Evaluation of the etiology, prevalence of familial mediterranean fever and irritable bowel syndrome in patients presenting to the emergency department with abdominal pain

Introduction and Aim: Patients with abdominal pain constitute an important part of admissions to the emergency department. Despite advancing technological possibilities, diagnosis and treatment of acute abdominal pain in emergency departments is still one of the leading causes of important clinical problems. It is important to take a good medical history and to know the causes of intra-abdominal and extra-abdominal pain in order to evaluate the abdominal pain correctly and to provide good care to the patient. Problems are encountered in the diagnosis of acute abdominal pain even while using history, physical examination, biochemical tests and imaging methods. This may lead to unnecessary surgery and to miss diseases that cause nonspecific abdominal pain findings such as IBS and FMF and that do not have specific imaging findings. In this study, we evaluated the distribution of causes of abdominal pain and the frequency of FMF and IBS diagnosis in patients presenting with abdominal pain. Thus, we aimed to protect patients from unnecessary surgery, to reduce repeated emergency room visits, to prevent potentially fatal complications with early diagnosis, and to direct patients for correct and effective treatment. Material and Method: This study was performed as a prospective and cross-sectionally between December 1, 2019 - June 30, 2020, in the Department of Emergency Medicine at Balcalı Hospital with the approval of Çukurova University Faculty of Medicine Ethics Committee. 74 patients aged 18 years or older, who admitted to the Adult Emergency Medicine Service within the specified time period, who had abdominal pain were included in the study. Serum fibrinogen, sedimentation, CRP and lactate levels of the patients were studied. In addition, detailed family and genetic histories of the patients were questioned. ROME IV criteria were used for the diagnosis of IBS and Tel-Hashomer diagnostic criteria for FMF diagnosis. It was aimed to detect the presence of MEFV gene mutation by using PCR method for genetic diagnosis. In the study, the demographic characteristics, vital signs and medical history of the patients, as well as additional complaints, laboratory findings, ADBG, USG and CT findings were collected and recorded in a previously prepared study sheat. Research data was uploaded and analyzed on computer via " IBM SPSS for Windows 23.0". Results: 74 patients were included in the study. The average age of the patients evaluated in the study was 46.32 ± 18.2 years, 42 (56.8%) of the patients were female and 32 (43.2%) were male. The most common additional complaint of the patients was nausea / vomiting in 44.6% (n: 33). The most common pain localization in patients was diffuse pain in 41 (55.4%) of the patients. The most common physical examination finding in the patients was sensitivity in 77.0% (n: 57). The average duration of the patients staying in the emergency room was 4.81 ± 7.02 hours. When the relationship between the BMI and USG results of the patients was examined, it was found that the incidence of renal abscess was statistically significantly higher in extremely obese patients with a BMI above 40 (p = 0.043). As a result of the genetic analysis of the patients, there was no statistically significant difference in serum fibrinogen values between the groups with and without MEFV gene mutation. Serum CRP levels were found to be statistically significantly lower in the group of patients diagnosed with IBS than patients with other diseases (p =, 012). When the relationship between the clinical pre-diagnosis and diagnosis of the patients and ADBG is examined; It was observed that the incidence of gas was higher in patients diagnosed with IBS compared to patients in the non-specific and other diagnosis groups, and there was a statistically significant difference (p = 0.020). Discussion and Conclussion: In our study, the etiology and frequency of FMF and IBS of the patients who applied to the emergency department with the complaint of abdominal pain were examined. It has been determined that the presence of gas in the ADBG in the diagnosis of IBS should be a warning for the clinician, thus increasing the quality of life and reducing the number of emergency services in patients with IBS with effective guidance and treatment. It was seen that serum CRP, serum Lactate and serum Fibrinogen levels are not relevant in IBS and FMF diagnoses, but can be used for differential diagnoses. It was found that the diagnostic criteria in the diagnosis of FMF in patients with abdominal pain were not sufficient to meet the diagnosis for each patient, therefore genetic analysis should be performed in patients with unexplained abdominal pain. It was seen that studying the MEFV gene mutation would protect patients from unnecessary surgical risk and possible complications, and would be beneficial in terms of regulating effective treatment. Keywords: IBS, FMF, Abdominal pain, MEFV, İmaging, Familial mediterranean fever, İrritable bowel syndrome