Restless abdomen meets all other diagnostic criteria for RLS except for the affected anatomy.6,8 In most cases of restless abdomen, the uncomfortable sensation involves the abdomen, as well as other parts of the body (eg, legs and arms). Cases in which the symptoms are confined to the abdomen are rare, with only 7 reported to date. 6,8-10 All of these cases have involved patients older than 40 years. 6,8-10
Treatment is straightforward, but consider iron supplementation, as well
Because RLS or its variants degrade the quality of life and sleep in patients,3,4 appropriate therapy must be initiated early. Although the optimal treatment strategy for restless abdomen is yet to be established, an oral dopamine agonist—specifically, pramipexole—has been used successfully in almost all cases.6,8-10
Previous clinical research has shown that patients with RLS have low levels of iron in the brain and may benefit from iron supplementation, even if they are not anemic.3,4 Iron replacement is suggested for patients with RLS whose fasting serum ferritin level is ≤ 75 µg/L.4 It is not known to what extent iron deficiency is involved in the pathophysiology of restless abdomen, and further research is required to determine the optimal therapy for it.
Our patient was started on oral supplementation with sodium ferrous citrate (50 mg/d) based on an initial suspicion that iron deficiency was the cause of her restless abdomen. We also suggested that the patient undergo a fecal occult blood test or colonoscopy, but she declined because of her advanced age.
After 2 months of iron supplementation, the patient’s serum ferritin levels improved (100 µg/L) and her insomnia and abdominal discomfort improved a bit. However, 3 months after starting on the iron supplementation, her symptoms flared again.
Continue to: We then prescribed...