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Gut Aug 2022
Topics: Abdominal Pain; Diagnosis, Differential; Humans
PubMed: 33685967
DOI: 10.1136/gutjnl-2021-324270 -
The British Journal of Radiology Aug 2022Abdominal pain in pregnancy is a diagnostic challenge with many potential aetiologies. Diagnostic imaging is a valuable tool in the assessment of these patients, with... (Review)
Review
Abdominal pain in pregnancy is a diagnostic challenge with many potential aetiologies. Diagnostic imaging is a valuable tool in the assessment of these patients, with ultrasound commonly employed first line. MRI is an excellent problem-solving adjunct to ultrasound and has many advantages in terms of improved spatial resolution and soft tissue characterisation. This pictorial review aims to outline the role of MRI in the work up of acute abdominal pain in pregnancy and provide imaging examples of pathologies which may be encountered.
Topics: Abdomen, Acute; Abdominal Pain; Female; Humans; Magnetic Resonance Imaging; Pregnancy; Pregnancy Complications; Ultrasonography
PubMed: 35604640
DOI: 10.1259/bjr.20211114 -
American Journal of Physiology.... Nov 2022Abdominal pain, which is a form of visceral pain, is a highly prevalent symptom worldwide frequently occurring following food ingestion. Its pathophysiology is complex,... (Review)
Review
Abdominal pain, which is a form of visceral pain, is a highly prevalent symptom worldwide frequently occurring following food ingestion. Its pathophysiology is complex, and many factors, including intestinal environmental cues, the immune system, or the molecular composition of foods, can influence the development of postprandial abdominal pain. Because of the poor efficacy of drug treatments, current strategies are often limited to the exclusion of culprit food(s) from the diet. However, there are two important limitations to this approach. First, patients suffering from food-induced abdominal pain usually recognize several food items as the cause of their gastrointestinal symptoms. Second, not all offending foods can always be identified by these patients. Newly identified mechanisms involving neuroimmune interactions and their communication with the intestinal microbiota shed light on the development of new therapeutic strategies. In this Mini-Review, these novel mechanisms and relevance of such findings are highlighted.
Topics: Humans; Abdominal Pain; Gastrointestinal Diseases; Visceral Pain; Gastrointestinal Microbiome; Eating
PubMed: 36126222
DOI: 10.1152/ajpgi.00173.2022 -
Cleveland Clinic Journal of Medicine May 2024Functional dyspepsia is defined as persistent symptoms of postprandial bloating, early satiety, or pain in the center of the upper abdomen, without findings on upper... (Review)
Review
Functional dyspepsia is defined as persistent symptoms of postprandial bloating, early satiety, or pain in the center of the upper abdomen, without findings on upper endoscopy such as peptic ulcer disease to explain these symptoms. It is common, affecting up to 30% of the global population, but it often goes undiagnosed for years. There are 2 subtypes: epigastric pain syndrome (burning and pain) and postprandial distress syndrome (bloating and satiety). The authors discuss how to diagnose and treat both subtypes.
Topics: Humans; Dyspepsia; Abdominal Pain; Postprandial Period
PubMed: 38692696
DOI: 10.3949/ccjm.91a.23062 -
South African Family Practice :... Mar 2021Abdominal pain is a common presenting problem with multiple aetiologies that often pose diagnostic and therapeutic dilemmas for primary care practitioners. The vague... (Review)
Review
Abdominal pain is a common presenting problem with multiple aetiologies that often pose diagnostic and therapeutic dilemmas for primary care practitioners. The vague symptomatology and difficult correlation to specific organ pathology obscures clinical findings leading to incorrect diagnoses. Although most presentations of abdominal pain are benign, a significant number of patients have life-threatening conditions that require a meticulous approach to management in order to prevent morbidity and mortality.The skill in assessing patients presenting with abdominal pain is fundamental for all primary care doctors. This review will discuss an approach to the assessment and diagnosis of abdominal pain in the primary care setting.
Topics: Abdominal Pain; Adult; Humans; Primary Health Care
PubMed: 33764143
DOI: 10.4102/safp.v63i1.5280 -
The British Journal of General Practice... May 2022Quantifying cancer risk in primary care patients with abdominal pain informs diagnostic strategies. (Observational Study)
Observational Study
BACKGROUND
Quantifying cancer risk in primary care patients with abdominal pain informs diagnostic strategies.
AIM
To quantify oesophagogastric, colorectal, liver, pancreatic, ovarian, uterine, kidney, and bladder cancer risks associated with newly reported abdominal pain with or without other symptoms, signs, or abnormal blood tests (that is, features) indicative of possible cancer.
DESIGN AND SETTING
This was an observational prospective cohort study using Clinical Practice Research Datalink records with English cancer registry linkage.
METHOD
The authors studied 125 793 patients aged ≥40 years with newly reported abdominal pain in primary care between 1 January 2009 and 31 December 2013. The 1-year cumulative incidence of cancer, and the composite 1-year cumulative incidence of cancers with shared additional features, stratified by age and sex are reported.
RESULTS
With abdominal pain, overall risk was greater in men and increased with age, reaching 3.4% (95% confidence interval [CI] = 3.0 to 3.7, predominantly colorectal cancer 1.9%, 95% CI = 1.6 to 2.1) in men ≥70 years, compared with their expected incidence of 0.88% (95% CI = 0.87 to 0.89). Additional features increased cancer risk; for example, for men, colorectal or pancreatic cancer risk with abdominal pain plus diarrhoea at 60-69 years of age was 3.1% (95% CI = 1.9 to 4.9) predominantly colorectal cancer (2.2%, 95% CI = 1.2 to 3.8).
CONCLUSION
Abdominal pain increases intra-abdominal cancer risk nearly fourfold in men aged ≥70 years, exceeding the 3% threshold warranting investigation. This threshold is surpassed for the >60 years age group only with additional features. These results will help direct appropriate referral and testing strategies for patients based on their demographic profile and reporting features. The authors suggest non-invasive strategies first, such as faecal immunochemical testing, with safety-netting in a shared decision-making framework.
Topics: Abdominal Neoplasms; Abdominal Pain; Aged; Colorectal Neoplasms; Female; Humans; Male; Middle Aged; Primary Health Care; Prospective Studies
PubMed: 35379605
DOI: 10.3399/BJGP.2021.0552 -
Revista Do Colegio Brasileiro de... 2023upon infection with SARS-CoV-2, patients presented with non-classical symptoms, such as gastrointestinal phenomena including loss of appetite, nausea, vomiting,... (Review)
Review
INTRODUCTION
upon infection with SARS-CoV-2, patients presented with non-classical symptoms, such as gastrointestinal phenomena including loss of appetite, nausea, vomiting, diarrhea, and abdominal pain abdominal pain. These occurrences, typically, were found in severely affected patients with COVID-19. With this, the aim of this paper is to analyze the available knowledge on the development of acute abdomen in SARS-CoV-2 infected patients.
METHODOLOGY
this is an Integrative Review in PubMed, Web of Science and VHL databases. The following descriptors were used: "Acute abdomen", "COVID-19", "Abdominal pain" and "SARS-CoV-2" with the Boolean operator "AND", and articles relevant to the theme were selected. Initially, 331 articles were selected, all published between 2020 and 2023, in Portuguese and/or English. After analysis, 11 articles matched the proposed objective.
RESULTS
the relationship between tenderness in the right upper region or the presence of Murphy's sign contributed in the association between abdominal pain and the more severe forms of COVID-19 in infected patients. The number of diagnoses for acute conditions such as cholecystitis, appendicitis, diverticulitis and pancreatitis decreased with the pandemic, but at the same time there was an increase in the duration of surgical procedures and in the length of hospital stays. These acute abdominal conditions were the result of delayed demand for hospital care, which also contributed to an increase in the conversion rate to open surgery and in the number of perforative conditions.
CONCLUSION
the development of acute abdomen in SARS-CoV-2 infected patients was predictive of an unfavorable prognosis.
Topics: Humans; COVID-19; SARS-CoV-2; Abdomen, Acute; Abdominal Pain; Appendicitis
PubMed: 37646728
DOI: 10.1590/0100-6991e-20233576-en -
Clinical Therapeutics Mar 2023Rifaximin is indicated for the treatment of irritable bowel syndrome with diarrhea (IBS-D) in adults. The current aim was to evaluate rifaximin efficacy on individual... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
Rifaximin is indicated for the treatment of irritable bowel syndrome with diarrhea (IBS-D) in adults. The current aim was to evaluate rifaximin efficacy on individual and composite IBS-D symptoms using definitions not previously examined.
METHODS
Phase III post hoc analyses of two randomized, double-blind, placebo-controlled trials and the open-label phase of a randomized, double-blind, placebo-controlled trial were conducted. Adults with IBS-D received a 2-week course of rifaximin 550 mg TID. Individual and composite responses for abdominal pain (mean weekly improvements from baseline of ≥30%, ≥40%, or ≥50%), bloating (mean weekly improvements from baseline of ≥1 or ≥2 points; or ≥30%, ≥40%, or ≥50%), stool consistency (mean weekly average stool consistency score <3 or <4), and urgency (improvement from baseline of ≥30% or ≥40% in percentage of days with urgency) for ≥2 of the first 4 weeks after treatment, and weekly for 12 weeks, were assessed.
FINDINGS
Overall, 1258 patients from the double-blind trials (rifaximin [n = 624]; placebo [n = 634]) and 2438 from an open-label trial were analyzed. The percentage of bloating or urgency responders was significantly greater with double-blind rifaximin versus placebo (P ≤ 0.03). A significantly greater percentage of the double-blind group were composite abdominal pain and bloating responders versus placebo for all thresholds analyzed (P < 0.05). A significantly greater percentage of the double-blind group were tri-symptom composite end point responders (abdominal pain, bloating, and fecal urgency) versus placebo (P = 0.001). A significantly greater percentage of patients achieved response (≥30% composite tri-symptom threshold) with double-blind rifaximin versus placebo as early as 1 week posttreatment, with significance maintained through ≥5 weeks after treatment. Open-label results were consistent with those of the double-blind study.
IMPLICATIONS
Rifaximin significantly improved multiple, concurrent IBS-D symptoms, using clinically relevant definitions of treatment response. Using a novel tri-symptom composite end point (ie, abdominal pain, bloating, fecal urgency), adults with IBS-D treated with a 2-week course of rifaximin were significantly more likely to be composite end point responders than those receiving placebo (≥30% or ≥40% threshold) for the three symptoms. Thus, rifaximin not only met current standard thresholds used for adjudication of responders in clinical trials but also achieved higher thresholds for many of these symptoms, suggesting potential for even more robust clinical improvements.
CLINICALTRIALS
gov identifiers: NCT00731679, NCT00724126, and NCT01543178.
Topics: Adult; Humans; Rifaximin; Irritable Bowel Syndrome; Diarrhea; Double-Blind Method; Abdominal Pain; Treatment Outcome
PubMed: 36922331
DOI: 10.1016/j.clinthera.2023.01.010 -
Pain Management Jan 2021Abdominal pain continues to be a major challenge and unmet need in clinical practice. Normalization of bidirectional gut-brain signaling has generated much interest as a... (Review)
Review
Abdominal pain continues to be a major challenge and unmet need in clinical practice. Normalization of bidirectional gut-brain signaling has generated much interest as a therapeutic approach to treat chronic abdominal pain. Vagal nerve stimulation (VNS) is emerging as a potential non-pharmacologic strategy for the treatment of abdominal pain. In this review paper, we will summarize the etiologies of chronic pain in gastrointestinal disorders and discuss the rational for VNS as a therapeutic approach to chronic abdominal pain, with particular emphasis in the gammaCore stimulator which allows for noninvasive VNS.
Topics: Abdominal Pain; Central Nervous System Sensitization; Chronic Pain; Gastrointestinal Diseases; Humans; Vagus Nerve Stimulation
PubMed: 33111642
DOI: 10.2217/pmt-2020-0067 -
Journal of Clinical GastroenterologyFunctional abdominal cramping pain (FACP) is a common complaint, which may present either on its own or in association with a functional gastrointestinal disorder. It is...
Functional abdominal cramping pain (FACP) is a common complaint, which may present either on its own or in association with a functional gastrointestinal disorder. It is likely caused by a variety of, probably partly unknown, etiologies. Effective management of FACP can be challenging owing to the lack of usable diagnostic tools and the availability of a diverse range of treatment approaches. Practical guidance for their selection and use is limited. The objective of this article is to present a working definition of FACP based on expert consensus, and to propose practical strategies for the diagnosis and management of this condition for physicians, pharmacists, and patients. A panel of experts on functional gastrointestinal disorders was convened to participate in workshop activities aimed at defining FACP and agreeing upon a recommended sequence of diagnostic criteria and management recommendations. The key principles forming the foundation of the definition of FACP and suggested management algorithms include the primacy of cramping pain as the distinguishing symptom; the importance of recognizing and acting upon alarm signals of potential structural disease; the recognition of known causes that might be addressed through lifestyle adjustment; and the central role of antispasmodics in the treatment of FACP. The proposed algorithm is intended to assist physicians in reaching a meaningful diagnostic endpoint based on patient-reported symptoms of FACP. We also discuss how this algorithm may be adapted for use by pharmacists and patients.
Topics: Abdominal Pain; Consensus; Gastrointestinal Diseases; Humans; Parasympatholytics
PubMed: 36149666
DOI: 10.1097/MCG.0000000000001764