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Gas, bloating, and belching are primarily caused by functional gastrointestinal disorders; psychological distress can make symptoms worse. Exhaustive testing is not necessary for diagnosis. Most patients are classified as having gastric or small bowel bloating, bloating with constipation, or belching disorders. Patients with symptoms of irritable bowel syndrome should be tested for celiac disease; patients with chronic constipation should have a rectal examination. There is insufficient evidence to support the routine use of highly restrictive exclusion diets except in patients with confirmed celiac disease.
Dec 15, 2018 Issue
Crohn's Disease: ACG Releases Updated Management Guidelines [Practice Guidelines]
Options for managing Crohn’s disease continue to increase, as does the prevalence of the disease. The American College of Gastroenterology (ACG) has released an updated clinical practice guideline outlining features of the disease, as well as diagnosis and treatment options.
Many clinicians are unfamiliar with abdominal wall pain and may order expensive and unnecessary laboratory tests, imaging studies, and consultations, potentially exposing patients to unwarranted invasive procedures. Find out how to distinguish benign etiologies from more serious intra- or extraabdominal causes, and learn about the emerging data on point-of-care ultrasonography and surgical intervention for abdominal wall pain.
Acute intestinal obstruction occurs when the forward flow of intestinal contents is interrupted or impaired by a mechanical cause, most commonly intraabdominal adhesions, malignancy, and herniation. Find out which patients can be managed nonoperatively, and when medical therapy or surgery is required.
Although recurrent abdominal pain in children is most often considered functional or nonorganic, organic causes are sometimes found. Certain signs and symptoms warrant further workup. Management focuses on improving quality of life, reducing parent and child concerns about the seriousness of the disease, and reducing the disability associated with pain rather than complete resolution of pain. Learn the signs and symptoms that warrant further workup and about possible therapies.
Pathologic diseases, besides GERD, are becoming more prevalent and should be considered in the differential diagnosis of patients presenting with symptoms of esophageal dysfunction.
Jan 1, 2018 Issue
Dietary Interventions for Recurrent Abdominal Pain in Childhood [Cochrane for Clinicians]
Probiotics relieve pain in children with recurrent abdominal pain in the short term (number needed to treat [NNT] = 8). There is no convincing evidence that fiber supplements improve pain in children with recurrent abdominal pain.
The initial assessment of a child with acute abdominal pain should aim to identify the severity of the pain and whether the child has a condition that is likely to require surgery. A complete physical examination, as well as auscultation of bowel sounds, laboratory testing, and imaging, can reveal important signs and symptoms needed to make a diagnosis.
Find out which history and physical examination findings can help narrow the differential diagnosis, and which imaging and laboratory tests are most helpful.
Review the American College of Radiology Appropriateness Criteria for choosing the optimal imaging method for abdominal pain. Decisions are guided by the location of the pain and suspected diagnosis.