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

We report a retrospective review of primary peptic ulcer disease in 16 children, 8 boys and 8 girls between 2 and 14 years of age, seen at our hospital over a 4 years and 4 months period. Endoscopy was realized in all children and revealed 7 duodenal ulcers (DU) and 11 gastric ulcers (GU) (two patients had both locations). At the initial diagnosis 5 patients were less than 6 years old with a ratio GU/DU of 4:1; in the other patients this ratio was 1:1. In children with duodenal ulcer 56.5% of them had positive family history. The commonest presenting symptoms were abdominal pain (87.5%) and acute gastrointestinal bleeding (68.7%). The follow-up period ranged from 2 to 52 months; in 13 cases follow-up was more than 1 year. Four patients (3 DU and 1 GU) older than 6 years recurred.
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PMID:[Primary peptic ulcer in childhood: apropos of 16 cases]. 356 62

Four cases of annular pancreas diagnosed by endoscopic retrograde cholangiopancreatography (ERCP) are described and 105 cases of this anomaly in adults in Japan were reviewed. Among 105 cases, abdominal pain was the most frequent symptom. Concerning associated diseases, peptic ulcer was present in 24.8% and pancreatitis in 13.3%. In case 1, duodenal ulcer and pancreatic cyst were noted. Pancreatolithiasis was found in two cases (case 1 and 2). Case 4 presented the clinical features of acute pancreatitis. Out of 105 cases, well-described 26 were divided into six types. The following results were obtained. 1) The most frequent type was that in which the annular duct arose from the duct of Wirsung. 2) The next most frequent type was that in which the main pancreatic duct encircled the duodenum. 3) The other types corresponded to those in which the annular duct arose from the duct of Santorini and the common bile duct. We emphasized that ERCP is the most important procedure to find the characteristic features and to establish the therapeutic strategy in cases of annular pancreas.
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PMID:Annular pancreas detected in adults, diagnosed by endoscopic retrograde cholangiopancreatography: report of four cases. 356 55

Information concerning the natural history of peptic ulcer disease commencing in childhood is limited. We have followed up 19 individuals in whom this diagnosis had been made in childhood 14-27 years previously. Strict diagnostic criteria were used. A high incidence of morbidity persisting into adult life was found. On investigation 9 (47%) had had a proven ulcer since entering adult life. Ten (53%) were no longer prone to recurring abdominal pain, but four of these had undergone vagotomy and pyloroplasty (three after the age of 21) for intractable symptoms. Thus, only six patients (31%) had made a lasting and spontaneous recovery. Serious complications had occurred at some time in the past in 10 cases (53%). Overt gastrointestinal bleeding had occurred in eight (42%), and this had been after the age of 18 years in three. Duodenal perforation occurred in one subject, and severe pyloric stenosis in another, both of whom were aged 21 years. One subject developed a penetrating duodenal ulcer at the age of 24 years. Seven (37%) had undergone surgery, and in two of these cases more than one operation had been performed. Fifty-eight percent of complications suffered and 89% of surgical operations performed involved patients of 21 years or older. These findings firmly reinforce the opinion that the disorder frequently persists into adult life. The impact of modern means of medical therapy, such as the H2 receptor antagonists, has not yet been fully evaluated.
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PMID:Peptic ulcer disease in childhood: long-term prognosis. 369 66

Of 31 patients (18 male and 13 female) followed up 13-29 years after diagnosis, recurrent or persistent duodenal ulcer had occurred in four. In 22 (71%) gastrointestinal symptoms persisted into adult life, although only abdominal pain was significantly more frequent than in 126 controls.
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PMID:Twenty year review of duodenal ulcer. 370 95

A 15-year-old boy complained of abdominal pain and massive upper gastrointestinal hemorrhage. Endoscopic evaluation demonstrated an ulcerated, submucosal mass involving the ampulla. This was locally excised and found to show the characteristic histologic and ultrastructural features of a gangliocytic paraganglioma. Similar lesions have been reported in 29 patients with a mean age of 55 years (range, 32-80). Twenty-six patients complained of abdominal pain or gastrointestinal bleeding, symptoms that mimic those of peptic ulcer disease. These tumors are uniformly benign, nonencapsulated, and submucosal. They usually arise in the second portion of the duodenum and are treated by simple excision. This patient is the youngest reported, and his case is presented as an illustration of an unusual tumor that can masquerade clinically and radiologically as a duodenal ulcer. The importance of endoscopic evaluation is stressed.
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PMID:Duodenal gangliocytic paraganglioma occurring in adolescence. 373 18

We performed upper gastrointestinal endoscopy in 60 rural Haitian patients who complained of chronic upper abdominal pain. Twenty-five of 37 men (68%) and 5 of 23 women (22%) had abnormal findings. In men the predominant abnormalities were severe duodenal ulcer, duodenitis, and pyloroduodenal obstruction; duodenal ulcer or duodenitis appeared to precede obstructive disease by about 20 years. In women the abnormal findings invariably were milder than in men and consisted of duodenal ulcer, duodenitis, and gastritis. These observations as well as the observations of others indicate that peptic ulcer disease is common in developing countries, particularly among men. We hypothesize that this familiar abnormality reported from unfamiliar places represents the ordinary spectrum of peptic ulcer disease, but that inadequate treatment of recurrent episodes over time leads to obstruction. Physicians need to learn more about the epidemiology of peptic disease in developing countries and to devise better methods of effective treatment to prevent the late complication of gastric outlet obstruction.
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PMID:Tropical peptic ulcer disease: an endoscopic study from rural Haiti. 376 May 17

Interobserver variation was estimated in radiologists' detection of duodenal ulcer and deformity of the duodenal bulb. A consecutive series of 156 patients with upper abdominal pain had a double contrast barium examination. The films were first read by routine by a specialist in radiology. A second reading was performed by another specialist who did not know the result of the first reading. Overall agreement between the two readings in the detection of duodenal ulcer and deformity of the duodenal bulb was 0.91 and 0.94, respectively. The overall agreement was adjusted for the expected chance agreement and kappa values were calculated. Kappa was 0.63 for the detection of duodenal ulcer and 0.85 for the detection of deformity of the duodenal bulb.
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PMID:Interobserver variation in the radiographic diagnosis of duodenal ulcer disease. 396 17

A 35-yr-old man with moderate hypertriglyceridemia, associated with a positive family history for hyperlipidemia, developed chylomicronemia with abdominal pain, muscle pain, and splenomegaly while being treated with cimetidine for a duodenal ulcer. The chylomicronemia and the pain subsided after the drug was stopped. When the patient was rechallenged with the drug 6 mo later, the chylomicronemia reappeared after a treatment period of 6 days. Chylomicronemia and its complications should therefore be considered as a potential risk when cimetidine is prescribed to patients with known hyperlipidemia.
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PMID:Chylomicronemia induced by cimetidine. 401 6

Heterogeneity is the most important consideration in the pathophysiology of peptic ulcer disease. Acute ulcers and erosions present clinically with gastrointestinal bleeding or perforation. If they heal there is no predictable recurrence. Factors concerned with mucosal defense are relatively more important than aggressive factors such as acid and pepsin. Local ischemia is the earliest recognizable gross lesion. The gastric mucosa is at least as vulnerable as the duodenal mucosa and probably more so. Most drug-induced ulcers occur in the stomach. Chronic or recurrent true peptic ulcers (penetrating the muscularis mucosae) usually present with abdominal pain. Many duodenal ulcer patients report that the pain occurs when the stomach is empty or is relieved by food, and follows a pattern of relatively long periods of freedom from symptoms between recurrences. Approximately 50% of patients experience a recurrence within a year if anti-ulcer medication is stopped. In most western countries recurrent duodenal ulcer is more common than gastric ulcer. Peptic ulcer disease is also more common in men. Recent evidence indicates genetic and familial factors in duodenal ulcer and increased acid-pepsin secretion in response to a variety of stimuli. However, it is also becoming clear that of all the abnormal functions noted, few are present in all subjects and many are clustered in subgroups. In chronic gastric ulcer of the corpus, defective defense mechanisms, such as duodenogastric reflux and atrophic gastritis, seem to be more important than aggressive factors. Nevertheless, antisecretory medications accelerate the healing of such ulcers. It remains to be seen whether prostaglandins, mucus secretion, or gastric mucosal blood flow are impaired in chronic ulcer disease.
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PMID:The pathophysiology of peptic ulcer disease. 405 22

Twenty-five cases of benign giant duodenal ulcer have been studied. In every case a barium meal examination showed an ulcer crater with a radiographic diameter of at least 2 centimetres. Abdominal pain was the commonest symptom but less than half of the patients had had pain characteristic of chronic peptic ulcer. Haemorrhage from the ulcer occurred in a large majority of them. The radiological appearances are described, and it has been shown that the giant ulcer may be missed through being mistaken for the duodenal cap or else misdiagnosed.It appears that the death rate in this condition has been falling but it is still high. The management of patients with giant ulcers is discussed.
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PMID:Giant duodenal ulcer. 498 52


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