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Colegio de Medicina Interna de México.

2014, Number 5

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Med Int Mex 2014; 30 (5)

Clinical effect of obesity on treatment of abdominal pain at Emergency Room

Lee-Cervantes DE, Sánchez-Jiménez BA, Gutiérrez-Grobe Y, Yeverino-Suárez P, Juárez-Hernández E, Chávez-Tapia NC

Language: Spanish
References: 28
Page: 546-553
PDF size: 420.39 Kb.


ABSTRACT

Background: Obesity represents the main cause of morbidity and mortality worldwide. At the emergency room, the obese patient acquires significance due to the possibility of having different clinical presentation, requiring an increased number of complementary tests and displaying unequal evolution.
Objective: To assess the difference in clinical presentation, evaluation and evolution of acute abdominal pain between in obese patients.
Material and method: A retrospective, analytic and comparative study was done with patients who presented with acute abdominal pain, from February 2009 to January 2011. Differences on clinical presentation, radiologic complementary studies, and different outcomes as surgery, admission to ICU and death were evaluated. Consistency between initial and final diagnosis was also analyzed.
Results: There were included 594 patients (68% female), 81 were obese. There was a difference on hemoglobin (14.7 ± 1.6 vs 14.3 ± 1.8 mg/ dL) and GGT (101 ± 145 vs 55.9 ± 104 U/L, p=0.05), no differences were found on diagnostic imaging tests; CT 49% vs 44% (p=0.32), abdominal ultrasound 47% vs 42% (p=0.42), and abdominal radiography 28% on both groups (p=0.42). There was surgical resolution in 28% of both groups (p=0.99), with no difference found on UCI admission (1.2% vs 1.6%, p=0.82) or death (0% vs 0.8%, p=0.43). There was poor correlation between initial and final diagnosis on obese patients (Kappa 0.319 vs -0.02).
Conclusion:At the emergency service, obese patients with acute abdominal pain exhibit poor correlation between initial and final diagnosis. However, clinical presentation and evaluation was the same in obese and non-obese patients.


REFERENCES

  1. Foxx-Orenstein AE. Gastrointestinal symptoms and diseases related to obesity: an overview. Gastroenterol Clin North Am 2010;39:23-37.

  2. Sánchez-Castillo CP, Pichardo-Ontiveros E, López R. Epidemiología de la obesidad. Gac Méd Méx 2004;140:3-20.

  3. Moayyedi P. The epidemiology of obesity and gastrointestinal and other diseases: an overview. Dig Dis Sci 2008;53:2293-2299.

  4. Cremonini F, Camilleri M, Clark MM, Beebe TJ, et al. Associations among binge eating behavior patterns and gastrointestinal symptoms: a population-based study. Int J Obes (Lond) 2009;33:342-353.

  5. Delgado-Aros S, Locke GR 3rd, Camilleri M, Talley NJ, et al. Obesity is associated with increased risk of gastrointestinal symptoms: a population-based study. Am J Gastroenterol 2004;99:1801-1806.

  6. El-Serag HB, Graham DY, Satia JA, Rabeneck L. Obesity is an independent risk factor for GERD symptoms and erosive esophagitis. Am J Gastroenterol 2005;100:1243- 1250.

  7. Nguyen DM, El-Serag HB. The big burden of obesity. Gastrointest Endosc 2009;70:752-757.

  8. Talley NJ, Quan C, Jones MP, Horowitz M. Association of upper and lower gastrointestinal tract symptoms with body mass index in an Australian cohort. Neurogastroenterol Motil 2004;16:413-419.

  9. Martinez J, Johnson CD, Sanchez-Paya J, de Madaria E, et al. Obesity is a definitive risk factor of severity and mortality in acute pancreatitis: an updated meta-analysis. Pancreatology 2006;6:206-209.

  10. Feldman M LF, Lawrence B. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Frankfurt: Elsevier, 2010.

  11. Platts-Mills TF, Burg MD, Snowden B. Obese patients with abdominal pain presenting to the emergency department do not require more time or resources for evaluation than nonobese patients. Acad Emerg Med 2005;12:778-781.

  12. Chen EH, Shofer FS, Hollander JE, Robey JL, et al. Emergency physicians do not use more resources to evaluate obese patients with acute abdominal pain. Am J Emerg Med 2007;25:925-930.

  13. Ho W, Spiegel BM. The relationship between obesity and functional gastrointestinal disorders: causation, association, or neither? Gastroenterol Hepatol (NY) 2008;4:572-578.

  14. Dinsa GD, Goryakin Y, Fumagalli E, Suhrcke M. Obesity and socioeconomic status in developing countries: a systematic review. Obes Rev 2012;13:1067-1079.

  15. Foxx-Orenstein AE. Gastrointestinal symptoms and diseases related to obesity: an overview. Gastroenterol Clin North Am 2010;39:23-37.

  16. Sánchez-Castillo CP, Pichardo-Ontiveros E, López R. Epidemiología de la obesidad. Gac Méd Méx 2004;140:3-20.

  17. Moayyedi P. The epidemiology of obesity and gastrointestinal and other diseases: an overview. Dig Dis Sci 2008;53:2293-2299.

  18. Cremonini F, Camilleri M, Clark MM, Beebe TJ, et al. Associations among binge eating behavior patterns and gastrointestinal symptoms: a population-based study. Int J Obes (Lond) 2009;33:342-353.

  19. Delgado-Aros S, Locke GR 3rd, Camilleri M, Talley NJ, et al. Obesity is associated with increased risk of gastrointestinal symptoms: a population-based study. Am J Gastroenterol 2004;99:1801-1806.

  20. El-Serag HB, Graham DY, Satia JA, Rabeneck L. Obesity is an independent risk factor for GERD symptoms and erosive esophagitis. Am J Gastroenterol 2005;100:1243- 1250.

  21. Nguyen DM, El-Serag HB. The big burden of obesity. Gastrointest Endosc 2009;70:752-757.

  22. Talley NJ, Quan C, Jones MP, Horowitz M. Association of upper and lower gastrointestinal tract symptoms with body mass index in an Australian cohort. Neurogastroenterol Motil 2004;16:413-419.

  23. Martinez J, Johnson CD, Sanchez-Paya J, de Madaria E, et al. Obesity is a definitive risk factor of severity and mortality in acute pancreatitis: an updated meta-analysis. Pancreatology 2006;6:206-209.

  24. Feldman M LF, Lawrence B. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Frankfurt: Elsevier, 2010.

  25. Platts-Mills TF, Burg MD, Snowden B. Obese patients with abdominal pain presenting to the emergency department do not require more time or resources for evaluation than nonobese patients. Acad Emerg Med 2005;12:778-781.

  26. Chen EH, Shofer FS, Hollander JE, Robey JL, et al. Emergency physicians do not use more resources to evaluate obese patients with acute abdominal pain. Am J Emerg Med 2007;25:925-930.

  27. Ho W, Spiegel BM. The relationship between obesity and functional gastrointestinal disorders: causation, association, or neither? Gastroenterol Hepatol (NY) 2008;4:572-578.

  28. Dinsa GD, Goryakin Y, Fumagalli E, Suhrcke M. Obesity and socioeconomic status in developing countries: a systematic review. Obes Rev 2012;13:1067-1079.




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