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Question 1: Should steroids be used to treat abdominal pain caused by Henoch–Schonlein purpura?
  1. Pamela Bowman,
  2. Michael Quinn
  1. Department of Paediatrics, Royal Devon and Exeter Hospital, Exeter, UK
  1. Correspondence to Dr Pamela Bowman, Department of Paediatrics, Royal Devon and Exeter Hospital, Barrack Road, Exeter EX2 5DW, UK; pamelabowman{at}nhs.net

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Scenario

An 8-year-old girl with known Henoch–Schonlein purpura (HSP) and a raised urinary albumin:creatinine ratio (which was improving) complained of ongoing abdominal pain. The pain prompted hospital admission. It was intermittent, colicky, not associated with vomiting, and did not resolve with simple analgesia. An abdominal ultrasound scan showed no intussusception. The clinical team considered whether it was appropriate to prescribe a course of oral steroids to improve the patient's symptoms.

Structured clinical question

Do children with abdominal pain and HSP [population] treated with steroids [intervention] compared to children not treated with steroids [comparison] show a more rapid resolution of their symptoms [outcome]?

Search strategy and outcome

The search used a combination of (‘Steroids’ OR ‘corticosteroids’ OR ‘prednisolone’ OR ‘hydrocortisone’) AND (‘abdominal pain’) AND (‘HSP’) as suited each database. The Cochrane database yielded one hit, which was relevant; Medline yielded 308 hits, of which four were relevant; and Embase yielded 67 hits, of which three were relevant.

Commentary

Previous retrospective studies specifically examining this question suggested that abdominal pain in HSP is self-limiting and …

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