An Etiology And Clinical Analysis On 237 Cases Of Abdominal Pain In Children

Objective: To analyze the causes , clinical symptoms and examinations of abdominal pain in children.Methods: From November 2009 to February 2010, 237 children were erolled into this study.All the chilaren have a chief complaiment of abdominal pain,and went on Upper gastrointestinal endoscopy.clinical informations were collected by history taking.We also followed up the endoscopic findings and the other auxiliary examinations of all the 237cases and the outcome of abdominal pain of 135cases.Results:(1)The causes of abdominal pain in the 237 cases were as follows:chronic gastroduodenitis in 186 cases(78.5%), peptic ulcer in 4 cases(1.7%), Henoch-Schonlein purpura in 21 cases(8.8%), migraine eguivnlent in 5 cases(2.1%),acute gastritis in 7 cases(3.0%), congenital intestinal volvulus in 1 case,Meckel diverticulum in 1 case, cholangitis in 1 case, enlarged mesenteric lymph nodes in 1 case, limitations of peritonitis in 1 case, gastric retention in 1 case,unclear etiology in 8 cases(3.4%).(2)The duration,characteristics,degree,localization,cocomplication of abdominal pain,stool characteristics and endoscopic findings of chronic gastroduodenitis differed significantly from those of HSP(P<0.05).(3)5 children have dignosis of migraine eguivnlent,80%(4/5)of them were school-age. Those children have a major clinical manifestation of paroxysmal abdominal pain and trigger factors.(4)In chronic gastroduodenitis,the duration,characteristics,cocomplication,family history of abdominal pain were also compared between Hp-positive group and Hp-negative group,no significant difference were found(P>0.05);Endoscopic findings of those two group were difference significantly(P<0.05).(5)In Hp-positive children, the prognosis of abdominal pain were significantly different between children who accepte eradicated therapy and those did not(P =0.023).(6)In Hp-negative children, the prognosis of abdominal pain were not significantly different between between children who accepte antibiotic therapy and those did not(P =0.94).Conclusions:(1)The etiology of abdominal pain in children are complicated. Chronic gastroduodenitis is the main cause,second cause is HSP.(2)The characteristics of abdominal pain caused by Chronic gastroduodenitis are longer last,irregular;Localization of the pain is upper abdomen. Those children also have a complaiment of eructation,nausea, vomitting,halitosis; Endoscopic finding is hyperemia and oedema of mucosa;The characteristics of abdominal pain caused by HSP are short last,paroxysmal,worse after meals;Localization of the pain is cullen. Those children also have a complaiment of bloody stools,melena,vomitting; Endoscopic finding is erosions of mucosa.(3)Elder children who have a major clinical menifestation of paroxysmal abdominal pain should considered the possibility of migraine eguivnlent.(4)The clinical symptoms of chronic gastroduodenitis caused by Hp were not specific but endoscopic findings of antral nodularity is meaningful.(5)The Hp-positive children should accepte eradicated therapy ; Antibiotics is not necessary in the treament of non-Hp infected chronic gastroduodenitis.Therapies like protect the stomach mucous membrane,dietary therapy,alvi dejectiones are enough。(6)Upper gastrointestinal endoscopy is useful in children to located the cause of abdominal pain.