Acute Abdominal Pain

This research aims to improve how appendicitis, a common emergency surgery condition, is managed worldwide by studying different emergency care systems. Appendicitis requires quick diagnosis and treatment to avoid complications. Using appendicitis as a marker, the study looks at access, quality, and efficiency across hospitals in various countries, including low- and middle-income regions, to find ways to enhance emergency surgical care. The study collects data from about 500 hospitals globally between February and May 2025, focusing on patients undergoing appendicectomy using any surgical method, including open, laparoscopic, or robotic approaches. Hospitals will record information for consecutive patients over 14-day periods. The study includes two sub-studies: one on sustainability and waste management in operating rooms and another on the financial impact of surgery on patients, especially in resource-limited settings. Participants will have their care observed through routine health records without extra follow-up visits. Researchers will measure key factors such as time from symptoms to surgical assessment, rates of minimally invasive surgery, complications within 30 days, and hospital stay length. This data will help identify gaps and guide improvements in emergency surgical care worldwide, aiming to make treatment safer, faster, and more affordable.

Adhesion-related small bowel obstruction (ASBO) is a common digestive emergency that can be treated either conservatively or with surgery. This condition carries a risk of death, especially if surgery is delayed. Researchers are evaluating a procalcitonin-based algorithm to improve decision-making between these treatment options, aiming to enhance patient management and outcomes. The study compares two approaches: one uses clinical examination combined with procalcitonin blood tests to guide treatment decisions, while the other relies on clinical examination alone without procalcitonin testing. Patients in both groups initially receive conservative care including nasogastric tubes and intravenous fluids, with surgery considered after 48 hours if bowel function does not return. The algorithm arm uses specific procalcitonin thresholds to identify patients needing surgery sooner. Participants will be monitored for up to 90 days to see how many achieve a textbook outcome, which reflects quality care. Additional assessments include patient satisfaction questionnaires, complication scores, and length of hospital stay up to 12 months after surgery. The study involves clinical exams, blood tests, and follow-ups to evaluate the impact of the algorithm on treatment timing and patient recovery.

Trauma is a leading cause of death in children in the US, with abdominal trauma accounting for 30% of pediatric traumatic deaths, second only to brain injury. This research evaluates the use of the Focused Assessment with Sonography for Trauma (FAST) examination, a bedside abdominal ultrasound, to determine if it can safely reduce abdominal CT scans in hemodynamically stable children with blunt abdominal trauma. The study aims to improve care quality and reduce morbidity and mortality by identifying appropriate evaluation strategies for injured children. The trial is a multicenter, randomized, controlled study involving 3,194 children under 18 years presenting within 24 hours of blunt abdominal trauma. Participants are assigned to either the FAST examination arm, where a bedside ultrasound is performed to detect blood in the abdomen, or to the standard care arm without FAST. The FAST exam is quick, radiation-free, and performed by emergency or trauma physicians. The study compares CT scan rates and tracks delayed or missed diagnoses of intra-abdominal injuries over up to 30 days. Throughout the emergency department stay and initial hospitalization (up to 24 hours), participants undergo assessments including FAST or standard evaluation, CT scan monitoring, and tracking of injuries for up to 30 days if hospitalized. Outcomes measured include CT scan frequency, missed injuries, emergency department length of stay, hospitalization rates, physician suspicion of injury, and surgery rates. The study also examines factors influencing CT use in low-risk patients after a negative FAST exam, aiming to optimize diagnostic care in pediatric trauma.

Researchers are evaluating the impact of regular use of a consumer-grade FODMAP-targeting digestive enzyme blend called FODZYME® on gastrointestinal symptoms in adults who experience self-reported bloating. The study focuses on how this enzyme blend affects symptoms such as bloating and abdominal pain, which are often triggered by fermentable carbohydrates known as FODMAPs. This is a randomized, double-blind, placebo-controlled crossover trial that aims to provide a more flexible alternative to the restrictive Low FODMAP Diet by breaking down FODMAPs before they ferment in the colon. Participants will take the enzyme blend or a placebo with each meal, snack, or substantial beverage, applying it directly to their food. The trial is divided into two main periods: half the participants will start with the enzyme blend for four weeks followed by a two-week washout and then switch to placebo for another four weeks; the other half start with placebo and then switch to the enzyme blend after the washout. The study product is designed to target specific FODMAPs like fructan, GOS, and lactose and is intended for adults with or without IBS symptoms. During the study, participants will complete daily questionnaires and assessments over about 19 weeks, including patient-reported outcome measures for bloating, gastrointestinal symptoms, abdominal pain, food-related quality of life, and anxiety. The study is conducted remotely, allowing participants to complete assessments at home using a smartphone app. Safety is monitored by excluding those with known allergies to corn or previous reactions to digestive enzyme supplements, and researchers will review changes in bloating symptoms as the primary outcome.

Researchers are studying gut and digestive health by evaluating changes before and after using a dietary supplement system for eight weeks. This study focuses on adults aged 18 to 80 years who have self-reported gastrointestinal symptoms. The goal is to understand how the supplement affects gut microbiota, inflammation, immune activity, and digestive function, which are important for overall health and well-being. Participants will take a dietary supplement system consisting of two products, PhytoPower 1 and PhytoPower 2, daily for eight weeks. They will mix one stick pack of each product into 16 fluid ounces of water and drink it each morning, with or without food. The study is open-label and single-arm, meaning all participants receive the supplement while maintaining their usual diet and lifestyle. During the study, participants will provide stool samples at the beginning and end to measure various biomarkers related to gut microbial diversity, inflammation, immune activity, digestion, and intestinal barrier integrity. They will also complete questionnaires about gastrointestinal symptoms and digestive well-being at several points throughout the study. Safety and tolerability will be monitored by tracking adverse events and compliance, with the total participation lasting eight weeks.

Researchers are investigating the factors that influence whether adolescents seek immediate medical care when experiencing symptoms of testicular torsion. This observational study focuses on adolescents aged 10 to 17 who underwent surgery for testicular torsion between 2020 and 2025. The main goal is to understand what causes delays of six hours or more between symptom onset and first medical visit. Participants are grouped based on their timing of medical consultation: those who attended within less than six hours of symptom onset and those who attended six hours or more after onset. The study involves completing a questionnaire designed to assess factors linked to delayed medical care for testicular torsion. During the study, participants will complete the "Questionnaire for Assessing Factors Associated with Delay in Seeking Medical Care for Testicular Torsion in Adolescents." Researchers will evaluate barriers to healthcare access, prior knowledge of testicular torsion, perception of symptom severity, and the role of parents or guardians in seeking care. The study aims to identify factors associated with delayed consultation to improve timely medical attention for adolescents with this condition.

The trial investigates the clinical and cost-effectiveness of using povidone-iodine (PVI) irrigation during surgery for patients with perforated appendicitis. It aims to understand barriers and facilitators for implementing PVI irrigation and to collect cost and patient-reported outcomes for those with non-perforated appendicitis. This is a phase 4 randomized study sponsored by The University of Texas Health Science Center, Houston. Participants undergoing appendectomy for perforated appendicitis will be randomly assigned to receive either PVI irrigation or usual care. In the PVI group, after appendix removal and controlling bleeding, 10 mL/kg of 1% PVI (up to 1,000 mL) is used to irrigate the pelvis and abdominal quadrants, left to dwell for 1 minute, then suctioned out. The usual care group may receive local or large volume saline irrigation as per the surgeon's practice but will not receive PVI irrigation. Participants will be followed to assess cost-effectiveness at 30 days, including hospital costs, length of stay, complications, and patient-reported costs and quality of life up to 12 months. Additional outcomes include days of work missed and postoperative complications. The study includes single-blind monitoring and tracks health-related quality of life with the EQ-5D-5L questionnaire.

Researchers are evaluating the use of artificial intelligence-driven virtual standardized patients (VSPs) to improve the ability of primary care doctors in China to manage common pediatric diseases. The study addresses challenges in China's pediatric healthcare system, including limited capacity in primary care and a lack of effective training tools. It involves a randomized controlled trial with over 459 doctors from various specialties across more than 10 provinces, aiming to enhance pediatric care through innovative training methods. The trial involves three groups: one using a virtual patient platform where doctors interact with AI-driven simulated patients covering diseases like pneumococcal pneumonia, rotavirus enteritis with hypovolemic shock, hand-foot-and-mouth disease, acute appendicitis, and respiratory failure; another group uses case teaching manuals, and the third group uses case teaching videos. Participants engage in a two-week learning period with their assigned training method. During the study, doctors' management skills will be assessed through clinical vignettes to measure adherence to best clinical practice guidelines. Researchers will monitor diagnosis accuracy, examination scores relevant to disease handling, and doctors' focus on patient needs. The study runs for about six months and includes over 300 primary healthcare institutions to ensure wide representation. The trial also evaluates the acceptance and costs of the training methods used.

This research aims to evaluate the current standard care for general surgical patients undergoing emergency laparotomy, focusing on factors that affect clinical outcomes and the quality of life in the year following abdominal surgery. It seeks to understand what factors are linked to adverse post-operative events, whether care differs based on sex or age, and how quality of life changes over time. The study also plans to compare outcomes before and after introducing standardized care protocols for these patients. The study observes two groups: one receiving the traditional care routine without standardized protocols and another treated under a newly introduced standardized laparotomy care protocol. No experimental treatments are given as part of the study; rather, the study compares outcomes between these two existing care approaches. This approach allows the assessment of improvements in patient survival and equality in care provision. Participants will be monitored for outcomes including in-hospital mortality within 30 days, serious complications during the hospital stay within 30 days, long-term mortality over one year, and responses to quality of life questionnaires during the year after surgery. Data collection and evaluation will help assess the effectiveness and equality of care over time. The overall participation duration spans one year after the surgery procedure.

This research investigates the impact of polyethylene glycol (PEG) bowel preparation on the gut microbiota in people who have had an appendectomy compared to those who have not. It explores how PEG, commonly used before colonoscopy, may affect intestinal microbes and how the appendix plays a role in protecting and restoring the gut microbiome. The study focuses on the differences in microbial changes and recovery between appendectomy patients and healthy controls over time. Participants will undergo colonoscopy with PEG laxatives used for bowel preparation following standard clinical procedures. Two groups are studied: one with a history of appendectomy or right hemicolectomy including appendectomy, and a control group without such history. Fecal samples will be collected at five time points: before colonoscopy, at the first non-watery stool after colonoscopy, and at one, three, and six months post-colonoscopy for detailed microbial analysis. During the study, participants will provide stool samples and complete questionnaires about their intestinal and general health. Researchers will analyze changes in gut microbes, diversity, and metabolic functions over six months after colonoscopy. Participant identities will be kept confidential, and they can withdraw at any time. The study will share progress updates and individual results with participants throughout the trial.