Karın ağrısı nedeni ile Çocuk Gastroenteroloji ve Çocuk Romatoloji polikliniklerine yönlendirilen hastaların özellikleri

Yıl 2023, Cilt: 6 Sayı: 2, 235 - 241, 30.06.2023

Nihal Şahin , Nilüfer Ülkü Şahin

https://doi.org/10.53446/actamednicomedia.1221481

Öz

Amaç
Çocukluk çağında en sık hastane başvuru nedenlerinden biri karın ağrısıdır. Amacımız genel pediatri polikliniklerinden karın ağrısı nedeniyle çocuk gastroenteroloji ve romatoloji polikliniklerine yönlendirilen hastaların özelliklerini değerlendirmektir.
Yöntem
Karın ağrısı nedeni ile genel pediatri polikliniklerinden Çocuk Gastroenteroloji veya Çocuk Romatoloji polikliniklerine yönlendirilen hastalar elektronik sistemden tarandı. Çalışmaya başvuru dışında en az 1 kez kontrol vizit yapılmış, 18 yaş altı hastalar dahil edildi. Dahil edilen hasta sayısı 209’du. Hastaların klinik özellikleri, laboratuvar sonuçları, son tanıları ve tedavileri yönlendirilen kliniğe göre incelendi.
Bulgular
Hastaların yaş ortalaması 10,95±4,73 yıl ve median 11 yıl (1,42-18 yıl) idi. Hastaların 115’i (%55) kızdı. Karın ağrısı başlangıç süresi medyan değeri 12 aydı ve 5 gün-10 yıl arasındaydı. 117 hasta (%56) yalnızca çocuk gastroenteroloji polikliniğine, 43 hasta (%20,6) yalnızca Çocuk Romatoloji polikliniğine, 49 hasta (%23,4) ise her ikisine yönlendirilmişti. Hastaların 125’inde (%59,8) karın ağrısı her gündü ve 106’ında (%50,7) ağrı 1 saatten kısa süreliydi. Ağrı 86’ında (%41,1) yaygın, 67’inde (%32,1) periumblikal, 36’ında (%17,2) epigastrik yerleşimliydi. En sık eşlik eden semptom 94’ünde (%45) yemeklerle artan ağrıydı. Ateş, eklem bulgusu, döküntü, miyalji, oral aft, tonsilit, ailede ailevi Akdeniz ateşi (AAA) varlığı yalnızca Çocuk Gastroenteroloji polikliniğine yönlendirilen anlamlı olarak azdı (p<0,05). Konulan tanılar 56’ında (%26,8) iritable barsak sendromu (İBS), 44’ünde (%21,1) AAA, 44’ünde (%21,1) gastrit, 37’inde (%17,7) kabızlık, 30’unda (%14,4) gastroözefageal reflüydü (GÖRH) ve 29’unda (%13,9) patoloji saptanmadı.
Sonuç
Karın ağrısı nedeni ile Çocuk Gastroenteroloji ve Çocuk Romatoloji polikliniklerine yönlendirilen hastalarda başlıca saptanan hastalıklar İBS, AAA, gastrit, kabızlık, GÖRH idi. Hastaların yarısından fazlasında genel pediatri kliniklerinde takip edilebilecek hastalıklar mevcuttu.

Anahtar Kelimeler

abdominal pain, familial Mediterranean fever, functional gastrointestinal disorders, pediatric, referrals clinics

Characteristic of patients with abdominal pain referred to pediatric gastroenterologist and pediatric rheumatologist

Öz

Objective
We aim to investigate the characteristics of patients with abdominal pain who were referred from general pediatric to pediatric gastroenterology and rheumatology.
Methods
We searched patients with abdominal pain who were referred from general pediatric to pediatric gastroenterology and rheumatology in the registry system. Under 18 years, patients whose at least one visit was done after the first admission were included. The number of patients is 209. We assessed clinical characteristics, laboratory results, final diagnoses, and treatments according to admission to subdivision clinics.
Results
The mean age was 10.95±4.73 years, and the median was 11 years ( 1.42-18 ). One hundred fifteen(55%) were girls. The duration of onset of abdominal pain was between 5 days and ten years; its median was 12 months. The number of patients who were referred only to pediatric gastroenterology was 117(56%), to pediatric rheumatology was 43(20.6%), and to both clinics was 49(23.4%). Abdominal pain was lasting every day in 125(59.8%), and episode duration was less than one hour in 106(50.7%). The location of pain was generalized in 86(41.1%), periumbilical in 67(32.1%), and epigastric in 36(17.1%). The most common accompanying symptom was meal-related pain in 94(45%). Fever, joint findings, rashes, myalgia, oral aphthae, tonsillitis, and familial Mediterranean fever (FMF) in the family were significantly less in referred to pediatric gastroenterology (p<0.05). The diagnosis was irritable bowel syndrome (IBS) in 56(26.8%), FMF in 44(21.1%), gastritis in 44(21.1%), constipation in 37(17.7%), gastroesophageal reflux disease (GERD) in 30(14.4%), and no pathology in 29(13.9%).
Conclusion
The most common diagnoses were IBS, FMF, gastritis, constipation, and GERD, and almost half of the patients had diagnoses that could follow in general pediatrics.

Anahtar Kelimeler

abdominal pain, familial Mediterranean fever, functional gastrointestinal disorders, pediatric, referrals clinics

Kaynakça

• 1. Yarger E, Sandberg K. Updates in diagnosis and management of chronic abdominal pain. Curr Probl Pediatr Adolesc Health Care. 2020;50(8):100840. doi:10.1016/J.CPPEDS.2020.100840
• 2. M Ayşin T. Çocuklarda karın ağrısı nedenlerinin değerlendirilmesi. Gülhane Týp Derg . 2005;(47):199-203.
• 3. Barron K, Kastner DL. Periodic Fever Syndromes and Other Inherited Autoinflammatory Diseases. In: Petty RE, Laxer RM, Lindsley CB, Wedderburn L, Mellins E, Fuhlbrigge RC, eds. Textbook of Pediatric Rheumatology. 8th ed. Philadelphia, PA: Elsevier; 2021:525-542.
• 4. Duşunsel R, Dursun I, Gündüz Z, Poyrazoǧlu MH, Gürgöze MK, Dundar M. Genotype-phenotype correlation in children with familial Mediterranean fever in a Turkish population. Pediatr Int. 2008;50(2):208-212. doi:10.1111/j.1442-200X.2008.02554.x
• 5. Barut K, Sahin S, Adrovic A, et al. Familial Mediterranean fever in childhood: a single-center experience. Rheumatol Int. 2018;38(1):67-74. doi:10.1007/s00296-017-3796-0
• 6. Öztürk K, Coskuner T, Baglan E, et al. Real-Life Data From the Largest Pediatric Familial Mediterranean Fever Cohort. Front Pediatr. 2022;9:805919. doi:10.3389/fped.2021.805919
• 7. Yalçinkaya F, Özen S, Özçakar ZB, et al. A new set of criteria for the diagnosis of familial Mediterranean fever in childhood. Rheumatology. 2009;48(4):395-398. doi:10.1093/rheumatology/ken509
• 8. Gaggiano C, Vitale A, Obici L, et al. Clinical Features at Onset and Genetic Characterization of Pediatric and Adult Patients with TNF- α Receptor-Associated Periodic Syndrome (TRAPS): A Series of 80 Cases from the AIDA Network. Mediators Inflamm. 2020;2020:8562485. doi:10.1155/2020/8562485
• 9. Van Der Hilst JCH, Bodar EJ, Barron KS, et al. Long-term follow-up, clinical features, and quality of life in a series of 103 patients with hyperimmunoglobulinemia D syndrome. Medicine (Baltimore). 2008;87(6):301-310. doi:10.1097/MD.0B013E318190CFB7
• 10. Wright NJ, Hammond P, Curry JI. Chronic abdominal pain in children: help in spotting the organic diagnosis. Arch Dis Child Educ Pr Ed. 2013;98(1):32-39. doi:10.1136/ARCHDISCHILD-2012-302273
• 11. Kakotrichi A, Borrelli O, Thapar N. The evaluation and management of recurrent abdominal pain in childhood. 2016;26(10):433-440. doi:10.1016/j.paed.2016.06.012
• 12. Rexwinkel R, Vlieger AM, Saps M, Tabbers MM, Benninga MA. A therapeutic guide on pediatric irritable bowel syndrome and functional abdominal pain-not otherwise specified. Eur J Pediatr. 2022;181(7):2603-2617. doi:10.1007/S00431-022-04459-Y
• 13. Thapar N, Benninga MA, Crowell MD, et al. Paediatric functional abdominal pain disorders. Nat Rev Dis Prim. 2020;6(1):89-112. doi:10.1038/S41572-020-00222-5
• 14. Şimşek D, Özkeçeci FC, Demirkaya E. Ailesel Akdeniz Ateşi. In: Poyrazoğlu HM, Sözeri B, eds. Çocuk Romatoloji Kitabı. 1st ed. Ankara: Güneş Tıp Kitabevi; 2018:261-267.
• 15. Yıldız M, Haslak F, Adrovic A, et al. Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis Syndrome: A Single-Center Experience. Turkish Arch Pediatr. 2022;57(1):46-52. doi:10.5152/TURKARCHPEDIATR.2021.21229
• 16. Pagani K, Lukac D, Bhukhan A, McGee JS. Cutaneous Manifestations of Inflammatory Bowel Disease: A Basic Overview. Am J Clin Dermatology 2022 234. 2022;23(4):481-497. doi:10.1007/S40257-022-00689-W
• 17. Çayir Y, Baydar Artantaş A, Çayir A, et al. Çocukluk Çağı Karın Ağrıları: Prospektif Bir Çalışma. Çocuk Derg. 2012;12(2):78-82. doi:10.5222/j.child.2012.078
• 18. Taşar MA. Çocuklarda karın ağrısı nedenlerinin değerlendirilmesi. Gülhane Tıp Derg. 2005;47(3):199-203. http://search/yayin/detay/57960. Accessed December 5, 2022.
• 19. Türkiye İstatistik Kurumu. İstatistiklerle Çocuk, 2020. https://data.tuik.gov.tr/Bulten/Index?p=Hanehalki-Bilisim-Teknolojileri-(BT)-Kullanim-Arastirmasi-2021-37437. Published 2021. Accessed January 16, 2022.
• 20. Martin RF, Rossi RL. The acute abdomen. An overview and algorithms. Surg Clin North Am. 1997;77(6):1227-1243. doi:10.1016/S0039-6109(05)70615-0
• 21. Demiroren K, Guney B, Bostanci M, Ekici D. A Comparison Between Rome III and Rome IV Criteria in Children with Chronic Abdominal Pain: A Prospective Observational Cohort Study. Turk J Gastroenterol. 2022;33(11):979-984. doi:10.5152/TJG.2022.21893
• 22. Lo Curto M, Maggio MC, Campisi F, Corsello G. The correlation of functional pain and psychological distress: a study in Italian school students. Ital J Pediatr. 2019;45(1):81-87. doi:10.1186/S13052-019-0668-0
• 23. Marciano ND, Chehter EZ. The Role of Endoscopy in Dyspeptıc Syndrome in Chıldren and Adolescentes. Arq Gastroenterol. 2022;59(2):257-262. doi:10.1590/S0004-2803.202202000-46
• 24. Akbulut UE, Emeksiz HC, Kocak FG, Livaoglu A. Diagnostic yield of esophagogastroduodenoscopy in children with chronic abdominal pain. Arch Med Sci. 2018;14(1):74-80. doi:10.5114/AOMS.2017.67675
• 25. Dipasquale V, Cicala G, Spina E, Romano C. A Narrative Review on Efficacy and Safety of Proton Pump Inhibitors in Children. Front Pharmacol. 2022;13:839972. doi:10.3389/FPHAR.2022.839972
• 26. Ozen S, Demirkaya E, Erer B, et al. EULAR recommendations for the management of familial Mediterranean fever. Ann Rheum Dis. 2016;75(4):644-651. doi:10.1136/annrheumdis-2015-208690
• 27. Sönmez HE, Sözeri B, Aktay Ayaz N. Editorial: Hereditary Periodic Fevers and Autoinflammatory Diseases. Front Pediatr. 2022;10:855738. doi:10.3389/FPED.2022.855738
• 28. Batu ED. Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome: main features and an algorithm for clinical practice. Rheumatol Int. 2019;39(6):957-970. doi:10.1007/s00296-019-04257-0