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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This paper describes the results obtained from a study of 14 patients with symptoms of abdominal pain, nausea and vomiting which had continued for considerable periods of time and which, despite extensive investigation, eluded diagnosis. The study sought to examine the characteristics of patients who continue to suffer these symptoms and to identify their social and psychological effects. It was found that this symptom complex disrupted roles and activities in a manner out of proportion with clinical seriousness. Results from this preliminary investigation seem to point in the direction of two distinguishable groups of patients in whom the emergence and prognosis of symptoms are different. In one group, symptoms appear to be precipitated and exacerbated by problems within the environment and which disappear when such problems are ameliorated; in the other group symptoms appear as part of a long-term psychiatric illness. Implications for management are discussed.
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PMID:A study of patients with abdominal symptoms of undefined cause. 49 48

One hundred and sixty-two children (57 boys and 105 girls), aged between three and 15 years and suffering from recurrent abdominal pain, were seen in general practice in Thamesmead during a seven-year period. Only five were found to have possible organic causes for the pain. Comparison with a control group showed that the close relatives of children with pain consulted doctors more often, had had more abdominal complaints and operations, a higher rate of psychiatric illness and referral, and more known marital problems. Relations between mothers and children with recurrent pain were often unstable and inconsistent. The clinical picture was unhelpful and investigation unproductive.Recurrent abdominal pain in childhood is often a reflection of family disorder, and assessment of the state of the family should precede decisions on management.
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PMID:Recurrent abdominal pain in childhood. 55 75

The clinical presentation and treatment of 31 consecutive patients with sigmoid volvulus are reviewed. Nearly half of these patients had a history of mental illness and one-third of all patients were chronically constipated. The main clinical features of abdominal pain and gross abdominal distension had been present for an average of 8 days before presentation of the patient to hospital. The clinical diagnosis of sigmoid volvulus was not difficult but the presence of non-viable bowel was more difficult to establish. A silent abdomen was the most valuable indication of the presence of gangrenous bowel. Conservative measures, including sigmoidoscopy and therapeutic barium enema, successfully reduced the volvulus in half of the cases so treated. In those patients undergoing surgery the procedure associated with the lowest mortality was sigmoid resection with end-to-end anastomosis. The overall mortality was 35%.
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PMID:Volvulus of the sigmoid colon. 89 Feb 83

Somatic symptoms reflecting psychic components were recorded in connection with the Finnish National Epidemiological Study of Psychiatric Disorders. In the present work, according to the parents' concerns, frequent headache was found in 2.8%, recurrent abdominal pain in 2.4%, asthma in 0.7%, enuresis in 1.5% and soiling in 0.3% of the children. Children complaining frequently of different pains were reported in 1.0% by the teachers. Distribution by sex, population density areas and family structure are also given.
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PMID:Prevalence of psychosomatic symptoms in children. 189 86

A series of 25 patients referred for psychiatric consultation with nonspecific abdominal pain (NSAP) are compared with a prospectively admitted series who were not referred. The referred patients had a longer duration of pain and also had high levels of psychiatric illness. The referred patients had more life events associated with the onset of their pain than controls. Inquiry about previous psychiatric history, childhood abuse, and a symptom model would increase the detection of NSAP patients who require psychiatric evaluation. Outcome after recommended treatment is also addressed.
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PMID:Psychogenic abdominal pain. 199 16

United States estimates of the frequency of visits to physicians and patterns of medical care for the diagnosis of the irritable bowel syndrome were derived from the 1975, 1980-1981, and 1985 National Ambulatory Medical Care Surveys. These surveys of office-based physicians allow national estimates of various aspects of ambulatory care. The overall rate of visits with the diagnosis of irritable bowel syndrome in 1980-1981 and 1985 were 10.6 per thousand U.S. population. Women had 2.4 times the rate of visits by men and rates rose in both sexes until middle-age. Irritable bowel syndrome was the leading digestive disease diagnosis among gastroenterologists but only the seventh leading diagnosis among all physicians. Gastrointestinal symptoms, association with mental disorders, prescriptions, and disposition were also examined in patients with visits for irritable bowel syndrome. Among records with digestive tract symptoms and a first listed diagnosis of irritable bowel syndrome, stomach or abdominal pain was listed on only about one half of records and disorders of bowel function were listed on fewer than 40%. In 1975 and 1985, irritable bowel syndrome was noted approximately twice as often as other digestive diseases at visits with mental disorder symptoms and diagnosis, although mental disorder symptoms and diagnoses were noted at fewer than 15% of visits with irritable bowel syndrome. Medications were prescribed at approximately 75% of visits for irritable bowel syndrome; the most common were gastrointestinal medications followed by combination gastrointestinal-psychoactive medications. Subsequent appointments were scheduled following at least 50% of the visits of patients with irritable bowel syndrome.
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PMID:Irritable bowel syndrome in office-based practice in the United States. 200 37

Among medical clinic patients consulting for IBS, symptoms of psychologic distress are common, and more than half of these patients are found to have a psychiatric diagnosis in addition to bowel dysfunction. Many investigators have therefore concluded that IBS is a psychophysiologic disorder and proposed that patients with IBS be treated with psychologic techniques. However, recent studies suggest that this association may be spurious; persons in the community who have symptoms of IBS but do not consult a doctor have no more psychologic symptoms than persons without bowel symptoms. This indicates that psychologic symptoms do not cause bowel symptoms, but, instead, influence which persons with bowel symptoms will consult a physician. The bowel symptoms and the psychologic symptoms that coexist in most patients with IBS may be best thought of as comorbid conditions. Neither causes the other, but both may be serious enough to warrant treatment. Moreover, in some patients whose bowel symptoms consist of vague complaints of abdominal pain not specifically related to defecation or to changes in the frequency or consistency of bowel habits, the psychologic disorder may be primary. Psychologic stress may exacerbate IBS whether or not the patient has a psychiatric disorder, and psychologic stress may trigger acute episodes of symptoms similar to those of IBS even in persons without IBS. However, the magnitude of this correlation is modest, suggesting that only about 10% of the variation in bowel symptoms is attributable to stress. Psychologically oriented treatments have a role in the management of IBS. Most patients who consult internists about bowel symptoms have significant levels of depression and anxiety, and they tend to notice and to worry about somatic complaints more when they experience these dysphoric affects. Psychologic treatments that reduce the level of their psychologic distress also frequently reduce the frequency and severity of complaints about bowel symptoms. Tricyclic antidepressants may be tried as a first line of treatment; they have been shown to be superior to placebo for the management of abdominal pain and diarrhea but not constipation. In patients who do not show an adequate response to antidepressants, brief psychotherapy focusing on better ways of coping with current problems, hypnosis, or behavior therapy emphasizing methods of controlling reactions to stress are recommended. Controlled trials show these treatment approaches to be superior to medical management alone. It may appear paradoxical that psychologic treatments aimed at the management of emotions are so frequently found to reduce bowel symptoms, because the motility disorder responsible for the bowel symptoms may be unrelated to the psychologic symptoms that influence the patient to seek treatment.+4
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PMID:Psychologic considerations in the irritable bowel syndrome. 206 51

Subtotal colectomy has been performed in 40 patients with severe constipation. Only one patient was male. Five patients (13 per cent) had a history of a serious psychiatric disorder. Twenty-six patients (65 per cent) could not expel a 100-ml air-filled balloon and 19 patients (48 per cent) had electromyographic evidence of abnormal puborectalis contraction during attempted defaecation before operation. Median preoperative passage of 50 radio-opaque markers over 5 days was 16 per cent. Sixteen patients had had a previous anorectal myectomy to exclude Hirschsprung's disease. Initial resections were subtotal colectomy and ileorectal anastomosis (n = 34), caecorectal (n = 5) or ileosigmoid (n = 1) anastomosis. Secondary operations included restorative proctocolectomy and ileal pouch-anal anastomosis (n = 6) and six patients eventually had an ileostomy. Median bowel frequency per week significantly increased after operation (0.3 (range 0-1) preoperatively to 21 (range 2-70) postoperatively, P less than 0.005), the percentage of patients with abdominal pain fell after operation from 93 to 39 per cent but symptoms of abdominal distension remained the same (86 per cent preoperatively and 82 per cent postoperatively).
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PMID:Clinical results of colectomy for severe constipation. 275 67

The concept of psychogenic pain in children is by no means new; it has been researched for at least 3 decades. There is increasing recognition of the relationship between emotional factors and complaints of pain in the absence of organic disease. By their very nature these conditions warrant a team approach, incorporating both medical and psychological perspectives, to treatment. A study was undertaken that focused on identifying the incidence and related features of this problem at a general hospital. Over a 2-year period 46 children showed psychogenic pain disorder according to the criteria of Diagnostic and Statistical Manual of Mental Disorders. Physical examinations and basic investigations revealed no organic disease. The majority of the children (34, 73.9%) complained of abdominal pain, although limb and chest pains also featured. Marital problems between parents constituted the most common stressor, affecting 31 of the children (67.4%). Psychotherapeutic management was initiated with all the children and their families. Thirty-five (76.1%) had remission of symptoms after psychotherapy.
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PMID:Psychogenic pain disorder in children. 277 65

Seventy patients presenting to the gastroenterologist with upper abdominal pain were examined by a psychiatrist to establish the presence of psychiatric disorder, illness behaviour and to record in detail their symptom pattern. The 37 patients who had no organic cause for their abdominal complaints were subdivided into those with and without psychiatric disorder. The former (21 patients) demonstrated more illness behaviour, they complained of more abdominal symptoms and their pain was both more severe and more persistent than in the patients with organic disease and those with non-organic illness who did not have psychiatric disorder. The latter group reported no symptoms of 'psychoneurosis' and should probably be regarded as a separate group if the aetiology of functional abdominal pain is to be clarified. Those with non-organic abdominal complaints who had psychiatric illness could be distinguished by the presence of three symptoms, namely depression, anxiety and fatigue. Detection and treatment of their psychiatric disorder might lead to a decrease in their symptomatic complaints and illness behaviour.
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PMID:Symptom complaints, psychiatric disorder and abnormal illness behaviour in patients with upper abdominal pain. 327 Aug 33


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