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

The symptoms, diagnosis, and management of three patients with gastrocolic fistula secondary to benign peptic ulcer disease are reviewed. To our knowledge, this brings the total of such cases reported in the literature to 50. The most frequent symptoms were abdominal pain, weight loss, diarrhea, and vomiting followed by anemia, foul eructations, and fecal vomiting. Barium meal demonstrated the fistula in about 70% of the patients, whereas barium enema examination demonstrated the fistula in nearly all of them. The diagnostic workup should rule out the possibility of a malignant cause for the fistula. The surgical management of these patients consists of the one-stage, when possible, resection of the involved portion of the antrum and the fistula of the transverse colon with appropriate reconstruction of gastrointestinal continuity. An increased awareness of the benign cause of some gastrocolic fistulas is necessary to avoid unduly extensive surgery in these cases.
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PMID:Gastrocolic fistula as a complication of benign gastric ulcer. 53 62

The clinical records of 13 school-age children and of 22 adolescents with chronic peptic ulcer were reviewed. There was a predominance of the male sex and duodenal localization showed greater frequency than the gastric. The duration of symptoms previous to the diagnosis was greater in adolescents and repeated X-ray studies were required in school-agers to confirm the presence of an ulcer niche. The common symptoms were abdominal pain and vomiting. However, in 43% of the patients, abdominal pain was not typical of ulcer; therefore, all school-age children and adolescents with recurrent abdominal pain should be submitted to careful investigation. Anxiety and depression were found in 92.3% of the cases. Special ulcer diets and antiacids were given to all patients, but 8 cases showed no improvement. Psychiatric treatment and administration of psychodrugs may be useful. Diazepam was given to 50% of the patients who recovered and to one who did not recover.
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PMID:[Chronic peptic ulcer among students and adolescents]. 61 28

The family physician who sees many children with vague abdominal pain must include peptic ulcer disease in the differential diagnosis. A case report is presented and the characteristics of primary and secondary ulcers in children are reviewed with respect to symptoms, signs, diagnosis, and treatment. Ulcers in children may be primary or secondary (stress) ulcers. Clinical and radiographic diagnosis is difficult. Medical therapy suffices in most cases, but there is a high recurrence rate in adolescence and adulthood. Peptic ulcer disease in children is a diagnostic dilemma, but the family physician may be in an excellent position to make the diagnosis since he/she is often the first physician to see the patient and is aware of altered family dynamics, which may play a role in this disease.
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PMID:Peptic ulcer disease in children: report of a case and a problem-oriented review. 68 95

Within a period of 14 years 23 children were treated for peptic ulcer (0.039% of all inpatients). Acute ulcers were seen in neonates or after major surgery, and were diagnosed only after perforation or bleeding. Chronic ulcers predominantly occurred after the sixth year. In addition to abdominal pain and colic, perforation and haemorrhage were also seen, the latter occasionally without previous symptoms. Three children were operated on for perforation, two for gastroduodenal haemorrhage. One of them, a neonate, died of septicaemia with subarachnoid haemorrhage. The bleedings were stopped by purse-string suture, the perforations by oversewing in two, local excision in one. Follow-up examination was undertaken in 14 of the 22 surviving children six months to 12 years after the initial manifestation. None had a recurrence. It is concluded that peptic ulcer is more frequent in children than is generally supposed. Treatment is mainly conservative. In case of perforation or haemorrhage the least possible surgical intervention should be practised.
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PMID:[Peptic ulcer in children: diagnosis and treatment (author's transl)]. 71 Feb 80

Elevation in fasting serum gastrin levels was found in three patients being evaluated for persistent upper abdominal pain without radiographic evidence of peptic ulcer disease. Fiberoptic endoscopy of the upper gastrointestinal tract in each patient revealed characteristic changes of chronic atrophic gastritis. Gastric biopsies showed diffuse chronic inflammation in the lamina propria, a decrease in the number of parietal cells, and "intestinalization" of gastric mucosa. Total achlorhydria was demonstrated after a maximal histalog stimulus; however, serum levels of vitamin B12 and Schilling test values were normal in all three patients. Parietal cell antibodies were found in the serum in all patients in a dilution of 1:20 to 1:80. These cases represent autoimmune (type A) chronic atrophic gastritis and should be distinguished from chronic simple (type B) gastritis, in which serum gastrin levels are normal and no parietal cell antibodies are found in the serum. Patients with autoimmune gastritis should be observed at frequent intervals for the occurrence of pernicious anemia or gastric carcinoma.
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PMID:Autoimmune atrophic gastritis with hypergastrinemia. 101 70

The present study is a follow-up of 34 cases admitted to a paediatric department with recurrent abdominal pain (RAP) in 1942 and 1943. 45 persons without a history of RAP were selected at random and included as controls. Using a questionnaire, there was a higher incidence of gastrointestinal symptoms among persons with a history of RAP during childhood than among controls (P less than 0.05). 18 of the original 34 cases who still had symptoms were re-examined; 11 had a clinical picture consistent with a diagnosis of irritable colon, 5 had a picture compatible with both irritable colon and peptic ulcer/gastritis, and 2 had duodenal ulcer. Abdominal pains occurred no more frequently among children of parents who had had RAP during childhood than among children of parents without such a history. However, there was a higher incidence of abdominal pain among children of parents who were complaining of abdominal discomfort at the time of the investigation than among children whose parents were without such symptoms (P less than 0.005).
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PMID:Long-term prognosis in children with recurrent abdominal pain. 113 Aug 15

Thirty-four patients with abdominal pain, tenderness, and hyperamylasemia suggesting acute pancreatitis were studied prospectively to elucidate the relationship between peptic ulcer disease and pancreatitis. Confirming evidence of pancreatitis and/or ulcer was obtained either at laparotomy of by upper gastrointestinal roentgenograms. The presence or absence of pancreatitis was substantiated by measurement of the amylase/creatinine clearance ratio, which is significantly higher (p less than 0.001) in patients with acute pancreatitis (9.3 plus or minus 0.9), than in patients without pancreatitis (3.1 plus or minus 0.2). Nine of the 34 patients were found to have gastric or duodenal ulcers. However, seven of the nine, despite an elevated serum amylase, had no sign of pancreatitis at surgery, on radiological examination, or by elevation of the amylase/creatinine clearance ratio (3.1 plus or minus 0.4). It is suggested that hyperamylasemia associated with peptic ulcer disease is most often not indicative of acute pancreatitis and that treatment is most appropriately directed at the ulcer.
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PMID:Amylase clearance in differentiating acute pancreatitis from peptic ulcer with hyperamylasemia. 113 Aug 48

A study was performed to determine the value of peritoneal lavage in the acute abdomen not related to trauma. Lavage was performed in 33 patients in the evaluation of abdominal pain of sufficient degree to warrant consideration for surgical intervention. Peritoneal lavage was truly positive or truly negative in 64% of the cases. It showed false negative results in 28% and false positive results in 8%. The lavage was most accurate in the evaluation of appendicitis, colonic disease, and intra abdominal bleeding. It was highly inaccurate in the evaluation of cholecystitis and peptic ulcer disease. It was concluded that the peritoneal lavage can be a useful adjunct in the evaluation of patients with abdominal pain and should be considered in difficult diagnostic problems but not routinely employed.
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PMID:Diagnostic peritoneal lavage in evaluating acute abdominal pain. 113 36

Laparoscopy is fully recognized for diagnosis and even treatment of various acute abdominal conditions. In a 42-year-old woman with intense lower abdominal pain, laparoscopy revealed a perforated peptic ulcer. The ulcer was closed and patched with omentum and the abdomen was irrigated, all by laparoscopic techniques. Except for a minor wound infection recovery was uneventful.
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PMID:[Laparoscopic closure and tegmentation of perforated ulcer]. 138 66

Hp now appears to be more than a simple commensal organism in patients with gastritis or peptic ulcer disease. Microbiologic, serologic, and epidemiologic studies all confirm that Hp has an important role in children with abdominal pain. Hp is found in the gastric mucosa of children with histologically proven gastritis or peptic ulcer. The organism can be transmitted from human to human with evidence of colonization, appearance of gastritis, and serum antibody response. Antimicrobial therapy directed at Hp eradicates colonization and resolves symptoms. Hp antibodies appear more frequently in familial clusters and the frequency of antibody positivity increases with age. Children are more likely to have symptomatic disease associated with elevated antibody titers. Recurrence of disease is associated with reappearance of the organism. At the present time, colonization can be detected only by gastric biopsy; however, it may be possible eventually to diagnose or follow infections by obtaining serum antibody titers or urea breath-testing. The natural history of Hp infection is unclear. Although it can cause an acute gastritis, it generally is found in association with chronic gastritis. The increase in seropositivity with age may mean that slow changes evolve over decades or that age cohorts have been infected differentially. How does antral colonization with Hp cause duodenal ulceration? The organism is not found in the duodenum and most patients with gastritis do not develop ulcers. This may be related to changes in acid production and mucosal protection associated with Hp colonization, but few studies have been done. What factors initiate Hp infection? Both volunteers who became colonized first suppressed acid secretion with H2-antagonists. Hypochlorhydria also seems to follow Hp infection in these same studies. The role of diet and drugs, or other environmental and genetic factors, in initiating infection is largely unexplored. An effective means of therapy needs to be developed. Although Hp appears sensitive in vitro to many compounds, it is difficult to eradicate in vivo, especially with monotherapy. Single-drug therapy suppresses the organism, but recurrence rates are high. It is difficult to deliver effective doses of drugs to the mucous niche the organism has selected and concerns about long-term therapy and its side effects persist. Current data suggest no ready solution to the initial case presentation. A child with primary gastritis or duodenal ulcer should be treated first with standard antacid and H2-receptor antagonist therapy. If endoscopy is performed, biopsies of normal-appearing areas of gastric antrum should be stained for Hp and a biopsy urease test should be performed.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Helicobacter pylori, gastritis, and ulcers in pediatrics. 144 15


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