FCPD: An unusual cause of abdominal pain; reminder of important clinical lesson

Fibrocalculous pancreatic diabetes (FCPD) is a type of chronic calcific non-alcoholic pancreatitis. This type is reported mostly in the developing tropical and subtropical countries. Definite diagnosis of FCPD requires younger age of onset, history of malnutrition, and presence of diabetes mellitus along with extensive pancreatic calcification and ductal calculi. Pain abdomen is one of the classical clinical triad of the disease with steatorrhoea and diabetes. In this case report we are presenting a case of 17 years old girl with past history of recurrent pain abdomen for last two years. She came to casualty with complaints of generalized weakness along with pain abdomen. She was diagnosed as case of FCPD with uncontrolled hyperglycemia on subsequent investigations. Importance of this case is that patient has multiple episode of abdominal pain over two years and she consulted several practitioners for the same and she was treated symptomatically without proper work-up. However, FCPD is a rare entity but should be considered in case of recurrent abdominal pain in young patient.

The Introducion of Professor YE Jin's Experience in Treating Infantile Recurrent Abdominal Pain / 浙江中医药大学学报

[Objective]The paper was designed to introduce the Professor YE Jin's personal clinical experience which can provide an effective means for other pediatrician.[Method]By introducing the Professor YE Jin's personal clinical experience,we summarize the effective therapies about the infantile recurrent abdominal pain(RAP). [Result]According to the Professor YE Jin, the pathomechanism of RAP includes mainly cold stagnation, the indigestion, parasite and Qi stagnancy. RAP caused bycoldcan be treated from warming the middle-energizer and fending off the cold,RAP resulting from retention of food can be cured by removing the retention and invigorating the stomach, RAP incurred by ascaris can be cured by relieving ascariasis,expelling parasite and purgation simultaneously,and RAP resulting from Qi stagnation can be cured by soothing liver, regulating qi activity, rather than relieving pain merely. Based on the above-mentioned theory,she tends to use Liquorice and prefers Paeonia a lot in curing the disease, that is always effective in clinic as a result.The recurrence rate is also lower.One case was provided for verification.[Conclusion]Professor YE Jin thinks that warming the middle-energizer and fending off the cold, removing the retention and invigorating the stomach, the RAP can be improved the curative effect,and that can provide another idea for other clinicians.

Mild-Aortic Syndrome : A Cause of Recurrent Abdominal Pain

Mid-aortic syndrome (MAS) is a rare clinical entity that is characterized by coarctation involving the distal thoracic and/or abdominal aorta and its major branches accounting for 0.5–2% of all cases of coarctation of the aorta (1). Renovascular hypertension can be a significant sequelae - it is the main symptomatic presentation of this disease among children and adolescents. We describe a 9-year-old girl who presents with recurrent abdominal pain and symptomatic hypertension. Due to significant left ventricular systolic dysfunction and uncontrolled hypertension, percutaneous balloon angioplasty was performed to treat the coarctation. To our knowledge, this is the first reported case of MAS in Malaysia. This case report highlights the clinical presentation, the role of computed tomography angiogram (CTA) in the diagnosis and current options in the management of MAS.

Challenges in Management of Irritable Bowel Syndrome in Children.

Irritable bowel syndrome (IBS) is a common cause of recurrent abdominal pain (RAP) in children and can be a debilitating experience for both child and family. Organic causes of RAP symptoms such as celiac and inflammatory bowel diseases should be excluded before a diagnosis of IBS is made. Treatment consists of dietary manipulation, drugs, and stress management. Newer therapies may offer better control of symptoms with minimal side-effects. This article discusses the challenges faced by pediatricians in managing IBS and reviews management in the context of children from the Indian subcontinent.

Changes and Significance of Plasma Gastrin, Substance P and Vascoactive Intestinal Peptide among Children with Recurrent Abdominal Pain and Their Family Members / 昆明医科大学学报

Objective To study the changes of plasma gastrin (Gas), substance P (SP) and vascoactive intestinal peptide (VIP) among children with recurrent abdominal pain and their family members,and to explore if there is the rule of the changes.Methods The fasting plasma Gas, SP and VIP were determined by radioimmunoassay method among 30 children with recurrent abdominal pain, and 45 family members including first-degree relatives and second-degree relatives as well as 35 normal healthy children and 20 normal healthy adults. Individuals were divided into five groups:children with recurrent abdominal pain (study group 1), family members with recurrent abdominal pain (study group 2), normal healthy children (control group1), family adults without recurrent abdominal pain (control group2) and normal healthy adults (control group3) . The whole family members of 7 children with recurrent abdominal pain were focused on and analysed.Results 55 of 130 volunteers were with recurrent abdominal pain including 30 children and 25 adults. There were 22 adults with and 20 adults without recurrent abdominal pain in the whole family members of 7 children with recurrent abdominal pain. The fasting plasma Gas content had no difference between study group 1 and control group1 ( 0.05) .The levels of fasting plasma Gas content had no difference between study group 2 and control group 3 (>0.05),but the levels of fasting plasma SP and VIP were both in increase and had difference between study group 2 and control group3. The fasting plasma Gas content had no difference between country group 1 and control group3 ( 0.05) .Conclusions There are the same plasma Gas contents in normal children and adults.However, the plasma SP and VIP contents are higher in normal children than ones in normal adults. The plasma SP and VIP contents are lower in children with recurrent abdominal pain than ones in normal children. The plasma SP and VIP contents are higher in adults with recurrent abdominal pain than ones in normal adults. These suggested that the increases of plasma SP and VIP may have a close relationship with the pathogenesis of children and adults with recurrent abdominal pain. The contents of plasma Gas, SP and VIP were consistent in the whole family members of 7 children with recurrent abdominal pain. It suggested that the secretion of gastrointestinal hormone is disorder in the families with recurrent abdominal pain.

Helicobacter pylori and recurrent abdominal pain in children: Is there any relation.

Background: The role of Helicobacter pylori (HP) as a cause of recurrent abdominal pain (RAP) and gastrointestinal symptoms is controversial and there still remains a big debate whether to test and treat or not. Aim: To investigate the correlation between HP infection and RAP as well as other GI symptoms. Methods: We conducted a case control study at the Jeddah Clinic Hospital from January 2009 to December 2010. It included 244 cases (group I) aged 2-16 years with RAP after exclusion of any organic disease. Cases receiving antibiotics, bismuth, H2 antagonists or proton pump inhibitors during last 45 days were excluded. 122 age and gender matched asymptomatic children (group II) were enrolled as controls. Both groups were tested for Helicobacter pylori infection using stool antigen and/ or urea breath test. Results: The mean age of cases was 7.76 ± 3.38 years. 48% of cases were males. There was no significant statistical difference between both groups regarding age and sex distribution, nationality and body weight (BW). 42.6% cases were positive for H. pylori infection in group I and 45% in group II. Comparison between HP positive cases and HP negative cases in group I revealed a statistically significant difference in incidence of vomiting, epigastric pain, history of infected family member and iron deficiency anemia (p=0.001, 0.000, 0.000 and 0.025 respectively). Conclusion: HP infection is documented in more than 40% of both symptomatic and asymptomatic children. There is no association between RAP and HP.

Dolor abdominal recurrente (dar) o crónico en niños y adolescentes / Recurrent or chronic abdominal pain in childrens and adolescents

El dolor abdominal crónico es muy frecuente en la edad pediátrica. Los criterios de Roma III permiten hacer el diagnóstico de las diferentes entidades con dolor abdominal funcional, en base a la sintomatología, y no como de exclusión. Actualmente se propone una etiología biopsicosocial, que obliga a una aproximación integrada para ofrecer tratamiento centrado en la sintomatología de cada paciente pudiendo combinarse cambios en la alimentación, fármacos e intervenciones psicosociales. Aunque la mayoría de los pacientes mejora al tranquilizarlos y con el tiempo, una proporción significativa sigue con sintomatología intensa y discapacitante en la adultez.

Chronic abdominal pain is common in childhood. Rome III criteria allows the diagnosis of different entities with functional abdominal pain, based on by symptoms, rather than exclusion. The biopsychosocial etiology proposed currently, requires an integrated approach to provide focused treatment to each patient's symptoms and may combine changes in food, drugs and psychosocial interventions. Although most patients will improve with reassurance and time, a significant number of patients continue to have intense and disabling symptoms in adulthood.

Acute Intermittent Porphyria Presented with Recurrent Abdominal Pain and Hypertension / 대한소아소화기영양학회지

Acute intermittent porphyria (AIP) is a rare disorder characterized biochemically by the increased excretion of porphyrins and porphyrin precursors, including delta-aminolevulinic acid (ALA) and porphobilinogen (PBG). AIP has variable clinical manifestations, such as acute abdominal pain, vomiting, nausea, constipation, peripheral neuropathy, seizures, tachycardia, and hypertension. A 16-year-old girl presented with recurrent abdominal pain, vomiting, hypertension, seizures, hypercholesterolemia, and red urine. AIP was confirmed by clinical features and increased 24-hour urine ALA and PBG. AIP should be considered in the differential diagnosis of patients who have abdominal pain, hypertension, and seizures when the results of all other tests are normal.

Functional Abdominal Pain in Children / 대한소아소화기영양학회지

Functional abdominal pain (FAP) is one of the most common pain syndromes in childhood and is a functional gastrointestinal disorder (FGID). Recurrent abdominal pain (RAP) is characterized by three or more episodes of abdominal pain that occurover at least 3 months and are severe enough to interfere with activities. It may be caused by many conditions, including inflammatory bowel disease, peptic ulcer, pancreatitis or, functional abdominal pain. The most common clinical manifestation is periumbilical pain related to autonomic and functional symptoms like nausea, vomiting, pallor and other painful conditions like headache and limb pains. RAP requires accurate diagnostic tests to rule out organic causes of pain based on 'red flag' sign. Furthermore, to diagnose and classify functional abdominal pain, Rome III criteria were published and updated with multiple discussions of FGIDs. Conventional interventions for RAP include reassurance and general advice, symptom-based pharmacological therapies, and psychological and behavioral treatments. But further research should be conducted to advance our understanding of the multiple factors involved in the pathogenesis of this group of conditions and to provide evidence for its therapeutic benefit.

Dor abdominal recorrente na criança como sintoma da família / Recurrent abdominal pain in children as a family symptom

O objetivo do estudo foi analisar a dinâmica familiar de crianças com dor abdominal recorrente, investigando se fatores comuns em famílias psicossomáticas, como conflitos conjugais, família emaranhada, superprotetora, rígida e/ou com ausência de resolução de conflitos estavam relacionados ao sintoma da criança. O delineamento utilizado foi estudo de casos múltiplos. Foram realizadas entrevistas e foi construído um genograma com as mães de quatro crianças. Percebeu-se a presença de fatores comuns em famílias psicossomáticas associados ao sintoma da criança. Observou-se vínculos conturbados, a existência de eventos estressores anteriores ao sintoma, além da ocorrência de perdas reais ou simbólicas. As famílias parecem ser matrifocais e os pais, mesmo nos casos em que estão presentes, parecem virtuais.

The purpose of this study was to analyze the family dynamics of children with recurrent abdominal pain without organic cause. It was investigated whether common factors in psychosomatic families such as parental conflicts, relationship enmeshments, overprotectiveness, rigidity, and/or lack of conflict resolution were related with child symptoms. The design was a multiple case study. Interviews and the construction of a genogram were conducted with mothers of four children. It was observed an association between common factors in psychosomatic families and the child's recurrent abdominal pain. Disturbed bonds, stressful events prior to the symptoms, and the occurrence of real or symbolic losses were noticed. The families seem to focus on the mother while the fathers, even when present, are virtual.

Development and initial validation of Chinese version of multidimensional measure for recurrent abdominal pain scale / 中国实用护理杂志

Objective To develop the Chinese version of multidimensional measure for recurrent ab-dominal pain scale(MM-RAP) and test the reliability and validity of it. Methods The Chinese version of MM-RAP was translated and revised and 100 children with recurrent abdominal pain and their parents were surveyed by it. Then the reliability and validity of the scale was tested. Results The teat-retest reliability coefficient of MM-RAP was 0.86. The total Cronbach's coefficient α of the scale was 0.80. Cronbach's coef-ficient α of each dimensions was above 0.70. The results of correlation analysis showed that there was higher correlation between items and its belonged dimensions than that with other dimensions. The results of confir-matory factor analysis indicated the factor structure was similar with the theoretical construction of the in-strument. Conclusions The Chinese version of MM-RAP demonstrated good reliability and validity and was an effective assessment instrument for measuring recurrent abdominal pain of Chinese children.

Medically unexplained physical symptoms in children in a non-specialist paediatric setting.

Introduction Medically unexplained symptoms (MUS) are equally common and disabling across countries and cultures. Most prevalent symptoms identified in children are recurrent abdominal pain (RAP), headache, limb pain, and fatigue. Objectives To identify the presenting profile of MUS and associated features in a hospital based, nonspecialist paediatric outpatient setting. Method Randomly selected children attending the study setting were screened to identify those who fit a working definition for MUS, which specified undiagnosed symptoms being present for 3 months or more. Parents of the identified children answered an interviewer administered semi-structured questionnaire designed to investigate the profile of symptoms, their impact on the child's life, beliefs about the cause and anticipated prognosis and any associated stressful experiences in the child's life. Results 125 children (mean age 7.8 years) were identified with MUS. Commonest presenting symptoms were abdominal pain and headache. On average, 6.01 medical consultations were made for the symptoms. Difficulties with attending school and studying were the most prominent impact of the symptoms. Majority of the mothers believed that an underlying physical disorder was present, but an associated psychologically stressful experience was identified by them in 51.2% of cases. Conclusion Children with MUS warrant extended assessments for associated psychosocial and behavioural factors to enable effective management.

The Relationship of between Anxiety Tendency and Recurrent Abdominal Pain in Elementary School Children / 대한소아소화기영양학회지

PURPOSE: It has been reported that children with chronic pain have higher levels of anxiety than age-matched controls. Therefore, this study was designed to determine the relationship between anxiety and recurrent abdominal pain in elementary school children. METHODS: In 2005, we surveyed 1,254 elementary school children (592 boys and 662 girls) whose ages ranged from 7 to 12 years. The degree of trait and state anxiety was compared between agroup suffering from intermittent abdominal pain, a group suffering from recurrent abdominal pain and a normal control group following the Korean version of Spielberger's State-Trait Anxiety Inventory YZ form (STAI-YZ). RESULTS: 709 (56.5%) and 69 (5.5%) of the patients reported intermittent abdominal pain and and recurrent abdominal pain, respectively, during the 12 month period before this study was conducted, and trait and state anxiety values for each of these groups was 116 (9.3%) and 63 (5.0%), respectively. In addition, the State-Trait Anxiety score was significantly higher in the group with intermittent abdominal pain and RAP than the anxiety score of the normal control group. Additionally, the STAI-YZ score increased in proportion to the severity of abdominal pain, but was not correlated with the duration, frequency, onset time or location of abdominal pain. Furthermore, the proportion of the group with abdominal pain in the group that had trait or state anxiety was significantly higher than the proportion of the group that did not have trait and state anxiety. CONCLUSION: Recurrent abdominal pain during childhood is correlated with state and trait anxiety, therefore, psychological factors, such as anxiety duringtreatment, must also be considered when determining the cause of recurrent abdominal pain.

The Relationship of between Anxiety Tendency and Recurrent Abdominal Pain in Elementary School Children / 대한소아소화기영양학회지

PURPOSE: It has been reported that children with chronic pain have higher levels of anxiety than age-matched controls. Therefore, this study was designed to determine the relationship between anxiety and recurrent abdominal pain in elementary school children. METHODS: In 2005, we surveyed 1,254 elementary school children (592 boys and 662 girls) whose ages ranged from 7 to 12 years. The degree of trait and state anxiety was compared between agroup suffering from intermittent abdominal pain, a group suffering from recurrent abdominal pain and a normal control group following the Korean version of Spielberger's State-Trait Anxiety Inventory YZ form (STAI-YZ). RESULTS: 709 (56.5%) and 69 (5.5%) of the patients reported intermittent abdominal pain and and recurrent abdominal pain, respectively, during the 12 month period before this study was conducted, and trait and state anxiety values for each of these groups was 116 (9.3%) and 63 (5.0%), respectively. In addition, the State-Trait Anxiety score was significantly higher in the group with intermittent abdominal pain and RAP than the anxiety score of the normal control group. Additionally, the STAI-YZ score increased in proportion to the severity of abdominal pain, but was not correlated with the duration, frequency, onset time or location of abdominal pain. Furthermore, the proportion of the group with abdominal pain in the group that had trait or state anxiety was significantly higher than the proportion of the group that did not have trait and state anxiety. CONCLUSION: Recurrent abdominal pain during childhood is correlated with state and trait anxiety, therefore, psychological factors, such as anxiety duringtreatment, must also be considered when determining the cause of recurrent abdominal pain.

A Case of Abdominal Epilepsy Presenting withRecurrent Abdominal Pain / 대한소아소화기영양학회지

Abdominal epilepsy is an uncommon disorder and a rare cause of recurrent abdominal pain of children. Diagnostic criteria of this disorder include otherwise unexplained, paroxysmal gastrointestinal complaints, symptoms of a central nerve system disturbance, an abnormal electroencephalogram with a finding specific for a seizure disorder, and improvement with anticonvulsant medication. We present a case of a 6-year-old boy with abdominal epilepsy presenting with recurrent, paroxysmal abdominal pain for 4 years. This patient had definite electroencephalogram abnormalities and a striking response to administration of an anticonvulsant.

New approach to chronic recurrent abdominal pain in children / 소아과

Chronic recurrent abdominal pain is a common manifestation in children. Functional abdominal pain is the most common cause of chronic abdominal pain and can be diagnosed properly by the physician without the requirement of specific evaluation when there are no alarm symptoms or signs. Functional abdominal pain is categorized as functional dyspepsia, irritable bowel syndrome, functional abdominal pain, abdominal migraine, and aerophagia, according to the Rome II criteria for pediatric functional gastrointestinal disorders. New concepts on the pathogenesis of functional abdominal pain include brain-gut interaction, visceral hypersensitivity, gastrointestinal dysmotility, inflammation, autonomic dysfunction, genetic predisposition, and triggering factors including psycho-social stress.

Helicobacter pylori infection and abdominal pain in children / 소아과

The relationship between H. pylori(Hp) infection and recurrent abdominal pain(RAP) in children is not clear. Current data in the literature regarding a causal relationship between Hp infection and childhood RAP are conflicting. However, meta-analysis and most of the recently published studies have not supported an association between Hp infection and an increased prevalence of abdominal pain. Most published studies have some problems and have been criticized on methodological grounds. Most of the existing studies have not been designed to include double-blind placebo controls. And, because of the low incidence of Hp infection in children, they have a problem of obtaining sufficient numbers of the Hp infected children. There is also a concern about the heterogeneity of testing methodology in the studies and diagnostic accuracy problems of the non-invasive tests such as low sensitivity of the serology tests and false positive results of the UBT in children. And conflicting results may be explained, in part, by the poor definition of RAP or dyspepsia for the study subjects. To date, no consensus exists for the treatment of Hp-infected children with RAP. Some authors suggest the clinical efficacy of Hp. But others suggest that eradication of Hp is not associated with improvement of RAP. The problem of the most treatment studies is that they had usually no control groups and the number of the subjects was small. In order to make reasonable decisions about treatment of Hp infection in children with RAP, long-term, randomized, double blind, well controlled studies in large numbers of children will be required.

Helicobacter pylori Infection in Children with Recurrent Abdominal Pain / 대한소아소화기영양학회지

PURPOSE: The aim of this study was to evaluate the relationship between H. pylori infection and recurrent abdominal pain (RAP) in children and to evaluate the effects of eradication therapy on RAP. METHODS: From January 1998 to January 2005, 166 children with RAP (61 male, 105 female) aged 10.0+/-3.3 years were included. Upper gastrointestinal endoscopies were performed for all the patients. All H. pylori infected children (n=70) received the eradication therapy and were divided into two groups: Group Ia (n=52); eradicated, Group Ib (n=18); non-eradicated. H. pylori-negative children (n=96) were divided into three groups according to the medication: Group IIa (n=67); no medication, Group IIb (n=13); acid-suppressant, Group IIc (n=16); both acid-suppressant and antibiotics. Questionnaire for symptoms were asked at the first, 6th, 12th, 24th, and 36th months following the treatment (grade 0; completely resolved, grade 1; definitely improved, but there are occasional episodes of mild abdominal pain, grade 2; no change in the frequency and intensity of abdominal pain). RESULTS: In about 90% of H. pylori positive children, RAP improved in the both H. pylori-eradicated and non-eradicated children in a follow-up survey. In about 75% of H. pylori-negative children, RAP also improved among in the three groups of patients regardless of medication. CONCLUSION: These results suggest that there was no correlations between improvement of RAP and eradication of H. pylori, and between improvement of RAP and medication. Consequently the reassurance that the children with RAP have no serious organic cause was important to improvement of RAP.