Department of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Memorial Hospital, Northwestern University, Chicago, IL 60614, USA.
J Pediatr Gastroenterol Nutr. 2010 Nov;51(5):579-83. doi: 10.1097/MPG.0b013e3181de0639.
Pain-predominant-functional gastrointestinal disorders (PP-FGIDs) are common. The diagnosis is clinical and there are no biological markers to characterize these conditions. Despite limited evidence, investigations are commonly performed. The aim of the study was to investigate diagnostic practices, yield, and costs in children with PP-FGIDs.
Charts of all of the children older than 4 years diagnosed as having abdominal pain were reviewed. Results and costs of diagnostic investigations were analyzed.
Of 243 children with abdominal pain, 122 (50.2%) had PP-FGIDs (79 girls, mean age 12.7 years). All of the children underwent diagnostic work-up. Complete blood cell count was done in 91.8% of patients. None had elevated white blood cells, platelets, and low albumin. Six had either elevated erythrocyte sedimentation rate or C-reactive protein, but none had elevation of both; 4 of these 6 cases underwent endoscopies with normal results in 3 cases; Helicobacter pylori was found in 1 case. One child had elevated tissue transglutaminase 1 only antibodies with normal endoscopy. Amylase, lipase, direct bilirubin, stool cultures, and ova or parasites were always normal. One child had intermittent elevation of aspartate aminotransferase and alanine transaminase. There were no significant abnormalities in urinalysis or electrolytes. Abdominal x-rays were done in 38.5%, showing only retained stools in 13% of these patients. Abdominal ultrasound and computed tomography scan were done in 23.7% and 9% of cases, respectively, but were of no clinical value; 33.6% patients had esophagogastroduodenoscopy (9.7% abnormal: Helicobacter pylori, chemical gastritis, esophagitis) and 17.2% had colonoscopy (9.5% abnormal: rare fork crypts, lymphoid hyperplasia). Total costs: $744,726. Average cost per patient: $6104.30.
In children with PP-FGIDs, investigations are common, costs are substantial, and yield is minimal.
以疼痛为主的功能性胃肠病（PP-FGIDs）较为常见。此类疾病的诊断主要基于临床症状，目前尚无生物学标志物来对此类疾病进行特征描述。尽管证据有限，但通常会进行相关检查。本研究旨在调查以腹痛为主诉就诊的儿童患者的诊断实践、检查结果和费用。
回顾了所有年龄超过 4 岁且被诊断为腹痛的患儿的病历。分析了诊断性检查的结果和费用。
243 例腹痛患儿中，122 例（50.2%）为以疼痛为主的功能性胃肠病（79 例为女性，平均年龄 12.7 岁）。所有患儿均接受了诊断性检查。91.8%的患儿行血常规检查，均无白细胞、血小板升高和低白蛋白血症。6 例患儿红细胞沉降率或 C 反应蛋白升高，但均为单项升高；其中 4 例行内镜检查，3 例结果正常，1 例发现幽门螺杆菌感染。1 例患儿仅抗组织转谷氨酰胺酶 1 抗体升高，内镜检查正常。淀粉酶、脂肪酶、直接胆红素、粪便培养和寄生虫检查均正常。1 例患儿间歇性出现天门冬氨酸氨基转移酶和丙氨酸氨基转移酶升高，尿液分析和电解质检查未见明显异常。38.5%的患儿行腹部 X 线检查，仅 13%的患儿发现有粪便潴留。23.7%和 9%的患儿分别行腹部超声和 CT 检查，但无临床价值；33.6%的患儿行上消化道内镜检查（9.7%异常：幽门螺杆菌感染、化学性胃炎、食管炎），17.2%的患儿行结肠镜检查（9.5%异常：罕见叉状隐窝、淋巴组织增生）。总费用：744726 美元。平均每位患儿的费用：6104.30 美元。
在以疼痛为主的功能性胃肠病患儿中，检查较为常见，费用较高，但检查结果的临床意义有限。
