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The American Journal of Case Reports Jun 2023BACKGROUND Lead toxicity is a rare yet serious condition which can be difficult to diagnose due to vague presenting symptoms. Other pathologies can also mimic the...
BACKGROUND Lead toxicity is a rare yet serious condition which can be difficult to diagnose due to vague presenting symptoms. Other pathologies can also mimic the symptoms of chronic lead toxicity, making an already difficult diagnosis more challenging. There are multiple environmental and occupational contributors to lead toxicity. A thorough history and an open differential is the key to diagnosing and treating this rare disease. With increasing diversity of our patient population, we should keep an open differential, as the epidemiological features of presenting concerns have diversified as well. CASE REPORT A 47-year-old woman presented with persistent nonspecific abdominal pain despite extensive prior work, surgeries and a prior diagnosis of porphyria. This patient was eventually diagnosed as having lead toxicity when her most recent work-up for abdominal pain revealed no urine porphobilinogen and a high lead level. The cause of lead toxicity was attributed to be an eye cosmetic called "Surma", which can have variable lead levels. Chelation therapy was advised for the patient. CONCLUSIONS It is important to recognize the difficulty in this challenging diagnosis for nonspecific abdominal pain and to eliminate the mimickers. This case is interesting because the patient was initially diagnosed with porphyria, highlighting how heavy metals, lead in this case, can lead to a false-positive diagnosis of porphyria. Accurate diagnosis requires awareness of the role of urine porphobilinogen, checking lead levels, and an open differential. This case also emphasizes the importance of avoiding anchor bias to make a timely diagnosis of lead toxicity.
Topics: Female; Humans; Middle Aged; Lead; Porphobilinogen; Abdominal Pain; Lead Poisoning
PubMed: 37291827
DOI: 10.12659/AJCR.939504 -
Neurogastroenterology and Motility Aug 2022Itopride, a mixed D2 antagonist and cholinesterase inhibitor, has prokinetic effects on gastric motility. The Leuven Postprandial Distress Scale is a validated... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Itopride, a mixed D2 antagonist and cholinesterase inhibitor, has prokinetic effects on gastric motility. The Leuven Postprandial Distress Scale is a validated patient-reported outcome instrument for functional dyspepsia (FD) postprandial distress syndrome (PDS). We aimed to use the LPDS to assess treatment outcome in PDS and PDS/EPS (epigastric pain syndrome).
METHODS
Patients with PDS, with or without non-predominant EPS symptoms, were enrolled in an 8-week double-blind placebo-controlled multi-center trial with itopride (100 mg t.i.d.). Patients completed LPDS diaries and questionnaires to assess treatment response. Mann-Whitney test and mixed models were used.
RESULTS
One hundred patients (79% females, 39.1 ± 1.5 yo) were included. No significant difference was observed between treatment arms (p = 0.6). Compared to baseline, itopride treatment significantly improved the LPDS score (p = 0.001) and all individual symptoms (p < 0.0001). In the placebo arm, this was only the case for belching and epigastric pain (p < 0.05). In an exploratory analysis, outcomes in "pure" PDS (n = 45) and overlapping PDS/EPS (n = 55) patients were assessed and showed that the latter subgroup has the largest benefit with itopride compared to placebo (p = 0.03).
CONCLUSION
Using the LPDS score in a pilot controlled trial in FD, itopride shows no therapeutic benefit over placebo after 8 weeks of treatment. In an exploratory post hoc analysis, itopride but not placebo was associated with improvement of symptoms compared to baseline, and this was most prominent in patients with overlapping PDS/EPS. The efficacy of itopride in this subgroup needs to be evaluated in a large study using the same outcome measure. (clinialtrials.org ref.: NCT04647955).
Topics: Abdominal Pain; Benzamides; Benzyl Compounds; Dyspepsia; Female; Humans; Male; Postprandial Period; Stomach Diseases
PubMed: 35357058
DOI: 10.1111/nmo.14337 -
Advances in Therapy Sep 2022Irritable bowel syndrome with diarrhea (IBS-D) is a chronic disorder of gut-brain interaction, characterized by recurrent abdominal pain in association with more... (Review)
Review
Irritable bowel syndrome with diarrhea (IBS-D) is a chronic disorder of gut-brain interaction, characterized by recurrent abdominal pain in association with more frequent, loose stools. The pathophysiology of irritable bowel syndrome (IBS) includes disordered gut motility, alterations in gut microbiota, neural-hormonal system abnormalities, immune reactivity, and visceral hypersensitivity. Timely diagnosis of IBS-D can be achieved easily using clinical criteria. Formal IBS diagnosis is important for optimizing treatment and patient outcomes and facilitating patient access to appropriate educational resources. Yet, given the symptom overlap with other gastrointestinal conditions, diagnosis of IBS-D often is perceived to be challenging. Treatment of IBS includes both nonpharmacologic and pharmacologic options. Rifaximin, alosetron, and eluxadoline are effective treatments indicated for IBS-D, but have limited availability internationally. Dietary approaches may also be indicated for certain patients with IBS-D. Psychological interventions may be effective in treating abdominal pain alone and global symptoms in IBS. We describe use of these diverse therapies and provide an overview to facilitate the primary care provider's approach to distinguishing IBS-D from other conditions with symptom overlap.
Topics: Abdominal Pain; Diarrhea; Gastrointestinal Agents; Humans; Irritable Bowel Syndrome; Primary Health Care
PubMed: 35869354
DOI: 10.1007/s12325-022-02224-z -
Surgery For Obesity and Related... Aug 2023Chronic abdominal pain (CAP) after bariatric surgery is not extensively explored and may impact the postoperative outcomes. (Observational Study)
Observational Study
Chronic abdominal pain and quality of life after Roux-en-Y gastric bypass and sleeve gastrectomy - a cross-cohort analysis of two prospective longitudinal observational studies.
BACKGROUND
Chronic abdominal pain (CAP) after bariatric surgery is not extensively explored and may impact the postoperative outcomes.
OBJECTIVE
To compare the prevalence of patient-reported chronic abdominal pain (CAP) after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Secondarily, we compared other abdominal and psychological symptoms and quality of life (QoL). Preoperative predictors of postoperative CAP were also explored.
SETTING
Tertiary referral centers for bariatric surgery in Norway.
METHODS
Analyses of 2 separate prospective longitudinal cohort studies evaluating CAP, abdominal and psychological symptoms and QoL before and 2 years after RYGB and SG.
RESULTS
Follow-ups were attended by 416 patients (85.8%), 300/416 (72.1%) were females and 209/416 (50.2%) were RYGB procedures. At follow-up, the mean age was 44.9 (10.0) years, BMI 29.5 (5.4) kg/m, and total weight loss 31.6 (10.3) %. The prevalence of CAP was 28/236 (11.9%) before and 60/209 (28.7%) after RYGB (P < .001) and 32/223 (14.3%) before and 50/186 (26.9%) after SG (P < .001). Gastrointestinal symptom rating scale scores showed greater deterioration of diarrhea and indigestion after RYGB and reflux after SG. The improvement in depression symptoms was greater after SG, as well as several QoL scores improved more after SG. Patients with CAP after RYGB experienced deterioration in several QoL scores, while these scores improved in patients with CAP after SG. Preoperative hypertension, bothersome reflux symptoms, and CAP predicted postoperative CAP.
CONCLUSIONS
The prevalence of CAP increased comparably after RYGB and SG, with worsening of gastroesophageal reflux after SG and greater deterioration of diarrhea and indigestion after RYGB. In patients with CAP at follow-up, several QoL scores improved more after SG than RYGB.
Topics: Female; Humans; Adult; Middle Aged; Male; Prospective Studies; Gastric Bypass; Quality of Life; Dyspepsia; Longitudinal Studies; Abdominal Pain; Gastroesophageal Reflux; Diarrhea; Gastrectomy
PubMed: 36870870
DOI: 10.1016/j.soard.2023.01.020 -
Journal of Basic and Clinical... Sep 2022Symptoms of irritable bowel syndrome (IBS) have been associated to altered colonic motility and sensation. Smoking affects pain perception and is a risk factor in the...
BACKGROUND
Symptoms of irritable bowel syndrome (IBS) have been associated to altered colonic motility and sensation. Smoking affects pain perception and is a risk factor in the development of post-infectious IBS, but its effect on abdominal pain and colonic transit remains to be elucidated in IBS.
METHODS
Forty patients with IBS-C and 28 with IBS-M were selected based on Rome IV criteria. Colonic transit time was studied and smoking habit was recorded. Presence of mild or severe abdominal pain and the prevalent pain characteristics (diffuse or localized, chronic or acute, with cramps or gradually distending) were recorded. Data were analyzed by univariate and stepwise multiple logistic regression analysis to verify the risk association between pain and all other variables.
RESULTS
IBS-C patients had a longer transit time in the right colon and scored more chronic pain than IBS-M patients. When severity of abdominal pain was used as discriminating factor, a significant number of subjects reporting severe pain were males and smokers (16/30 vs. 4/38 and 20/30 vs. 4/38, both ƿ<0.001). Multivariate analysis confirmed that smoking was an independent factor associated with severe abdominal pain (OR 14.3, CI 2-99, p=0.007). Smoking was not associated with colonic transit times and colonic transit was not associated with IBS symptoms' severity (both ƿ=N.S.).
CONCLUSIONS
Smoking was the only factor independently associated with severe abdominal pain. As smoking does not seem to affect colonic transit time, we suggest that smoking may influence visceral perception and symptoms severity in IBS patients.
Topics: Abdominal Pain; Constipation; Female; Gastrointestinal Transit; Humans; Irritable Bowel Syndrome; Male
PubMed: 35659327
DOI: 10.1515/jbcpp-2022-0081 -
Digestive and Liver Disease : Official... Oct 2021Chronic abdominal pain occurs frequently in pediatric patients with inflammatory bowel disease (IBD) in remission.
BACKGROUND
Chronic abdominal pain occurs frequently in pediatric patients with inflammatory bowel disease (IBD) in remission.
AIMS
To assess the prevalence and factors associated with Functional Abdominal Pain Disorders among IBD children in remission (IBD-FAPD).
METHODS
Patients with IBD for > 1 year, in clinical remission for ≥ 3 months were recruited from a National IBD network. IBD-FAPDs were assessed using the Rome III questionnaire criteria. Patient- or parent- reported outcomes were assessed.
RESULTS
Among 102 included patients, 57 (56%) were boys, mean age (DS) was 15.0 (± 2.0) years and 75 (74%) had Crohn's disease. Twenty-two patients (22%) had at least one Functional Gastrointestinal Disorder among which 17 had at least one IBD-FAPD. Past severity of disease or treatments received and level of remission were not significantly associated with IBD-FAPD. Patients with IBD-FAPD reported more fatigue (peds-FACIT-F: 35.9 ± 9.8 vs. 43.0 ± 6.9, p = 0.01) and a lower HR-QoL (IMPACT III: 76.5 ± 9.6 vs. 81.6 ± 9.2, p = 0.04) than patients without FAPD, and their parents had higher levels of State and Trait anxiety than the other parents.
CONCLUSIONS
Prevalence of IBD-FAPD was 17%. IBD-FAPD was not associated with past severity of disease, but with fatigue and lower HR-QoL.
Topics: Abdominal Pain; Adolescent; Case-Control Studies; Cross-Sectional Studies; Fatigue; Female; Humans; Inflammatory Bowel Diseases; Male; Parents; Patient Reported Outcome Measures; Quality of Life; Remission Induction; Severity of Illness Index
PubMed: 34187767
DOI: 10.1016/j.dld.2021.05.034 -
American Journal of Transplantation :... Aug 2022
Topics: Abdominal Pain; Herpes Zoster; Herpesvirus 3, Human; Humans; Kidney Transplantation; Transplant Recipients
PubMed: 35920145
DOI: 10.1111/ajt.17100 -
Acta Gastro-enterologica Belgica 2021
Topics: Abdominal Pain; Humans
PubMed: 34965058
DOI: 10.51821/84.4.026 -
Andes Pediatrica : Revista Chilena de... Jun 2022Omental infarction describes ischemic torsion of the distal portion of the omentum and constitutes an infrequent cause of acute abdominal pain in childhood of which few...
INTRODUCTION
Omental infarction describes ischemic torsion of the distal portion of the omentum and constitutes an infrequent cause of acute abdominal pain in childhood of which few cases are known. Objec tive: To analyze through a clinical case the characteristics and management of this pathology, to consider this entity in the differential diagnosis of acute abdominal pain.
CLINICAL CASE
An 11-year- old child consulted the emergency department due to a 48-hour history of continuous abdominal pain, which had progressively increased. On the physical examination, the patient presented pain in the right side of the abdomen and the epigastric area, with no signs of peritoneal irritation, and was overweight (BMI 91st percentile). Biochemical analysis showed a slight increase in c-reactive protein (CRP) 41.31 mg/L (reference value < 3.0 mg/L) without leukocytosis and normal ultrasound study, without visualization of the appendix. Due to persistent pain, increased CRP, and absence of appen dix visualization in the ultrasound, the study was completed with an abdomen and pelvis CT scan which showed trabeculation of the fat of the anterior right subhepatic space, thus diagnosing omental infarction. The patient was hospitalized for conservative management with analgesia, anti-inflamma tory drugs, and fluid therapy, presenting good evolution in the first 48 hours.
CONCLUSION
Omental infarction is an infrequent cause of acute abdominal pain in childhood. Imaging studies play a funda mental role in the differential diagnosis of this entity with other clinical conditions of similar course, thus avoiding unnecessary surgical interventions.
Topics: Abdomen, Acute; Abdominal Pain; Child; Humans; Infarction; Omentum; Peritoneal Diseases; Vascular Diseases
PubMed: 35857016
DOI: 10.32641/andespediatr.v93i3.3830 -
Clinical and Translational... Jun 2023To evaluate the ability of intestinal ultrasound (IUS) in discriminating symptomatic uncomplicated diverticular disease (SUDD) among patients with abdominal symptoms... (Observational Study)
Observational Study
INTRODUCTION
To evaluate the ability of intestinal ultrasound (IUS) in discriminating symptomatic uncomplicated diverticular disease (SUDD) among patients with abdominal symptoms including irritable bowel syndrome (IBS).
METHODS
This observational, prospective study included consecutive patients classified into the following categories: (i) SUDD; (ii) IBS; (iii) unclassifiable abdominal symptoms; and (iv) controls, including asymptomatic healthy subjects and diverticulosis. The IUS evaluation of the sigmoid: assessed the presence of diverticula, thickness of the muscularis propria, and IUS-evoked pain, namely the intensity of pain evoked by compression with the ultrasound probe on sigmoid colon compared with an area of the left lower abdominal quadrant without underlying sigmoid colon.
RESULTS
We enrolled 40 patients with SUDD, 20 patients with IBS, 28 patients with unclassifiable abdominal symptoms, 10 healthy controls, and 20 patients with diverticulosis. Patients with SUDD displayed significantly ( P < 0.001) greater muscle thickness (2.25 ± 0.73 mm) compared with patients with IBS (1.66 ± 0.32 mm), patients with unclassifiable abdominal pain, and healthy subjects, but comparable with that of patients with diverticulosis (2.35 ± 0.71 mm). Patients with SUDD showed a greater (not significant) differential pain score than other patients. There was a significant correlation between the thickness of the muscularis propria and the differential pain score only for patients with SUDD ( r = 0.460; P : 0.01). Sigmoid diverticula were detected by colonoscopy in 40 patients (42.4%) and by IUS with a sensitivity of 96.0% and a specificity of 98.5%.
DISCUSSION
IUS could represent a useful diagnostic tool for SUDD, potentially useful in characterizing the disease and appropriately address the therapeutic approach.
Topics: Humans; Irritable Bowel Syndrome; Prospective Studies; Diverticular Diseases; Diverticulum; Abdominal Pain
PubMed: 36892507
DOI: 10.14309/ctg.0000000000000580