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Query: UMLS:C0013395 (dyspepsia)
 4,879 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

RAP is a broad descriptive term commonly used in pediatrics to define a heterogeneous group of patients who experience episodic attacks of abdominal pain over a period of at least 3 months. The majority of patients who seek medical attention for RAP have a functional disorder thought to be triggered by a motility or sensory disturbance of the GI tract provoked by a variety of physical and psychological stimuli. There are three distinct clinical presentations of functional abdominal pain in children and adolescents: periumbilical paroxysmal abdominal pain, dyspepsia, and irritable bowel. The medical history, physical examination, and selected laboratory, radiologic, and endoscopic evaluations allow a positive diagnosis of a functional disorder in each type of clinical presentation.
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PMID:Recurrent abdominal pain: an update. 928 50

H pylori infection is highly prevalent in asymptomatic children and it varies between countries and often within a country as well. Initial infection probably occurs at an early age and prevalence increases with age. Ethnic and racial factors, socio-economic status and living conditions affect the prevalence of infection. Long term population based studies are needed to identify the exact prevalence and clinical significance in Indian children. There is strong evidence for an association between H pylori infection and antral gastritis and duodenal ulcer disease in children, but it's association with recurrent abdominal pain needs further evaluation. Diagnostic tests for H pylori are based either on direct demonstration of the organism or indirectly by detecting a by-product (of the urease reaction) or by demonstrating antibodies. Histopathological identification of H pylori in [table: see text] antral biopsy specimen is by far the best method and is currently regarded as gold standard. Serological tests detecting IgG and IgA are possible tools for diagnosis but have many drawbacks. They may be useful for population surveys where invasive tests are not feasible. These tests should be standardized for the population for which they are going to be used. Urea breath test is a highly sensitive non-invasive test for H pylori infection and can be used even in a field setting. Urea Breath test needs to be standardized in tropical countries with high rates of dental colonization and duodenal microbial contamination. Newer diagnostic tests for H pylori infection are emerging but most have not been validated in various populations. Routine testing for H pylori is not indicated in children or adults. The decision to perform a diagnostic test has often to be linked with a therapeutic proposal. The only condition for which H pylori treatment is indicated is duodenal ulcer which is very uncommon in children. Treatment for RAP or even dyspepsia is not warranted on clinical grounds. There are several treatment regimens available, but it appears that at least three drugs including two antibiotics and a proton pump inhibitor are required for satisfactory eradication. In developing countries where the prevalence of infection is very high, well-planned double blind cross-over studies are needed before an evidence based answer can be provided for an optimal therapeutic strategy.
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PMID:Helicobacter pylori infection in children: a review. 1497 81

RAP is a common and challenging clinical presentation in general pediatrics and pediatric gastroenterology. The differential diagnosis is extensive and growing but dominated by functional disorders for which there are new diagnostic criteria despite the lack of specific confirmatory laboratory markers. Because FRAP, dyspepsia, and IBS are common and defined by clinical criteria, it is now prudent to initiate empiric therapy for suspected functional disorders while performing limited laboratory screening to exclude organic disorders. Using this approach, one is no longer bound to undertake extensive testing in all children with undifferentiated RAP. Alarm symptoms help identify children at greater risk for a specific underlying organic cause to their symptoms and can narrow the focus for diagnostic evaluation. Because of altered family dynamics, interaction with psychological comorbidities, and the child's disabled status, the role of the psychologist is critical in many cases. IBS is the most common single diagnosis in undifferentiated RAP and can be readily identified using the current Rome II criteria. The clinical patterns in children--pain plus altered bowel habits--help differentiate patients into diarrhea-predominant and constipation-predominant subtypes. Although the pathophysiology of IBS is unknown, specific approaches to identify and reduce triggers, pharmacologically reduce bowel spasm, and attenuate neural-pain processing are now commonly used and effective strategies.
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PMID:Differential diagnosis of recurrent abdominal pain: new considerations. 1499 44