Çocuklarda Kronik Karın Ağrısının Nedenlerinin Değerlendirilmesi ve Maliyet Analizi

Year 2021, Volume: 74 Issue: 3, 324 - 331, 17.09.2021

Göksel Vatansever

Abstract

Amaç: Kronik karın ağrısı (KKA) olan çocuklarda öykü, fizik inceleme ve tanıya yönelik yapılan tetkikler ile organik ve fonksiyonel karın ağrısının
sıklığının belirlenmesi ve tetkiklerin hasta başına maliyetinin hesaplanması amaçlanmıştır.

Gereç ve Yöntem: Çocuk gastroenteroloji polikliniğinde KKA ile izlenen 4-18 yaş arası çocukların geriye dönük olarak demografik verileri, öykü
özellikleri, alarm belirti/bulgu varlığı, fizik muayene, laboratuvar, görüntüleme, endoskopik ve histopatolojik bulguları değerlendirildi. Olguların tanı
aşamasında yapılan tetkiklerinin toplam maliyeti ve hasta başına maliyeti hesaplandı.

Bulgular: KKA olan 324 hastanın (yaş ortalaması 11,26±3,80 yıl, %67’si kız), 222’si (%68,3) fonksiyonel gastrointestinal bozukluklar (FGİB), 102’si
(%31,7) organik nedenli karın ağrısı tanısı aldı. Organik nedenli karın ağrısı grubunda gastrit (%31,1), gastroözofageal reflü (%22,6), Helikobakter pilori
enfeksiyonu (%19,8) ve çölyak hastalığı (%7,5) saptandı. FGİB grubunu ise fonksiyonel dispepsi (%40,1), fonksiyonel karın ağrısı (%32,5), fonksiyonel
kabızlık (%21,5), irritabl bağırsak sendromu (%5,5) ve siklik kusma (%0,4) oluşturdu. Kusma (p=0,01), karın ağrısının 1 saatten uzun sürmesi (p=0,01),
şiddetli olması (p=0,01) ve uykudan uyandırması (p=0,014), kilo kaybı (p=0,045), ateş (p=0,035), artrit (p=0,014) ve üst gastrointestinal sistem
kanaması (p=0,011) öyküsü, fizik muayenede herhangi bir patolojik bulgu varlığı (p=0,01) organik nedenli karın ağrısında daha sıktı. Tanı için yapılan
tetkiklerin hasta başı maliyeti organik nedenli KKA’da (163,79 TL), FGİB’ye göre (50,66 TL) yaklaşık 3 kat fazlaydı.

Sonuç: Çocukluk çağında KKA’nın en sık nedeni FGİB’ye bağlı karın ağrısıdır. Alarm belirtilerinin varlığı, daha çok organik nedenleri düşündürmektedir.
Ayrıntılı bir öykü ve fizik muayene ile organik nedenler dışlanabilmekte, gereksiz maliyetler önlenebilmektedir.

Keywords

Karın Ağrısı, Gastrit, Dispepsi, Maliyet

Ethical Statement

tik Etik Kurul Onayı: Ankara Üniversitesi Tıp Fakültesi Klinik Araştırmalar Etik Kurulu’ndan etik kurul onayı alınmıştır (karar no: 05-269-13). Hasta Onayı: Çalışma retrospektif çalışma olduğu için hasta onayı alınmamıştır. Hakem Değerlendirmesi: Editörler

Evaluation of Children with Chronic Abdominal Pain and Cost Analysis

Abstract

Objectives: We aimed to identify the frequency of functional and organic abdominal pain by history, physical examination and diagnostic tests in
children who presented with chronic abdominal pain (CAP) and to determine the cost per patient.

Materials and Methods: The children who presented to pediatric gastroenterology outpatient clinic with CAP, aged 4-18 years, were reviewed for
demographic data, history, physical examination, laboratory, imaging, endoscopic and histopathological findings retrospectively. The total cost of
examinations performed at the diagnosis stage of the cases and the amount per patient were calculated.

Results: Among 324 patients (11.26±3.80 years, 67% female), 222 (68.3%) patients were detected to have functional abdominal pain due to
functional gastrointestinal disorders (FGID) and 102 (31.7%) were found to have organic causes. Gastritis in the organic-caused abdominal pain
group (31.1%), gastroesophageal reflux (22.6%) Helicobacter pylori infection (19.8%) and celiac disease (7.5%) were the most frequent causes.
Within patients in the FGID group, 40.1% had functional dyspepsia, 32.5% had functional abdominal pain, 21.5% had functional constipation, 5.5%
had irritable bowel syndrome, and 0.4% had cyclic vomiting. The severity degree (p=0.01), duration time (for more than 1 hour) (p=0.01) and
awaking from sleep (p=0.014) of abdominal pain, presence of vomiting (p=0.01), weight loss (p=0.045), fever (p=0.035), arthritis (p=0.014), upperpathological finding in physical examination were more frequent in patients with organic causes. The average cost of diagnostic tests per patient in
the organic group (163.79 TL) was approximately 3 times higher than in the FGID group (50.66 TL).

Conclusion: The most common etiology of chronic abdominal pain in childhood is due to FGID. The presence of alarm symptoms suggests more
organic causes. Organic etiology can be excluded by detailed medical history and physical examination without unnecessary cost.

Keywords

Abdominal Pain, Gastritis, Dyspepsia, Cost-Analysis

Ethical Statement

Etik Etik Kurul Onayı: Ankara Üniversitesi Tıp Fakültesi Klinik Araştırmalar Etik Kurulu’ndan etik kurul onayı alınmıştır (karar no: 05-269-13). Hasta Onayı: Çalışma retrospektif çalışma olduğu için hasta onayı alınmamıştır. Hakem Değerlendirmesi: Editörler

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