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

Eosinophilic esophagitis (EE) is an increasingly recognized disease of the esophagus with distinct clinicopathologic features. Adult and pediatric patients experience upper intestinal symptoms including food impaction, vomiting, abdominal pain, or dysphagia. Histopathologic analysis of the distal and proximal esophageal mucosa demonstrates dense eosinophilic infiltration despite proton pump inhibition. Few studies document the long-term outcomes of EE but current evidence suggests that EE is a chronic condition that can sometimes lead to esophageal strictures. Although the incidence of this complication is not yet known, it has sparked significant interest in defining safe, effective treatments. Once a diagnosis of EE is made, patients should seek the consultation of the allergist in an effort to identify possible food sensitivities. This is particularly important because the etiologic agent(s) that drive the eosinophilia are likely different for each patient. If the allergic evaluation identifies a specific food, this food should be strictly avoided as a first-line treatment. If a food is not identified, an elemental formula should be used to induce a remission. If an elemental diet cannot be used, topical steroids are effective in inducing a remission. The side effects associated with long-term steroid administration limit their use as a maintenance medication. Given the lack of prognostic data, the use of systemic corticosteroids should be reserved for severe cases when dietary elimination or topical steroids are ineffective. Most importantly, patients should remain under the care of a physician so that long-term outcomes can be identified. To date, diet restriction has been identified as the only effective maintenance treatment, but montelukast and topical cromolyn may also offer benefit. Anti-interleukin-5 antibody represents an emerging form of targeted therapy.
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PMID:Treatment of eosinophilic esophagitis in children. 1616 5

A 66-year-old man with a history of abdominal pain, diarrhoea and weight loss was admitted for evaluation. Gastroscopy disclosed a severe gastric ulceration covering the lesser curvature. There was none of the usual risk factors for peptic ulcer disease and no malignancy was found. After 2 weeks' treatment with a proton pump inhibitor no healing was observed. The patient had a known atherosclerotic vascular disease, and angiography disclosed severe mesenteric ischaemia. After a revascularization procedure with stenting of the superior mesenteric artery was performed, the patient's symptoms disappeared. Healing of the gastric ulceration was observed at a further gastroscopy 2 weeks later. Chronic ischaemia is a rare cause of gastric ulcer, but should be suspected when no other cause is found and when the usual treatment with proton pump inhibitors does not result in healing.
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PMID:Ischaemic gastric ulceration with endoscopic healing after revascularization. 1653 21

Helicobacter pylori infection is basically acquired during infancy. H. pylori is associated with a great number of pathologies including gastritis, gastroduodenal peptic ulcer, gastric adenocarcinoma and MALT lymphoma. Its association with abdominal pain in children remains controversial. An association with iron deficiency anemia was recently described. The reference method for diagnosis still remains culture and histology of gastric biopsies realized during endoscopy. A few years ago, a lot of studies have shown the reliability of non-invasive tests (urea breath test 13C and the H. pylori stool antigen) for the diagnosis of the H. pylori infection in children. The treatment associating a proton pump inhibitor with two antibiotics (depending on the antimicrobial susceptibility when it's available) is recommended every time infection is proved. In children, the reinfection rate after H. pylori eradication is often higher than in adults. The eradication of H. pylori infection does not seem to produce the advent or the aggravation of gastro-oesophageal reflux oesophagitis. The eradication of this pathogen, in children as well as in adults, should theoretically lead to the disappearance of gastric cancer.
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PMID:[Helicobacter pylori infection in children]. 1654 42

A 6-year-old boy was hospitalized because of dark feces and facial pallor of 1 weeks duration. Other gastrointestinal symptoms, including vomiting and abdominal pain, were absent, but he felt dizziness when standing and fatigue on effort. Hematologic studies revealed iron-deficiency anemia, and endoscopy showed gastric erosions and a duodenal ulcer. All test results for Helicobacter pylori infection, including H. pylori antigen in stool, anti-H. pylori IgG immunoassay in serum, and the (13)C-urea breath test, were positive. Because an H. pylori-associated gastric ulcer had been diagnosed with endoscopy in the patients father 3 years earlier, father-son transmission was suspected. The patient was treated with triple-agent eradication therapy (proton pump inhibitor [lansoprazol], amoxicillin, and clarithromycin) for 2 weeks. One month after therapy was completed, eradication of H. pylori was confirmed by negative results on the stool antigen test. Peptic ulcer disease can occur in young children, as in this case. The stool antigen test kit is a useful and reliable method that can be used even in preschool children to diagnose H. pylori infection.
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PMID:Helicobacter pylori infection with a duodenal ulcer in a 6-year-old boy. 1710 82

A case of primary small bowel adenocarcinoma is reported because of the rarity of this malignancy. Interestingly, the location of the tumour was in jejunum, instead of the most common site in duodenum. The clinical presentation was anemia, with positive fecal blood test, under antiaggregant platelet treatment for coronary heart disease, initially related to endoscopic evidence of erosive gastroduodenitis. The exacerbation of gastrointestinal bleeding during proton pump inhibitors therapy and the recurrence of abdominal pain caused careful investigation. The source of the obscure gastrointestinal bleeding had been achieved by wireless capsule endoscopy, because of not diagnostic findings of conventional upper endoscopy control, colonscopy, double contrast enteroclysis and selective arteriography. The primary definitive therapy was a radical resection of the jejunal neoplastic loop, important prognostic factor.
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PMID:[Primary adenocarcinoma of jejunum with obscure gastrointestinal bleeding]. 1714 51

A 74-year-old man with compensated hepatitis C virus-related liver cirrhosis was admitted for the treatment of small hepatocellular carcinoma (HCC) by radiofrequency ablation therapy (RFA). As a routine pretreatment examination, gastrointestinal endoscopy was performed, and large nodular varices were observed in the gastric fornix, with telangiectasia on top of the varices. As soon as the RFA was completed, prophylactic balloon-occluded retrograde transvenous obliteration (B-RTO) was performed. Seven days after the B-RTO, the patient complicated of upper abdominal pain. Gastrointestinal endoscopy was performed, and a deep ulcer, located at the top of the tumor-shaped gastric varices, was found. The ulcer showed rapid healing after 1-week administration of a proton pump inhibitor (PPI). A severe ulcer after a B-RTO procedure, is extremely rare, because sclerosing agents rarely flow into the gastric mucosa. The ulcer in this patient was deep and large, and it may have been due to direct mucosal damage caused by the sclerosing agent, because mucosal telangiectasia on top of the varices was observed before the B-RTO. It is likely that, in this patient, the mucosal vessels communicated with the submucosal large varices, and ethanolamine oleate (EOI) flowed into the gastric mucosa via this communication. Based on our experience, we recommend periodic follow-up endoscopy.
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PMID:Gastric ulcer after prophylactic balloon-occluded retrograde transvenous obliteration. 1738 Feb 86

Hookworm infection and peptic ulcer disease are common in subtropical and tropical countries. While hookworm infection is endemic where sanitary conditions are poor, peptic ulcer disease is associated with a high prevalence of Helicobacter pylori infection. Dyspepsia and epigastric pain are common presenting symptoms of patients with either hookworm infection or peptic ulcer disease. Consequently it is common practice at our healthcare facility to examine stool for ova or parasites before considering empirical gastric acid suppressive therapy or Helicobacter pylori eradication therapy. We describe a patient who presented with dyspepsia and epigastric pain whose stool examination showed no ova or parasites. The patient's symptoms did not improve with proton pump inhibitor therapy. Endoscopy revealed hookworms in the first part of the duodenum. We review published reports of hookworms at this location. In hookworm endemic areas, when empirical treatment for dyspepsia and upper abdominal pain with acid suppressive agents does not offer remedy, antihelminthic agents should be considered even when stool for ova or parasites is negative.
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PMID:Hookworm infection of the duodenum associated with dyspepsia and diagnosed by oesophagoduodenoscopy: case report. 1768 16

Helicobacter pylori is causally associated with peptic ulcer disease and gastric carcinoma. Typically children get infected with this organism during the first decade of life but diseases, associated with H. pylori, are seen mainly in adults. In India, almost 80% of population is infected with H. pylori and most of them by 10 years of age. Hence, it is important for a pediatrician to know when to suspect this infection, how to investigate and how to treat it. Extensive electronic (PubMed) literature search was done for this review and literature (randomized controlled trials, clinical trials, meta-analysis, practice guidelines) related to H. pylori in children were reviewed. Special emphasis was given to Indian studies. From this review we can conclude that H. pylori infection is very common in Indian children especially in the low socioeconomic status but most infected children remain asymptomatic through out their childhood and about 15% develop peptic ulcer disease as young adults and 1% develop gastric cancer in older age. There is no association, what so ever, of H. pylori infection and recurrent abdominal pain (RAP). Endoscopy is the preferred method of investigation in children with upper digestive symptoms suggestive of organic disease. Children with H. pylori related disease (peptic ulcer, primary gastric B-cell lymphoma and atrophic gastritis with intestinal metaplasia) but not mere H. pylori infection should be treated with the triple drug regimen comprising of proton pump inhibitor (PPI) and two antibiotics for two weeks.
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PMID:Helicobacter pylori in children: an Indian perspective. 1799 76

Sickle cell disease is caused by molecular abnormalities in the formation of hemoglobin, leading to pain crisis from recurrent vascular occlusion by sickled hemoglobin. Impaired flow in the microvasculature can lead to ischemia, tissue infarction and ulceration. Abdominal pain, a common complaint in sickle cell disease, can be due to an uncommon etiology, ischemic duodenal ulceration. This is due to primary mucosal infarction caused by sickling, leading to poor healing of infarcted areas. Prompt endoscopic and/or urgent surgical intervention should be considered, particularly if anticoagulation is an issue, as proton pump inhibitor use is ineffective in healing this type of ulcer.
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PMID:Ischemic duodenal ulcer, an unusual presentation of sickle cell disease. 1839 28

Endoscopy is the primary investigation for patients over 50 years with upper abdominal pain. Endoscopy is also necessary for younger patients having alarming symptoms. For younger patients a treatment trial can usually be made. If the patient is diagnosed with Helicobacter, it should normally be treated and endoscopy performed only if symptoms continue in spite of the eradication. In the absence of Helicobacter, a proton pump inhibitor is recommended for the treatment trial. Submitting doctors are in key role in applying investigational indications.
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PMID:[When to perform gastroscopy for a patient with upper abdominal pain?]. 1934 Oct 31


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