdiagnosis as hepatitis (n = 12), incomplete investigation of abdominal pain (n = 6), and failure to note the significance of ultrasonographic findings (n = 10). Two patients referred late died from liver failure. Of the 76 patients with type I or IV cysts, 59 underwent radical cyst excision and hepaticojejunostomy as a primary procedure and 10 as a secondary operation after previously unsuccessful surgery. Sixteen patients have been lost to follow up but most of the remainder are well after a mean period of 4.1 (0.1-13) years. Choledochal cysts are often misdiagnosed, but prognosis is excellent if radical excision is performed.

Anisakidosis: report of 25 cases and review of the literature.

Abstract: Anisakidosis (previously known as anisakiasis) is a disease caused by the accidental ingestion of larval nematodes (Anisakis and sometimes Pseudoterranova) in raw fish Two groups of patients are studied: 5 clinical cases and 20 serological diagnoses 55 French cases are already published Most of them complained of acute symptoms, which occurred within 12 h of eating the seafood meal--epigastric pain, occlusion, diffuse abdominal pain, and appendicitis Larvae were attached to the gastric mucosa (25 cases), including an inflammatory response (erythema, oedema ulceration) Diagnosis of anisakiasis is made by gastroscopy which allows removal of the worms, and cures the patients In gastro-intestinal tract X-rays, oedema in the mucosa, pseudo tumour formation, and filling defects (worm) were observed In chronic infections, cases with intermittent feelings of ill health and abdominal pain, lasting from several weeks to months, were misdiagnosed as another intestinal disease Positive serological reactions are helpful, and surgery is necessary for resection of the lesion; diagnosis is made histologically by an eosinophilic granuloma, and the presence of a larva with Y shaped lateral cords Infestation rate is high in fishes: cod (88%), rock fish (86%), herring (88%), salmon, mackerel Public health education should discourage the eating of raw fish Thorough cooking to 70 degrees C or adequate freezing to -20 degrees C for 72 h are the best preventive measures Such legislation is only in force in the Netherlands, where cases have decreased dramatically

Reversible Magnetic Resonance Imaging Findings in metronidazole-induced Encephalopathy

Abstract: Metronidazole, a 5-nitroimidazole widely used for treatment of trichomoniasis, giardiasis, amebiasis, and anaerobic infections, produces a number of neurologic side effects including peripheral neuropathy, encephalopathy, cerebellar dysfunction, and seizures [1-3]. We report brain MRI findings in a patient with metronidazole-induced sensory neuropathy, encephalopathy, and cerebellar dysfunction. To our knowledge there are no previous reports of brain MRI changes due to metronidazole toxicity. Case report. A 45-year-old Asian Indian woman who had been living in the United States for the past 10 years was hospitalized with complaints of confusion, gait unsteadiness, and painful extremities. About 1 month prior to admission the patient had returned from India, where she had a brief episode of diarrhea with fever that was treated with "shots". Two days after returning from her trip, the patient was hospitalized with abdominal pain and diarrhea. Abdominal ultrasound revealed cholecystitis, and stool examination was positive for Blastocystis hominis, resulting in the patient's being started on metronidazole 750 mg three times a day. Two weeks later, she developed wrist and hand arthralgias and was prescribed ibuprofen and amitriptyline at night for sleep. Laboratory investigation at this time revealed an ESR of 24 mm/hr, normal complete blood counts, CK of 54, negative antinuclear antibodies screen, and mildly elevated rheumatoid arthritis factor at 66 IU/ml (reference, <40). One week later, she complained of difficulty in hearing and bilateral ankle pain. She denied any fever, chills, or night sweats. Examination did not reveal any inflammation of the …

Abnormal sensitivity to duodenal lipid infusion in patients with functional dyspepsia.

Abstract: Background and objectives:Patients with functional dyspepsia exhibit increased sensitivity to gastric distension (mechanoreceptors) and to meals rich in fat (chemoreceptors). The aim of this study was to test whether these patients were abnormally sensitive to intraduodenal lipid, and whether this s

Double blind placebo controlled trial of pizotifen syrup in the treatment of abdominal migraine.

Abstract: Fourteen children with abdominal migraine were treated with pizotifen and placebo in a double blind crossover trial. The results showed pizotifen to be clearly superior to placebo in the prophylaxis of abdominal migraine. The importance of clearly distinguishing abdominal migraine from other forms of recurrent abdominal pain is emphasised.

Irritable bowel, irritable body, or irritable brain?

Abstract: Summary points The irritable bowel syndrome affects about 20% of adults in the industrialised world The condition is a disturbance of gastrointestinal function of unknown cause, but abnormalities of intestinal motility and visceral sensation are found in some patients Symptoms of the irritable bowel syndrome are often associated with extraintestinal manifestations, including urinary symptoms, dyspareunia, and fatigue Overall, 40–60% of patients with the irritable bowel syndrome who seek medical advice have psychological symptoms of depression or anxiety, or both Diagnosis of the irritable bowel syndrome can usually be made on the basis of clinical history and examination, but exclusion of organic disease is advisable in patients aged >45 years who present with new bowel symptoms No uniformly successful treatment exists for the irritable bowel syndrome. End organ treatment aimed at relieving abdominal pain (antispasmodic drugs) or disturbed bowel habit (antidiarrhoeal and bulking agents) can produce symptomatic relief, and “central” treatment (for example, anti-depressants, hypnotherapy, psychotherapy) should be considered in patients with associated affective disorders

Papillary serous carcinoma of the peritoneum.

Abstract: Objective: To describe the clinical features of papillary serous carcinoma of the peritoneum followed by a short review of the literature. Methods: From January 1986 to May 1994, six patients with papillary serous carcinoma of the peritoneum were treated at our institution. Their presenting features, sites of disease at the time of staging laparotomy, subsequent treatment and follow-up were reviewed. Results: The mean age was 53.3 years (range 46–59). The most common presenting features were abdominal pain, distention and the presence of ascites. Common sites of disease at the time of laparotomy were the peritoneal and subdiaphragmatic surfaces, omentum, serosa of bowel and superficial involvement of the ovaries. Patients were treated with cytoreductive surgery and platinum — based chemotherapy. Conclusion: Although experience is scant and more data is needed, for the time being, management for primary peritoneal carcinoma is as for ovarian cancer.

A simple and effective way to reduce postoperative pain after laparoscopic cholecystectomy

Abstract: The aims of this study were to see if laparoscopic cholecystectomy is associated with a similar postoperative pain pattern to gynaecological laparoscopy and to see whether the use of a suprahepatic suction drain makes recovery from laparoscopic cholecystectomy more comfortable. After routine laparoscopic cholecystectomy and insertion of a suprahepatic suction drain, patients were randomized to suction or no suction on the drain. The time course of the severity of wound, abdominal and shoulder tip pain was assessed by visual analogue scales administered in the morning and afternoon of the first 3 postoperative days. The control group had a high incidence of shoulder tip pain similar to that after gynaecological laparoscopy. Patients in the treatment group reported significantly less shoulder tip pain than the control group (O.R. 0.16, 95% CI, 0.06-0.40). There was a tendency for the treatment group to report reduced abdominal and, to a lesser extent, wound pain. The authors recommend suprahepatic suction as a simple and more effective way to improve patient comfort after laparoscopic cholecystectomy.

Small bowel necrosis associated with postoperative jejunal tube feeding

Abstract: Background Postoperative enteral nutrition using jejunal tube feeding is widely practiced and usually well tolerated. Functional intestinal complaints occur frequently but generally respond to alteration of the infusion rate or tube feeding formula. Occasionally, however, nonspecific signs of intestinal disturbance progress to a syndrome of abdominal distention, hypotension, and hypovolemic shock resulting in extensive small bowel necrosis. Study design During a six-year period, four patients have been identified retrospectively who had this complication among 1,359 patients receiving jejunal tube feeding. Their clinical course was evaluated critically and compared with 11 cases described in the literature. Results Small bowel necrosis is a rare but highly morbid complication associated with postoperative jejunal tube feeding. Of 14 patients who had small bowel necrosis develop, 12 succumbed to this complication. The causative mechanism remains unclear, but is most likely the result of several factors. Conclusions Tube feeding should be discontinued immediately and total parenteral nutrition should be considered in patients who have abdominal pain, abdominal distention, increased nasogastric drainage, and signs of intestinal ileus.

Gastrointestinal metastases from malignant melanoma

Abstract: Between 1980 and 1992, 68 patients with clinical indications of involvement of the gastrointestinal (Gl) tract with metastatic melanoma were treated at Roswell Park Cancer Institute. Presenting symptoms were anaemia, abdominal pain, nausea and vomiting. Sites commonly involved were the small bowel (75%), the large intestine (25%), and the stomach (16%). Twenty-one patients were considered unsuitable for surgery; their median survival after diagnosis of Gl metastases was 2.9 months. Forty-seven patients underwent abdominal surgery; effective palliation was achieved in most of them. Complete resection of Gl metastases was accomplished in 47% of patients. The median survival after operation was 27.6 months for patients with complete resection of Gl metastasis and no other disease, 5.1 months for patients with resection of involved Gl tract and other metastases present, and 1.9 months for patients who had a by-pass procedure only. The 5-year survival for patients with complete resection of Gl metastases and no other evidence of disease was 28.3%. The other groups had only 1-year survivors. Surgical intervention is justified on the basis of these findings, and extended palliation can be achieved in patients with complete resection of metastatic disease.