功能性腹痛综合征与罗马Ⅲ

功能性腹痛综合征（functional abdominal painsvndrome．FAPS）是一种以腹痛为主要表现、与胃肠道功能异常无关或关系不大的功能性疾病。目前关于该病的相关研究不多，国外流行病学研究报道其发病率为0．5％。2％，女性患者多见。国内尚未见相关流行病学资料。     

中西医结合治疗功能性腹痛综合征46例

[目的]观察中西医结合疗法治疗功能性腹痛综合征(FAPS)的疗效,并探讨其作用机制.[方法]随机将88例分为两组,治疗组46例用西药配小柴胡汤治疗,对照组42例仅用西药治疗,观察两组治疗后腹痛缓解情况及总有效率.[结果]治疗组总有效率为93.5%,对照组为47.6%,两组比较差异有统计学意义(P ＜0.05),而完全缓解率及部分缓解率差异无统计学意义(P＞0.05).[结论]中西医结合疗法对FAPS有较好的疗效,小柴胡汤可有效地缓解其腹痛.     

儿童功能性胃肠疾病2:腹痛

儿童再发性腹痛 (Ｒｅｃｕｒｒｅｎｔａｂｄｏｍｉｎａｌｐａｉｎ ,ＲＡＰ)临床常见。但多数患儿经多次解痉剂或驱寄生虫药治疗后 ,症状并无明显好转 ,进一步加重患儿及其父母的精神负担及焦虑 ,并影响到患儿的日常生活和学习。其中不少患者并无器质性病变 ,主要是功能性的 ,临床上这类患儿的处理棘手 ,以致不少患儿反复就医、甚至频繁转诊到高一级的医疗机构 ,进行一些不必要的辅助检查 ,加重精神、经济的负担 ,患者的生活质量明显降低。越来越多的证据表明功能性腹痛与内脏痛觉超敏有关[1- 5] 。痛觉超敏是指由于肠传入神经元和中枢神经系…     

功能性胃肠病罗马Ⅲ标准解读:功能性腹痛

功能性腹痛(Functional Abdominal Pain syndrome,FAPs)是一种以腹痛为主要表现、与胃肠道无关或关系不大的功能性疾病,流行病学研究报道该疾病的发病率介于0.5%～2%之间,多见于女性患者,但因该疾病尚缺乏特异性诊断方法,目前临床上对该疾病的有关认识还很肤浅。为帮助今后对该     

肠易激综合征研究现状及展望

肠易激综合征 (ｉｒｒｉｔａｂｌｅｂｏｗｅｌｓｙｎｄｒｏｍｅ ,ＩＢＳ)是一种生物 -心理 -社会病症 ,包括持续或间歇发作的腹痛和大便习惯改变 ,但无特异的生物化学或形态学异常可资解释的症候群。ＩＢＳ最早于 182 0年由Ｐｏｗｅｌｌ报道 ,嗣后曾使用过多种术语 ,如结肠过敏、黏液性结肠炎、痉挛性结肠炎等。近年来 ,国内外有关ＩＢＳ的研究取得了以下一些进展。一、流行病学目前 ,还缺乏ＩＢＳ精确发病率的报道。在国际上 ,除印度以男性多见外 ,绝大多数国家都是女性多于男性 ,男女之比约为 1∶1.57,而且女性的发病常与月经周期密切相关…     

进一步加强肾综合征出血热的研究

肾综合征出血热 (ＨＦＲＳ)的病原———汉坦病毒 (Ｈａｎｔａｖｉｒｕｓ,ＨＶ)在我国已成功分离近 2 1年。在这段时间里 ,我国不仅在该病的病原学、流行病学、发病机制等基础研究方面取得了持续的发展 ,而且在该病的预防和临床救治实践中也取得了显著的成绩。但由于获得性免疫缺陷综合征、结核病等一批新老传染病的传播流行日趋严重 ,国内对出血热防治研究的人力物力投入正逐年减少。为此 ,现就当前如何集中有限的人力财力用于ＨＦＲＳ的研究 ,以及应重点研究哪些方面作一简要介绍 ,请国内同行予以关注。一、病原学和流行病学随着ＨＦＲＳ…     

脑诱发电位与功能性脑成像在肠易激综合征研究中的应用

肠易激综合征(Irritablebowelsyndmme，IBS)是腹部不适或腹痛伴排便异常的一组肠功能障碍综合征，因其缺乏明显形态学及生化异常，病因及发病机制不甚清楚，给诊断及治疗带来了许多困难。近年来，IBS患者内脏感觉异常这一病理生理改变受到广泛关注，为深入了解内脏感觉异常的神经生物学机制，最近几种可客观评价IBS患者感觉传入通路及大脑信息处理过     

功能性急性肾功能衰竭

急性肾功能衰竭 ( ARF)是肾小球滤过率 ( GFR)迅速下降、氮质代谢产物在体内蓄积所引起的临床综合征。主要由于肾脏低血流量所致 ,其主要特点是肾实质尚未受损 ,当触发因素及时解除后 ,肾功能可迅速恢复 ,但当触发因素严重或持续时间过久时 ,其将演变为器质性 ARF,肾功能衰竭发     

小儿功能性腹痛的中医诊疗进展

小儿功能性腹痛是影响儿童健康成长的一种常见临床症状.本文从小儿功能性腹痛中医病因及机制、治疗法则、治疗方法等方面总结小儿功能性腹痛的治疗进展.指出在今后研究中,应对本病病因及机制进行深入研究,形成统一认识;建立必要流行病学及询证医学支持;针对小儿特有特点,研制适宜小儿口味药物,提高服药依从性;提高临床医师临床能力及家长健康知识水平.     

肝肾综合征的发病机制

肝肾综合征(HRS)是发生于严重肝功能障碍和(或)门静脉高压基础之上的功能性肾衰竭,常见于肝硬化晚期患者,亦可发生于急性肝功能衰竭患者。它通常在肝硬化腹水的基础上发生,据国外报道在因肝硬化腹水而住院治疗的患者中其发生     

Functional abdominal pain syndrome

Functional abdominal pain syndrome (FAPS) differs from the other functional bowel disorders; it is less common, symptoms largely are unrelated to food intake and defecation, and it has higher comorbidity with psychiatric disorders. The etiology and pathophysiology are incompletely understood. Because FAPS likely represents a heterogeneous group of disorders, peripheral neuropathic pain mechanisms, alterations in endogenous pain modulation systems, or both may be involved in any one patient. The diagnosis of FAPS is made on the basis of positive symptom criteria and a longstanding history of symptoms; in the absence of alarm symptoms, an extensive diagnostic evaluation is not required. Management is based on a therapeutic physician-patient relationship and empirical treatment algorithms using various classes of centrally acting drugs, including antidepressants and anticonvulsants. The choice, dose, and combination of drugs are influenced by psychiatric comorbidities. Psychological treatment options include psychotherapy, relaxation techniques, and hypnosis. Refractory FAPS patients may benefit from a multidisciplinary pain clinic approach.     

Functional abdominal pain syndrome.

Functional abdominal pain syndrome (FAPS) is one of the less common functional gastrointestinal disorders, yet it is one with high health care impact. It is best understood from a biopsychosocial perspective as the interaction of biologic and psychosocial factors contributing to symptom experience and behavior. The pain of FAPS relates primarily to dysfunction of central pain modulatory systems; however, disturbances in motility or visceral hypersensitivity may contribute. There are characteristic clinical and behavioral features that typify patients with FAPS, and the medical evaluation must include their recognition through psychosocial assessment, physical examination, and a conservative, cost-effective effort to exclude other diseases. The treatment approach depends on establishing an effective physician-patient relationship, setting reasonable treatment goals, and using multicomponent medical and behavioral strategies that are individualized to patient needs. In refractory cases, referral to a multidisciplinary pain treatment center might be helpful.     

Functional abdominal pain disorders in children

Introduction: Chronic abdominal pain is a common problem in pediatric practice. The majority of cases fulfill the Rome IV criteria for functional abdominal pain disorders (FAPDs). At times, these disorders may lead to rather serious repercussions.

Area covered: We have attempted to cover current knowledge on epidemiology, pathophysiology, risk factors related to pathophysiology, clinical evaluation and management of children with FAPDs.

Expert commentary: FAPDs are a worldwide problem with a pooled prevalence of 13.5%. There are a number of predisposing factors and pathophysiological mechanisms including stressful events, child maltreatment, visceral hypersensitivity, altered gastrointestinal motility and change in intestinal microbiota. It is possible that the environmental risk factors intricately interact with genes through epigenetic mechanisms to contribute to the pathophysiology. The diagnosis mainly depends on clinical evaluation. Commonly used pharmacological interventions do not play a major role in relieving symptoms. Centrally directed, nonpharmacological interventions such as hypnotherapy and cognitive behavioral therapy have shown both short and long term efficacy in relieving pain in children with FAPDs. However, these interventions are time consuming and need specially trained staff and therefore, not currently available at grass root level. Clinicians and researchers should join hands in searching for more pragmatic and effective therapeutic modalities to improve overall care of children with FAPDs.     

Functional abdominal pain in the elderly.

Although aging per se affects function throughout the gut, particularly after age 70, the observed changes are relatively modest and often asymptomatic, perhaps because of the vast reserve of neuromuscular functional elements in the gut. The proximal esophagus, anus, and pelvic floor are possible exceptions to this generalization, and the combination of aging and factors such as minor strokes or obstetric damage often results in dysphagia, constipation, or fecal incontinence. Managing elderly patients with functional abdominal pain demands clinical acumen, tact, understanding, and patience. Further studies are required to elucidate the consequences of aging on gastrointestinal sensorimotor function at several levels of the digestive tract. With the expected explosion in the proportion of the population older than age 75, this field should become a high priority for clinical and research efforts. Also required will be a major campaign to educate patients and practitioners and multidisciplinary collaborations among primary care practitioners, gastroenterologists, psychologists, and physiatrists to provide optimal pain management in the elderly.     

Churg-Strauss syndrome revealed by acute abdominal pain.

We describe a 10-year-old girl with Churg-Strauss syndrome, who presented with acute abdominal pain, bloody diarrhea, and pulmonary infiltrates. She had a 6-year history of severe asthma. Bronchoalveolar lavage showed marked eosinophilia. She responded well to high-dose intravenous corticosteroid pulse therapy for 3 consecutive days, followed by oral steroids without developing major side effects. This case should remind pediatricians of the rare existence of this vasculitis in children. Relapse is not uncommon, and long-term careful supervision is necessary.     

Treatment of abdominal pain in irritable bowel syndrome

Functional abdominal pain in the context of irritable bowel syndrome (IBS) is a challenging problem for primary care physicians, gastroenterologists and pain specialists. We review the evidence for the current and future non-pharmacological and pharmacological treatment options targeting the central nervous system and the gastrointestinal tract. Cognitive interventions such as cognitive behavioral therapy and hypnotherapy have demonstrated excellent results in IBS patients, but the limited availability and labor-intensive nature limit their routine use in daily practice. In patients who are refractory to first-line therapy, tricyclic antidepressants (TCA) and selective serotonin reuptake inhibitors are both effective to obtain symptomatic relief, but only TCAs have been shown to improve abdominal pain in meta-analyses. A diet low in fermentable carbohydrates and polyols (FODMAP) seems effective in subgroups of patients to reduce abdominal pain, bloating, and to improve the stool pattern. The evidence for fiber is limited and only isphagula may be somewhat beneficial. The efficacy of probiotics is difficult to interpret since several strains in different quantities have been used across studies. Antispasmodics, including peppermint oil, are still considered the first-line treatment for abdominal pain in IBS. Second-line therapies for diarrhea-predominant IBS include the non-absorbable antibiotic rifaximin and the 5HT₃ antagonists alosetron and ramosetron, although the use of the former is restricted because of the rare risk of ischemic colitis. In laxative-resistant, constipation-predominant IBS, the chloride-secretion stimulating drugs lubiprostone and linaclotide, a guanylate cyclase C agonist that also has direct analgesic effects, reduce abdominal pain and improve the stool pattern.     

An abdominal pain syndrome in a lupus patient

Systemic lupus erythematosus can be complicated by the antiphospholipid syndrome (APS). The clinical manifestations of this syndrome most often documented thus far are recurrent deep venous thrombosis, recurrent spontaneous abortions, and cerebral vascular accidents. Abdominal ischemic events have received relatively little attention in prior reports. We report on a lupus patient with lupus anticoagulant positivity who presented with abdominal pain, anorexia, and weight loss who was subsequently diagnosed with gastric ulcers and pancreatitis. Computerized tomography of the abdomen in addition revealed splenic and kidney infarcts. We conclude that this patient had (ischemic) chronic pancreatitis with pseudocysts and splenic and renal infarcts probably due to secondary APS.