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Gastroenterology Clinics of North... Sep 2021Psychopharmacologic therapies are beneficial in reducing symptoms when treating irritable bowel syndrome (IBS) and other disorders of gut-brain interaction (DGBI).... (Review)
Review
Psychopharmacologic therapies are beneficial in reducing symptoms when treating irritable bowel syndrome (IBS) and other disorders of gut-brain interaction (DGBI). Noradrenaline, serotonin, and dopamine are neurotransmitters of key importance in psychopharmacology and pain-reduction mechanisms. The first-line (tricyclic antidepressants, serotonin noradrenaline reuptake inhibitors, selective serotonin reuptake inhibitors) and second-line (atypical antipsychotics, delta-ligand agents, low-dose naltrexone) neuromodulator treatment options are recommended when IBS-associated abdominal pain is of moderate or severe intensity and is persistent. To understand the implementation strategy, the multidimensional clinical profile as a template is used for presenting 3 case scenarios involving painful IBS and DGBI of varying complexity.
Topics: Abdominal Pain; Humans; Irritable Bowel Syndrome
PubMed: 34304793
DOI: 10.1016/j.gtc.2021.04.005 -
American Family Physician Jun 2018Recurrent abdominal pain (RAP) in children is defined as at least three episodes of pain that occur over at least three months and affect the child's ability to perform... (Review)
Review
Recurrent abdominal pain (RAP) in children is defined as at least three episodes of pain that occur over at least three months and affect the child's ability to perform normal activities. RAP is most often considered functional (nonorganic) abdominal pain, but an organic cause is found in 5% to 10% of cases. Further workup is warranted in children who have RAP and fever, vomiting, blood in the stool, more than three alarm symptoms, or a history of urinary tract infections. Physical examination findings that should prompt further workup include weight loss or failure to grow; jaundice; costovertebral tenderness or back pain with lower extremity neurologic symptoms; liver, spleen, or kidney enlargement; an abdominal mass; or localized tenderness on abdominal examination. Workup may include complete blood count, erythrocyte sedimentation rate, C-reactive protein level, fecal guaiac testing, fecal ova and parasite testing, or urinalysis. Pregnancy testing and screening for sexually transmitted infections should be considered in adolescents or if there are concerns about sexual abuse. Abdominal radiography can be helpful for diagnosing obstruction or constipation. Abdominal ultrasonography identifies an abnormality in up to 10% of children with RAP who meet criteria for further workup, compared with 1% of those who do not meet these criteria. Functional abdominal pain is a clinical diagnosis and no workup is needed. Management of functional abdominal pain focuses on improving quality of life, reducing parent and child concerns about the seriousness of the condition, and reducing the disability associated with pain rather than complete resolution of pain. Although evidence is lacking for most pharmacologic treatments of functional abdominal pain, psychological therapies such as cognitive behavior therapy and hypnotherapy have been shown to be beneficial.
Topics: Abdominal Pain; Child; Diagnosis, Differential; Humans; Quality of Life
PubMed: 30216016
DOI: No ID Found -
La Revue de Medecine Interne Apr 2022
Topics: Abdominal Pain; Embolization, Therapeutic; Humans; Pancreatitis
PubMed: 34509317
DOI: 10.1016/j.revmed.2021.07.007 -
Deutsche Medizinische Wochenschrift... May 2015Gastrointestinal symptoms are among the most common side effects of drugs. There is a broad spectrum of symptoms. Patients often report upper abdominal pain, an early...
Gastrointestinal symptoms are among the most common side effects of drugs. There is a broad spectrum of symptoms. Patients often report upper abdominal pain, an early sense of satiety, epigastric discomfort or pain in the upper abdomen or behind the breastbone, flatulence, diarrhoea or constipation. Some of these symptoms are attributed to the stomach or upper abdomen by the patient and/or the physician. "Stomach pain", pain in the epigastric region, occurs in most cases in combination with other symptoms such as a feeling of pressure in the upper abdomen or bloating, early satiety, nausea or vomiting--a combination called dyspepsia. Given the high frequency of these symptoms in the general population and the large number of medications many patients are taking, it can be very difficult in a given patient to differentiate between drug-induced side effects and spontaneously occurring symptoms.
Topics: Abdominal Pain; Diagnosis, Differential; Dyspepsia; Gastrointestinal Agents; Humans; Symptom Assessment
PubMed: 25970411
DOI: 10.1055/s-0041-101921 -
Nature Reviews. Gastroenterology &... Mar 2015Chronic abdominal pain is one of the most common clinical syndromes encountered in day to day clinical paediatric practice. Although common, its definition is confusing,... (Review)
Review
Chronic abdominal pain is one of the most common clinical syndromes encountered in day to day clinical paediatric practice. Although common, its definition is confusing, predisposing factors are poorly understood and the pathophysiological mechanisms are not clear. The prevailing viewpoint in the pathogenesis involves the inter-relationship between changes in hypersensitivity and altered motility, to which several risk factors have been linked. Making a diagnosis of functional abdominal pain can be a challenge, as it is unclear which further diagnostic tests are necessary to exclude an organic cause. Moreover, large, well-performed, high-quality clinical trials for effective agents are lacking, which undermines evidence-based treatment. This Review summarizes current knowledge regarding the epidemiology, pathophysiology, risk factors and diagnostic work-up of functional abdominal pain. Finally, management options for children with functional abdominal pain are discussed including medications, dietary interventions, probiotics and psychological and complementary therapies, to improve understanding and to maximize the quality of care for children with this condition.
Topics: Abdominal Pain; Child; Chronic Pain; Gastrointestinal Diseases; Humans; Prognosis; Risk Factors; Terminology as Topic
PubMed: 25666642
DOI: 10.1038/nrgastro.2015.21 -
The New Zealand Medical Journal Sep 2022The purpose of this study was to compare the frequency and profile of abdominal pain calls to Healthline with that from other national healthcare providers; to evaluate...
AIMS
The purpose of this study was to compare the frequency and profile of abdominal pain calls to Healthline with that from other national healthcare providers; to evaluate the outcomes for this symptom against international telehealth providers; and to explore any inter-clinician variation in the response to abdominal pain that could be part of a quality improvement cycle.
METHODS
Data routinely collected about abdominal pain calls to Healthline from 2017 to 2019 were extracted, analysed; and compared to the literature, hospital, and ambulance data and international telehealth providers. A specialist group was convened to review the profile of Healthline callers and outcome data. Variation in outcome changes and acuity grouping was evaluated at an individual level.
RESULTS
Approximately 50,000 abdominal pain calls to Healthline over three years were analysed, with three-quarters from women, mostly of childbearing age. The majority call afterhours, with NZ European and, to a lesser extent, Māori, and callers from smaller geographical areas are over-represented. One quarter of patients had a hospital outcome (including 4% receiving an ambulance), which was found to be less acute than comparable health systems. Whakarongorau's Clinical Governance Committee and the Specialist Group both supported the relative distribution of outcomes given by Healthline for abdominal pain. There was found to be variation in the outcomes given to abdominal pain callers at an individual clinician level. This was both in their changes to the disposition given by the Odyssey decision support tool and in their overall outcome distribution.
CONCLUSION
Healthline should be considered a key part of New Zealand's healthcare system, as illustrated by the volume of calls that it receives and the fact that presentation types are similar to general practice and emergency departments. Given that abdominal pain is a difficult symptom to accurately address without in-person examination and investigation, the findings support Healthline's outcomes as appropriate with hospitalisation rates lower than comparable healthcare systems. Whakarongorau's (the organisation which runs Healthline) ability to identify individual clinician behaviours gives it a unique opportunity to improve care through decreasing variation.
Topics: Abdominal Pain; Delivery of Health Care; Emergency Service, Hospital; Female; Hospitals; Humans; New Zealand
PubMed: 36049790
DOI: No ID Found -
Expert Review of Gastroenterology &... 2023Irritable bowel syndrome (IBS) is characterized by chronic symptoms (>6 months) of abdominal pain in combination with a disturbed bowel habit. There is an association... (Review)
Review
INTRODUCTION
Irritable bowel syndrome (IBS) is characterized by chronic symptoms (>6 months) of abdominal pain in combination with a disturbed bowel habit. There is an association between the intensity of abdominal pain and the need for health care utilization. A bidirectionally disordered gut-brain interaction is central in the pathophysiology of IBS where a number of factors, gastrointestinal and non-gastrointestinal, can contribute to the illness experience. In order to treat abdominal pain in IBS, mapping these factors in a multidimensional clinical profile is helpful.
AREAS COVERED
This review covers basic epidemiology and pathophysiology of abdominal pain in IBS, the diagnostic approach, and a multidimensional treatment model where the management of abdominal pain is in focus.
EXPERT OPINION
A personalized treatment of abdominal pain in IBS is possible in patients who understand the diagnosis, the potential of therapies used, and where a good continuity in the patient-doctor relationship is established.
Topics: Humans; Irritable Bowel Syndrome; Pain Management; Abdominal Pain; Brain; Patient Acceptance of Health Care
PubMed: 37552616
DOI: 10.1080/17474124.2023.2242775 -
Journal of the Royal Society of Medicine Sep 2014Functional abdominal pain syndrome is characterised by frequent or continuous abdominal pain associated with a degree of loss of daily activity. It has a reported... (Review)
Review
Functional abdominal pain syndrome is characterised by frequent or continuous abdominal pain associated with a degree of loss of daily activity. It has a reported population prevalence of between 0.5% and 1.7%, with a female preponderance. The pathophysiology of functional abdominal pain is incompletely understood although it has been postulated that peripheral sensitisation of visceral afferents, central sensitisation of the spinal dorsal horn and aberrancies within descending modulatory systems may have an important role. The management of patients with functional abdominal pain requires a tailored multidisciplinary approach in a supportive and empathetic environment in order to develop an effective therapeutic relationship. Patient education directed towards an explanation of the pathophysiology of functional abdominal pain is in our opinion a prerequisite step and provides the rationale for the introduction of interventions. Interventions can usefully be categorised into general measures, pharmacotherapy, psychological interventions and 'step-up' treatments. Pharmacotherapeutic/step-up options include tricyclic antidepressants, serotonin noradrenergic reuptake inhibitors and the gabapentinoids. Psychological treatments include cognitive behavioural therapy and hypnotherapy. However, the objective evidence base for these interventions is largely derived from other chronic pain syndrome, and further research is warranted in adult patients with functional abdominal pain.
Topics: Abdominal Pain; Female; Humans; Male; Spinal Cord; Spinal Nerves; Syndrome
PubMed: 25193056
DOI: 10.1177/0141076814540880 -
Annals of Emergency Medicine May 2023
Topics: Male; Humans; Vomiting; Abdominal Pain
PubMed: 37085199
DOI: 10.1016/j.annemergmed.2022.10.029 -
Emergency Medicine Journal : EMJ Aug 2020Recurrent abdominal pain accounts for a significant proportion of attenders and high impact users in the emergency department. Due to the heterogeneity of presentation... (Review)
Review
Recurrent abdominal pain accounts for a significant proportion of attenders and high impact users in the emergency department. Due to the heterogeneity of presentation and the broad spectrum of possible causes, abdominal pain presents as a significant clinical challenge within the emergency department, particularly as distress and pain are commonly elevated. Patients in this group are routinely prescribed opiate-based interventions and repeated investigations in a 'better safe than sorry' culture which saturates the field of persistent physical symptoms. This approach is contributing to the growing problem, and fuelling a cycle of repeated attendance and failure to resolve. This article reviews the current clinical and psychophysiological understanding of recurrent abdominal pain, critiquing guidelines and approaches to diagnosis and management. We offer an alternative evidence-based biopsychosocial approach using the mnemonic 'ERROR', recommending five steps to assessment and clinical management of recurrent abdominal pain in the emergency department.
Topics: Abdominal Pain; Diagnosis, Differential; Emergency Service, Hospital; Humans; Pain Management; Pain Measurement; Recurrence
PubMed: 31810974
DOI: 10.1136/emermed-2019-209113