Kang J Y, Tay H H, Guan R
Department of Medicine, National University Hospital, Singapore.
Gut. 1992 Jun;33(6):743-8. doi: 10.1136/gut.33.6.743.
Pain site and radiation and the effect of various foods were studied prospectively in a consecutive series of patients with chronic upper abdominal pain. Patients followed for less than one year were excluded unless peptic ulcer or abdominal malignancy had been diagnosed or laparotomy had been carried out. A total of 632 patients were eligible for the first study and 431 for the second. Gastric ulcer pain was more likely to be left hypochondrial (17%) compared with pain from duodenal ulcer (4%) or from all other conditions (5%). It was less likely to be epigastric (54%) compared with duodenal ulcer pain (75%). Oesophageal pain was more likely to be both retrosternal and epigastric (25%) compared with non-oesophageal pain (2%). Radiation to the back was more common in peptic ulcer (31%) and biliary pain (35%) compared with functional pain (20%). Pain precipitation by fatty foods was commoner in biliary disease (40%) than in duodenal ulcer (11%), peptic ulcer (9%), or non-ulcer dyspepsia (19%). Orange, alcohol, and coffee precipitated pain more frequently in duodenal ulcer (41%, 50%, and 43% respectively) than in biliary disease (17%, 0%, and 14% respectively). Chilli precipitated pain in one quarter to one half of subjects regardless of diagnosis. Approximately one tenth of all subjects avoided chilli, curry, coffee, and tea because of medical or other advice.
对一系列连续性慢性上腹部疼痛患者的疼痛部位、放射情况以及各种食物的影响进行了前瞻性研究。随访时间不足一年的患者被排除，除非已诊断为消化性溃疡或腹部恶性肿瘤，或已进行剖腹手术。共有632例患者符合首次研究的条件，431例符合第二次研究的条件。与十二指肠溃疡（4%）或所有其他疾病（5%）引起的疼痛相比，胃溃疡疼痛更可能位于左季肋部（17%）。与十二指肠溃疡疼痛（75%）相比，胃溃疡疼痛位于上腹部的可能性较小（54%）。与非食管性疼痛（2%）相比，食管性疼痛更可能同时位于胸骨后和上腹部（25%）。与功能性疼痛（20%）相比，消化性溃疡（31%）和胆绞痛（35%）向背部放射更为常见。脂肪类食物诱发疼痛在胆道疾病（40%）中比在十二指肠溃疡（11%）、消化性溃疡（9%）或非溃疡性消化不良（19%）中更为常见。橙子、酒精和咖啡诱发十二指肠溃疡疼痛的频率更高（分别为41%、50%和43%），而在胆道疾病中诱发疼痛的频率较低（分别为17%、0%和14%）。无论诊断如何，约四分之一至一半的受试者食用辣椒后会诱发疼痛。约十分之一的受试者因医学建议或其他建议而避免食用辣椒、咖喱、咖啡和茶。
