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

Dyspepsia, defined as chronic or recurrent upper abdominal pain or nausea, is a common occurrence. Dyspepsia without an ulcer (non-ulcer dyspepsia) is diagnosed in patients at least twice as often as peptic ulceration. Diseases that may present with similar symptoms include gastroesophageal reflux, biliary tract disease, chronic pancreatitis, and irritable bowel syndrome. A careful history and physical examination, supplemented by selected tests, usually lead to a correct diagnosis. The pathogenesis of non-ulcer dyspepsia remains unknown. Gastric acid secretion, duodenogastric reflux, psychological factors, environmental exposures, and heredity probably do not play a major role. Some patients may have motility disturbances, but whether these disturbances cause dyspepsia is unknown. Campylobacter pylori infection and associated gastritis are common in non-ulcer dyspepsia, but their etiologic role is controversial, as is the importance of chronic duodenitis. By recognizing the heterogeneity of patients who present with non-ulcer dyspepsia, more rational management may be possible. Although an empiric trial of antacids or H2 blockers has been recommended to treat dyspepsia, most controlled trials show that although these substances reduce severity of symptoms, they are no more effective than placebos in non-ulcer dyspepsia.
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PMID:Non-ulcer dyspepsia: potential causes and pathophysiology. 328 48

Nonulcer dyspepsia remains a difficult disorder to treat because it is a heterogeneous syndrome. Once patients with the irritable bowel syndrome, esophagitis, and other organic diseases are excluded, there remain patients with dyspepsia of unknown cause (termed "essential dyspepsia") and patients with dyspepsia plus symptoms of gastroesophageal reflux without esophagitis. The aim of this study was to determine whether cimetidine or pirenzepine is efficacious in relieving the symptoms of these latter subgroups. Sixty-two consecutive patients were studied who had chronic upper abdominal pain or nausea where endoscopy had shown no evidence of peptic ulceration, esophagitis, or malignancy; 47 had essential dyspepsia, and 15 had dyspepsia plus gastroesophageal reflux. They were initially randomized to either cimetidine or placebo, or pirenzepine or placebo. Patients continued each medication for 1 mo, and, after a washout period, crossed over when again symptomatic; 51 patients completed cimetidine and placebo, and 50 completed pirenzepine and placebo. The results showed that cimetidine was superior to placebo in decreasing the number of upper abdominal pain episodes weekly and the severity of pain, but the absolute improvement was small. Pirenzepine was not superior to placebo in decreasing symptoms.
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PMID:Randomized, double-blind, placebo-controlled crossover trial of cimetidine and pirenzepine in nonulcer dyspepsia. 351 48

Dyspepsia or indigestion is one of the most common disorders that is managed by general practitioners and gastroenterologists. Non-ulcer dyspepsia can be defined as upper abdominal pain or nausea in patients in whom endoscopy reveals no evidence of peptic ulceration or gastric cancer. Non-ulcer dyspepsia is a heterogeneous disorder and can be the result of such diverse entities as the irritable bowel syndrome, duodenitis or gastro-oesophageal reflux, or may be idiopathic ("essential" dyspepsia). This review traces the development of modern thought on dyspepsia and non-ulcer dyspepsia, from the 16th century to the present.
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PMID:Dyspepsia and non-ulcer dyspepsia: an historical perspective. 354 May 42

The aim of this study was to determine if there were predictors of the symptomatic course of patients with chronic unexplained (essential) dyspepsia. After endoscopic assessment, 111 patients with essential dyspepsia were followed up by telephone interview every second month. Data were gathered, for a mean of 17 mo per patient, on the number of days of upper abdominal pain (the response variable) each month. In the 6-mo period before entry to the study the following predetermined predictor variables were collected: demographic factors (age, sex, social grade), number of pain days in the 6 mo before diagnosis, environmental factors (analgesics, nonsalicylate nonsteroidal antiinflammatory drugs, alcohol, smoking, coffee, tea), length of dyspepsia history, and past history of peptic ulcer. Prospectively for each month of follow-up, the following additional variables were recorded: environmental factors, treatment, and development of gastroesophageal reflux symptoms. It was found that patients with more pain before diagnosis were significantly more likely to have pain over the follow-up, and the taking of medications for dyspepsia and development of gastroesophageal reflux were associated with more days of pain over the follow-up (all p less than 0.001). Demographic and environmental factors, length of dyspepsia history, and a past history of ulcer were of no significant predictive value. There was a decrease in pain over the follow-up period (p = 0.002), but this effect was limited to the first two periods after endoscopic diagnosis.
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PMID:Prognosis of chronic unexplained dyspepsia. A prospective study of potential predictor variables in patients with endoscopically diagnosed nonulcer dyspepsia. 355 87

Exercise-induced gastroesophageal reflux (GER) is described in an athletic child with chronic abdominal pain and vomiting in conjunction with strenuous exercise. Although continuous 24-h pH probe monitoring was negative for GER, simultaneous pH probe and exercise stress testing (treadmill) showed a prolonged, continuous episode of acid reflux throughout exercise and the 30-min recovery phase. The authors are unaware of other cases of exercise-induced GER in children and suggest that simultaneous pH probe and exercise stress testing may be a useful technique to evaluate exercise-induced symptoms in children. Moreover, the presence of acid reflux during stress may warrant exercise restriction during the early management of reflux esophagitis.
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PMID:Exercise-induced gastroesophageal reflux in an athletic child. 368 87

Radionuclide hepatobiliary imaging was performed on a patient with a longstanding history of scleroderma who presented with abdominal pain suggestive of biliary disease. Cystic duct patency was documented after 10 min with tracer accumulation in the second portion of the duodenum which failed to progress consistent with the duodenal hypomotility of scleroderma. The patient was given intravenous Kinevac resulting in gastroesophageal reflux of radionuclide.
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PMID:Gastroesophageal reflux demonstrated by hepatobiliary imaging in scleroderma. 381 54

It is widely acknowledged that Barrett's esophagus in adults is an acquired condition resulting from prolonged gastroesophageal reflux. Barrett's esophagus is rare in childhood, even though gastroesophageal reflux occurs commonly in the pediatric age group. When a columnar-lined esophagus is present in children, it is often regarded as a congenital anomaly rather than as a consequence of chronic gastroesophageal reflux. Over a 5-yr period (1978-1982), we retrospectively studied Barrett's esophagus in children 19 yr of age or younger who were evaluated for gastroesophageal reflux and whose symptoms warranted esophagoscopy and esophageal biopsy. Esophageal biopsies were performed on 103 patients with gastroesophageal reflux. Thirteen children (age range, 8 mo-19 yr) had Barrett's esophagus, for a prevalence of 13%. Gastroesophageal reflux was documented in these children by upper gastrointestinal radiographs or pH monitoring. Radiographs demonstrated esophageal stricture in 5 of the 13 children; none had hiatal hernia. Children presented with symptoms suggestive of gastroesophageal reflux and esophagitis: vomiting, abdominal pain, odynophagia, dysphagia, and heartburn. All children had a past history of excessive regurgitation during infancy. Histologically, three types of columnar epithelium were present: gastric fundic type (11 patients), junctional-type columnar epithelium reminiscent of gastric cardia (7 patients), and specialized columnar (metaplastic intestinal) type (2 patients). We believe that Barrett's esophagus is more common in children than had previously been appreciated. In these children, we suggest that the distal columnar-lined esophagus resulted from chronic gastroesophageal reflux and is not a congenital anomaly.
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PMID:Barrett's esophagus in children: a consequence of chronic gastroesophageal reflux. 669 Mar 59

Recurrent vomiting in adults is characterized by episodes of forceful vomiting which last several hours and recur at inconstant intervals; patients are free from symptoms between episodes. The series comprised 17 male and 14 female patients whose ages ranged from 14 to 69 years. In 10 patients, the vomiting attacks were accompanied by diarrhoea, and in 10 by abdominal pain. Eight patients suffered from bilious vomiting in childhood, and 11 patients had migraine. Five patients gave a family history of recurrent vomiting. Management necessitated a sympathetic approach and balanced investigation. Prochlorperazine administered by injection was helpful in the alleviation of an acute attack, but the possible value of more specific antimigraine therapy remains to be established. Evidence supports a link with migraine, which has an association with other gastrointestinal disorders such as irritable bowel and oesophageal reflux. In cases in which pain is prominent, cholelithiasis should be carefully excluded, but cholecystectomy did not always cure vomiting attacks.
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PMID:Recurrent vomiting in adults. A syndrome? 683 34

The study and clinical assessment of enterogastric bile reflux has been restricted for want of a simple non-invasive test for its detection and quantification. This paper describes such a test in which biliary excretion scintigraphy has been combined and a mild meal provocation. Two of 10 healthy volunteers studied showed probable reflux of approximately 5 per cent of total initial abdominal field activity. Among 73 patients studied, 37 patients showed definite reflux of up to 47 per cent. Reflux occurred in 19 of 22 post-gastric surgery patients and in 7 of 22 patients with peptic ulcer disease, gastritis or gastro-oesophageal reflux. None of 7 patients with 'non-specific' abdominal pain showed any reflux, but 11 of 22 patients with gallstone disease or previous cholecystectomy showed reflux of up to 35 per cent, including 9 of 11 patients with loss of gallbladder reservoir function.
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PMID:Milk 99Tcm-EHIDA test for enterogastric bile reflux. 689 57

Use of an antireflux prosthesis (Angelchik prosthesis) in the surgical treatment of symptomatic gastroesophageal reflux has increased steadily during the past several years. This report describes a patient in whom this device broke away from its insertion site at the cardioesophageal junction and migrated through the abdominal cavity to the pelvis. Variable abdominal and pelvic symptoms accompanied this passage, and abdominal roentgenograms identified the final pelvic location. Breakaway was caused by avulsion of the tie straps from the prosthesis. Four additional cases of migratory antireflux prostheses are reported briefly. Physicians should be aware that bizarre and otherwise unexplained abdominal pain in patients with this device may result from dislocation and migration of the prosthesis through the abdominal cavity. Abdominal roentgenograms are diagnostic and define the extent of migration.
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PMID:Intra-abdominal migration of an antireflux prosthesis. A cause of bizarre pain. 704 36


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