Biliary dyskinesia and symptomatic gallstone disease in children: two sides of the same coin?
Biliary dyskinesia and symptomatic gallstone disease in children: two sides of the same coin?
复制标题
儿童胆道运动障碍和症状性胆石病：同一枚硬币的两个面？
DOI：
10.1007/s10620-014-3126-2
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发表时间：
2014
影响因子：
3.1
通讯作者：
Bielefeldt,Klaus
中科院分区：
文献类型：
--
作者：
Srinath,ArvindI;Youk,AdaO;Bielefeldt,Klaus
背景尽管缺乏共识标准，胆道运动障碍（BD）是一种越来越被接受的儿科诊断。目的我们比较了 BD 和症状性胆囊结石（LITH）儿童的患者特征、结果和资源利用（手术前和手术后）。方法从 2002 年 12 月 1 日至 2012 年 11 月 30 日期间在美国儿童医院诊断为 BD 或 LITH 的儿童的电子病历中提取数据。匹兹堡。结果确定了 410 名患者（BD：213 名患者，LITH：197 名患者）。 BD 患者的 BMI 明显较低，症状持续时间较长，消化不良症状较多，并且更有可能出现其他症状。尽管胆囊射血分数 (GB-EF) 正常，但 41 名 BD 患者 (13.8%) 接受了胆囊切除术。其中 32 名患者中，辛卡利特引发了疼痛，而 155 名 GB-EF 较低的患者中，有 75 名患者出现了疼痛。手术后，双相情感障碍患者更常去胃肠科诊所就诊，并且因胃肠道相关住院的次数也更多，而两组的急诊就诊次数均有所减少。只有胆道疾病的性质才能独立预测术后持续疼痛，这反过来又是胆囊切除术后资源利用率更高的最佳预测因素。结论 很大一部分 BD 儿童不符合成人诊断标准。与 LITH 患者相比，BD 儿童的症状更广泛，并且在手术后继续使用更多的临床资源。这些发现表明，尽管 BD 具有良性预后，但它越来越多地像其他潜在的急性胆囊疾病一样进行治疗，尽管它具有 FGID 的典型表型，并且应该使用此类疾病中使用的方法进行治疗。
BackgroundDespite lack of consensus criteria, biliary dyskinesia (BD) is an increasingly accepted pediatric diagnosis.AimsWe compared patient characteristics, outcomes, and resource utilization (before and after surgery) between children with BD and symptomatic cholecystolithiasis (LITH).MethodsData from the electronic medical record were abstracted for children diagnosed with BD or LITH between December 1, 2002, and November 30, 2012, at Children’s Hospital of Pittsburgh.ResultsFour hundred and ten patients were identified (BD: 213 patients, LITH: 197 patients). Patients with BD had significantly lower BMI, longer symptom duration, more dyspeptic symptoms, and were more likely to present with other symptoms. Forty-one patients (13.8 %) with BD underwent cholecystectomy despite a normal gallbladder ejection fraction (GB-EF). In 32 of these, sincalide triggered pain compared to 75 of the 155 patients with low GB-EF. After surgery, patients with BD more commonly visited gastroenterology clinics and had more GI-related hospitalizations, while emergency room visits decreased in both groups. Only the nature of biliary disease independently predicted continuing pain after surgery, which in turn was the best predictor for higher resource utilization after cholecystectomy.ConclusionsA large percentage of children with BD did not meet the adult diagnostic standards. Compared to those with LITH, children with BD have more widespread symptoms and continue to use more clinical resources after surgery. These findings suggest that despite its benign prognosis, BD is increasingly treated like other potentially acute gallbladder diseases, although it has the typical phenotype of FGIDs and should be treated using approaches used in such disorders.