Department of Gastroenterology and Hepatology, Zurich University, 8091 Zurich, Switzerland.
Second Medical Clinic, Faculty of Medicine, Ippokration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Macedonia, Greece.
Int J Environ Res Public Health. 2019 Nov 20;16(23):4607. doi: 10.3390/ijerph16234607.
Abdominal pain is one of the commonest symptoms in emergency departments (EDs). Diagnosis demands full attention and critical thinking, since many diseases manifest atypically and the consequences of overlooking the symptoms may be disastrous. Despite intensive diagnostic procedures, some cases remain elusive and unclear abdominal pain (UAP) is not infrequent. Emerging evidence supports the hypothesis that functional pain might be attributed to vitamin D deficiency (VDD). People with darker or covered skin are predisposed to developing VDD. Patients in Switzerland stemming from low- and middle-income countries (LMIC) are such a population. To identify cases with UAP in LMIC patients and to compare vitamin D status with a control group. A retrospective single-center case-control study was carried out from 1 January 2013 to 31 August 2016 in all adult patients (more than 16 years old) stemming from LMIC and presenting at the university ED of Bern with abdominal pain. Vitamin D status was retrieved from these cases when available. The control group consisted of patients without abdominal pain or metabolic diseases and was matched (1:1) to the cases for age, gender, body mass index, geographic distribution, and season of vitamin D estimation. A total of 10,308 cases from LMIC were reported to the ED. In total, 223 cases were identified with UAP. The status of vitamin D was available for 27 patients; 27 matched individuals were subsequently retrieved for the control group. Women made up 56.7% of the UAP group and 43.3% of the control group. The most common origin of the LMIC subjects was southern Europe (20.4%), followed by southern Asia (16.7%) and Eastern Europe (13%). Fourteen UAP patients exhibited severe VDD (< 25 nmol/L) versus one in the control group ( = 0.001). The difference remained significant if the patients were identified as having VDD (<50 nmol/L) or not ( = 0.024). Comparison of the means indicated that the UAP group had lower vitamin D levels than the control group (41.3 vs. 53.7 nmol/L, respectively), but this difference was marginal ( = 0.060) and not statistically significant. After adjustment for potential confounders, including gender, mean vitamin D levels remained non-significantly different between groups. In the sub-group analysis, vitamin D levels were lower in women than in men (p = 0.037), compared to the respective controls. This study showed for the first time that patients from LMIC who presented to ED with UAP displayed VDD. Validation from larger studies is warranted to evaluate the linkage of VDD with UAP.
腹痛是急诊科（ED）最常见的症状之一。由于许多疾病表现不典型，忽视这些症状可能会带来灾难性的后果，因此诊断需要全神贯注和批判性思维。尽管进行了密集的诊断程序，但仍有一些病例难以确诊，且非特异性腹痛（UAP）并不少见。新出现的证据支持这样一种假设，即功能性疼痛可能归因于维生素 D 缺乏症（VDD）。皮肤较黑或有遮盖的人更容易患上 VDD。来自低收入和中等收入国家（LMIC）的瑞士患者就是这样的人群。 为了在 LMIC 患者中识别出 UAP 病例，并比较维生素 D 状态与对照组。 从 2013 年 1 月 1 日至 2016 年 8 月 31 日，对所有来自 LMIC 并在伯尔尼大学 ED 以腹痛就诊的 16 岁以上成年患者进行了回顾性单中心病例对照研究。当有病例时，会从这些病例中检索维生素 D 状态。对照组由无腹痛或代谢性疾病的患者组成，并与病例按年龄、性别、体重指数、地理分布和维生素 D 估计季节进行 1:1 匹配。 共有 10308 例来自 LMIC 的病例被报告到 ED。共有 223 例被确定为 UAP。27 名患者的维生素 D 状态可用；随后为对照组检索了 27 名匹配个体。女性占 UAP 组的 56.7%，对照组的 43.3%。LMIC 受试者最常见的来源是南欧（20.4%），其次是南亚（16.7%）和东欧（13%）。14 名 UAP 患者表现出严重的 VDD（<25 nmol/L），而对照组中只有 1 名（ = 0.001）。如果将患者确定为 VDD（<50 nmol/L）或非 VDD（ = 0.024），差异仍然显著。如果比较均值，UAP 组的维生素 D 水平低于对照组（分别为 41.3 与 53.7 nmol/L），但这一差异很轻微（ = 0.060），且无统计学意义。在调整了性别等潜在混杂因素后，两组间的平均维生素 D 水平仍无显著差异。在亚组分析中，与各自的对照组相比，女性的维生素 D 水平低于男性（p = 0.037）。需要更大规模的研究来验证 VDD 与 UAP 的关联性。
