A Million-dollar Work-up for Abdominal Pain: Is It Worth It?
A Million-dollar Work-up for Abdominal Pain: Is It Worth It?
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DOI：
10.1097/mpg.0b013e3181de0639
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发表时间：
2010-11-01
影响因子：
2.9
通讯作者：
Saps, Miguel
中科院分区：
文献类型：
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作者：
Dhroove, Gati;Chogle, Ashish;Saps, Miguel
背景与目的：疼痛为主的功能性胃肠疾病（pp - fgid）是一种常见的疾病。诊断是临床的，没有生物学标记来表征这些条件。尽管证据有限，但通常会进行调查。该研究的目的是调查pp - fgid儿童的诊断实践、产量和成本。患者和方法：回顾了所有4岁以上诊断为腹痛的儿童的图表。分析了诊断调查的结果和费用。结果：243例腹痛患儿中，122例（50.2%）有pp - fgid（79例女孩，平均年龄12.7岁）。所有的孩子都接受了诊断性检查。91.8%的患者进行了全血细胞计数。没有人有白细胞、血小板升高和低白蛋白。其中6例红细胞沉降率或c反应蛋白升高，但没有一例两者均升高；4例行内窥镜检查，3例结果正常；1例检出幽门螺杆菌。1例患儿组织转谷氨酰胺酶1抗体升高，内窥镜检查正常。淀粉酶、脂肪酶、直接胆红素、粪便培养、虫卵或寄生虫均正常。1例患儿间歇性升高天冬氨酸转氨酶和丙氨酸转氨酶。尿液分析及电解质无明显异常。38.5%的患者进行了腹部x光检查，其中13%的患者仅发现粪便残留。腹部超声和计算机断层扫描分别占23.7%和9%，但没有临床价值；33.6%患者行食管胃十二指肠镜检查（9.7%异常：幽门螺杆菌、化学性胃炎、食管炎），17.2%行结肠镜检查（9.5%异常：罕见分叉隐窝、淋巴样增生）。总成本：744,726美元。每位患者的平均费用：6104.30美元。结论：在患有pp - fgid的儿童中，检查是常见的，费用很大，而且疗效很低。
Background and Aim: Pain-predominant-functional gastrointestinal disorders (PP-FGIDs) are common. The diagnosis is clinical and there are no biological markers to characterize these conditions. Despite limited evidence, investigations are commonly performed. The aim of the study was to investigate diagnostic practices, yield, and costs in children with PP-FGIDs.Patients and Methods: Charts of all of the children older than 4 years diagnosed as having abdominal pain were reviewed. Results and costs of diagnostic investigations were analyzed.Results: Of 243 children with abdominal pain, 122 (50.2%) had PP-FGIDs (79 girls, mean age 12.7 years). All of the children underwent diagnostic work-up. Complete blood cell count was done in 91.8% of patients. None had elevated white blood cells, platelets, and low albumin. Six had either elevated erythrocyte sedimentation rate or C-reactive protein, but none had elevation of both; 4 of these 6 cases underwent endoscopies with normal results in 3 cases; Helicobacter pylori was found in 1 case. One child had elevated tissue transglutaminase 1 only antibodies with normal endoscopy. Amylase, lipase, direct bilirubin, stool cultures, and ova or parasites were always normal. One child had intermittent elevation of aspartate aminotransferase and alanine transaminase. There were no significant abnormalities in urinalysis or electrolytes. Abdominal x-rays were done in 38.5%, showing only retained stools in 13% of these patients. Abdominal ultrasound and computed tomography scan were done in 23.7% and 9% of cases, respectively, but were of no clinical value; 33.6% patients had esophagogastroduodenoscopy (9.7% abnormal: Helicobacter pylori, chemical gastritis, esophagitis) and 17.2% had colonoscopy (9.5% abnormal: rare fork crypts, lymphoid hyperplasia). Total costs: $744,726. Average cost per patient: $6104.30.Conclusions: In children with PP-FGIDs, investigations are common, costs are substantial, and yield is minimal.