만성 복통을 보이는 환자 어떤 순서로 접근을 해야 하나요?
Diagnostic Approaches to Chronic Abdominal Pain in Children
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Chronic abdominal pain (CAP) is a common complaint encountered in pediatric clinics and a great concern for patients and their caretakers as well as health care professionals. A constant challenge is detecting individuals with organic diseases or psychosomatic disorders from the majority of patients who have a functional disorder including functional dyspepsia, irritable bowel syndrome, functional abdominal pain, and abdominal migraine. Beginning with a detailed history and physical examination, physicians must determine a differential diagnosis of CAP by applying the symptom-based Rome III criteria to positively identify a functional disorder. These findings should then be further analyzed based on diagnostic clues and red flags that indicate the presence of specific organic diseases and/or the need for further testing. Once a functional diagnosis has been made or an organic disease is suspected, physicians can initiate an empiric therapeutic trial. Since psychological distress accompanies both organic and non-organic abdominal pain in children, a cooperative diagnostic approach involving pediatricians and psychiatrists is recommended. (Korean J Pediatr Gastroenterol Nutr 2011; 14: 26∼32)
Abstract
Chronic abdominal pain (CAP) is a common complaint encountered in pediatric clinics and a great concern for patients and their caretakers as well as health care professionals. A constant challenge is detecting individuals with organic diseases or psychosomatic disorders from the majority of patients who have a functional disorder including functional dyspepsia, irritable bowel syndrome, functional abdominal pain, and abdominal migraine. Beginning with a detailed history and physical examination, physicians must determine a differential diagnosis of CAP by applying the symptom-based Rome III criteria to positively identify a functional disorder. These findings should then be further analyzed based on diagnostic clues and red flags that indicate the presence of specific organic diseases and/or the need for further testing. Once a functional diagnosis has been made or an organic disease is suspected, physicians can initiate an empiric therapeutic trial. Since psychological distress accompanies both organic and non-organic abdominal pain in children, a cooperative diagnostic approach involving pediatricians and psychiatrists is recommended. (Korean J Pediatr Gastroenterol Nutr 2011; 14: 26∼32)
참고문헌 (14)
- Starfield B, "Who provides health care to children and adolescents in the United States", Pediatrics, 74, pp.991~997 (1984)
- Hyams JS, "Abdominal pain and irritable bowel syndrome in adolescents: a community-based study", J Pediatr, 129, pp.220~226 (1996)
- Frank L, "Health-related quality of life associated with irritable bowel syndrome: comparison with other chronic diseases", Clin Ther, 24, pp.675~689 (2002)
- Drossman DA, "U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact", Dig Dis Sci, 38, pp.1569~1580 (1993)
- Talley NJ, "Medical costs in community subjects with irritable bowel syndrome", Gastroenterology, 109, pp.1736~1741 (1995)
- Campo JV, "Adult outcomes of pediatric recurrent abdominal pain: do they just grow out of it", Pediatrics, 108, pp.1~ (2001)
- Apley J, "Recurrent abdominal pains: a field survey of 1,000 school children", Arch Dis Child, 33, pp.165~170 (1958)
- American Academy of Pediatrics Subcommittee on Chronic Abdominal Pain, "Chronic abdominal pain in children", Pediatrics, 115, pp.812~815 (2005)
- Kohli R, "Differential diagnosis of recurrent abdominal pain: new considerations", Pediatr Ann, 33, pp.113~122 (2004)
- Boey CC, "Psychosocial factors and childhood recurrent abdominal pain", J Gastroenterol Hepatol, 17, pp.1250~1253 (2002)
- Noe JD, "Navigating recurrent abdominal pain through clinical clues, red flags, and initial testing", Pediatr Ann, 38, pp.259~266 (2009)
- Di Lorenzo C, "American Academy of Pediatrics Subcommittee on Chronic Abdominal Pain; NASPGHAN Committee on Abdominal Pain. Chronic abdominal pain in children: a clinical report of the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition", J Pediatr Gastroenterol Nutr, 40, pp.245~248 (2005)
- 황진복, "소아청소년 만성 복통증의 진단적 접근의 실제", 대한의사협회지, 52(3), pp.271~284 (2009), 대한의사협회
- von Baeyer CL, "Understanding and managing children's recurrent pain in primary care: a biopsychosocial perspective", Paediatr Child Health, 12, pp.121~125 (2007)