Chiotakakou-Faliakou E, Dave U, Forbes A
St Mark's Hospital, Harrow, England.
J R Soc Med. 1996 Sep;89(9):490-2. doi: 10.1177/014107689608900904.
Diagnosis of functional abdominal pain requires exclusion of organic causes, and many patients undergo considerable investigation. A positive physical sign supporting a functional diagnosis could therefore be of benefit. Wheelchair use specifically for abdominal symptoms was suspected to represent such a sign. Review of 300 consecutive new referrals to a gastroenterology clinic revealed 10 wheelchair users. In four women the chair was used because of the abdominal condition. The final diagnosis (with follow-up to at least 12 months) was functional abdominal pain in each of these cases. All four had had surgery without symptom relief, and all had used their chairs intermittently (mainly for social occasions and hospital visits) for at least 12 months. They believed that normal walking was rendered impossible by abdominal pain whereas the other six wheelchair users gave a clear account of lower limb pain or weakness. Secondary gain with reinforcement of the 'sick role' was felt to be the probable explanation for wheelchair use in the former group. Wheelchair attendance at the gastroenterology clinic, in the absence of lower limb symptoms, is a rare observation but one that may usefully be added to criteria for diagnosis of a functional disorder.
功能性腹痛的诊断需要排除器质性病因，许多患者都接受了大量检查。因此，一个支持功能性诊断的阳性体征可能会有所帮助。专门因腹部症状而使用轮椅被怀疑是这样一种体征。对一家胃肠病诊所连续300例新转诊患者的回顾显示有10名轮椅使用者。在4名女性中，使用轮椅是因为腹部疾病。最终诊断（随访至少12个月）在每例中均为功能性腹痛。这4例患者均接受过手术，但症状未缓解，且均间歇性使用轮椅（主要用于社交场合和就医）至少12个月。她们认为腹痛使正常行走变得不可能，而其他6名轮椅使用者则明确诉说下肢疼痛或无力。前一组患者使用轮椅的可能原因被认为是继发获益并强化了“患病角色”。在没有下肢症状的情况下，在胃肠病诊所出现轮椅使用者是一种罕见现象，但这一现象可能会被有益地纳入功能性疾病的诊断标准中。
