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Annals of Emergency Medicine Oct 2022
Topics: Abdominal Pain; Humans; Male; Syncope
PubMed: 36153047
DOI: 10.1016/j.annemergmed.2022.03.023 -
Annals of Emergency Medicine Jan 2023
Topics: Male; Humans; Abdominal Pain; Diagnosis, Differential
PubMed: 36543490
DOI: 10.1016/j.annemergmed.2022.06.026 -
Gastroenterology Nov 2019
Topics: Abdominal Pain; Adult; Biomarkers; Chelating Agents; Humans; Lead; Lead Poisoning; Male; Medicine, Ayurvedic
PubMed: 31158375
DOI: 10.1053/j.gastro.2019.05.060 -
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 -
Pancreatology : Official Journal of the... Oct 2021Pain is the most common symptom in chronic pancreatitis (CP) with a major impact on quality of life. Few validated questionnaires to assess pain in CP exist, and the...
Pain is the most common symptom in chronic pancreatitis (CP) with a major impact on quality of life. Few validated questionnaires to assess pain in CP exist, and the lack of consensus negatively impacts clinical management, research and meta-analysis. This guideline aims to review generic pain questionnaires for their usability in CP, to outline how pain assessment can be modified by confounding factors and pain types, to assess the value of additional measures such as quality of life, mental health and quantitative sensory testing, and finally to review pain assessment questionnaires used specifically in CP. A systematic review was done to answer 27 questions that followed the PICO (Population; Intervention; Comparator; Outcome) template. Quality of evidence of the statements was judged by Grades of Recommendation, Assessment, Development and Evaluation (GRADE) criteria. The manuscript was sent for review to 36 experts from various disciplines and continents in a multi-stage Delphi process, and finally reviewed by patient representatives. Main findings were that generic pain instruments are valid in most settings, but aspects of pain are specific for CP (including in children), and instruments have to account for the wide phenotypic variability and development of sensitization of the central nervous system. Side effects to treatment and placebo effects shall also be considered. Some multidimensional questionnaires are validated for CP and are recommended together with assessment of quality of life and psychiatric co-morbidities. This guideline will result in more homogeneous and comprehensive pain assessment to potentially improve management of painful CP.
Topics: Abdominal Pain; Chronic Pain; Consensus; Humans; Pain Measurement; Pancreatitis, Chronic; Quality of Life; Surveys and Questionnaires
PubMed: 34391675
DOI: 10.1016/j.pan.2021.07.004 -
Annals of Internal Medicine Aug 2019
Topics: Abdominal Pain; Female; Humans; Internship and Residency; Jamaica; Middle Aged; Physician-Patient Relations; San Francisco; Superstitions
PubMed: 31426075
DOI: 10.7326/M18-3034 -
BMC Medicine Feb 2022Patients with disorders of gut-brain interaction (DGBI) report meal intake to be associated with symptoms. DGBI patients with meal-related symptoms may have more severe...
BACKGROUND
Patients with disorders of gut-brain interaction (DGBI) report meal intake to be associated with symptoms. DGBI patients with meal-related symptoms may have more severe symptoms overall and worse health outcomes, but this subgroup has not been well characterized. We aimed to describe the global prevalence of meal-related abdominal pain and characterize this subgroup.
METHODS
The data analyzed originated from the Internet survey component of the population-based Rome Foundation Global Epidemiology Study, completed in 26 countries (n = 54,127). Adult subjects were asked whether they had abdominal pain and how often this was meal-related. Respondents were categorized into "no," "occasional," and "frequent" meal-related abdominal pain groups based on 0%, 10-40%, and ≥50% of the pain episodes being meal-related, respectively. DGBI diagnoses, frequency of other GI symptoms, psychological distress, non-GI somatic symptoms, quality of life, and healthcare utilization were compared between groups. Mixed linear and ordinal regression was used to assess independent associations between psychological distress, non-GI somatic symptoms, quality of life, other GI symptoms, and meal-related abdominal pain.
RESULTS
Overall, 51.9% of the respondents reported abdominal pain in the last 3 months, and 11.0% belonged to the group with frequent meal-related abdominal pain, which included more females and younger subjects. DGBI diagnoses were more common in subjects with frequent meal-related abdominal pain, and the frequency of several GI symptoms was associated with having more frequent meal-related abdominal pain. Having meal-related abdominal pain more frequently was also associated with more severe psychological distress, non-GI somatic symptoms, and a poorer quality of life. The group with frequent meal-related abdominal pain also more often consulted a doctor for bowel problems compared to the other groups of meal-related abdominal pain.
CONCLUSION
Reporting frequent meal-related abdominal pain is common across the globe and associated with other GI and non-GI somatic symptoms, psychological distress, healthcare utilization, and a poorer quality of life. Individuals who frequently experience meal-related abdominal pain also more frequently fulfill the diagnostic criteria for DGBI. Assessing meal-related symptoms in all DGBI patients could be of major importance to improve and individualize symptom management.
Topics: Abdominal Pain; Adult; Female; Gastrointestinal Diseases; Humans; Irritable Bowel Syndrome; Prevalence; Quality of Life; Surveys and Questionnaires
PubMed: 35172840
DOI: 10.1186/s12916-022-02259-7 -
Annals of Emergency Medicine Jan 2023
Topics: Male; Humans; Abdominal Pain
PubMed: 36543485
DOI: 10.1016/j.annemergmed.2022.06.019 -
Medizinische Klinik, Intensivmedizin... Nov 2023Because 8-10% of children in the emergency room present with acute abdominal pain, a systematic work-up is essential to rule out acute abdomen. (Review)
Review
BACKGROUND
Because 8-10% of children in the emergency room present with acute abdominal pain, a systematic work-up is essential to rule out acute abdomen.
OBJECTIVES
This article highlights the etiology, symptoms, diagnostic workup, and treatment of acute abdomen in children.
MATERIALS AND METHODS
Review of the current literature.
RESULTS
Abdominal inflammation, ischemia, bowel and ureteral obstruction, or abdominal bleeding are causes of acute abdomen. Extra-abdominal diseases such as otitis media in toddlers or testicular torsion in adolescent boys can also lead to symptoms of acute abdomen. Abdominal pain, (bilious) vomiting, abdominal guarding, constipation, blood-tinged stools, abdominal bruise marks, and poor condition of the patient with symptoms such as tachycardia, tachypnea, and hypotonia up to shock are leading symptoms of acute abdomen. In some cases, emergent abdominal surgery is needed to treat the cause of the acute abdomen. However, in patients with pediatric inflammatory multisystem syndrome temporarily associated with SARS-CoV‑2 infection (PIMS-TS), a new disease causing an acute abdomen, surgical treatment is rarely needed.
CONCLUSIONS
Acute abdomen can lead to nonreversible loss of an abdominal organ, such as bowel or ovary, or develop into acute deterioration of the patient's condition up to the state of shock. Therefore, a complete history and thorough physical examination are needed to timely diagnose acute abdomen and initiate specific therapy.
Topics: Male; Female; Adolescent; Humans; Abdomen, Acute; Abdominal Pain; Abdomen; COVID-19
PubMed: 37294351
DOI: 10.1007/s00063-023-01030-x