Chronic Abdominal Pain: Finding the Right Specialist for Diagnosis

Chronic abdominal pain with no identifiable cause (consultation for diagnostic direction)?

Hello Doctor, I am inquiring on behalf of a 30-year-old female friend.
She has been experiencing abdominal pain for over two months.
Initially, she underwent an upper gastrointestinal endoscopy in the gastroenterology department, which was normal.
Later, she had a urinary tract infection and received treatment for that.
However, she continues to experience abdominal pain (during this time, she has consulted with nephrology and family medicine, but no cause has been identified).
When she is not in pain, she feels a sense of heaviness in her abdomen.
The pain can occur in various locations, either above or below the navel, and typically happens 1-2 hours after eating or when she is hungry.
(According to her, pressing on her abdomen when she is not in pain can elicit tenderness.
When she is in pain, it is described as a sharp, mild pain.) Which specialty should she consult for further evaluation, and what tests would be appropriate? Should she see gastroenterology or hepatobiliary medicine, and would a colonoscopy be advisable? (She is currently planning to visit family medicine for further assessment.)

Xiao V, 30~39 year old female. Ask Date: 2019/12/08

Dr. Chen Shidian reply Gastroenterology and Hepatology

In a major hospital's gastroenterology department, with careful follow-up appointments, adherence to medical orders, and dietary compliance, a reassuring answer should be attainable.

Reply Date: 2019/12/08

More Info

Chronic abdominal pain can be a complex and frustrating issue, especially when it persists for an extended period, as in the case of your friend. Given that she has already undergone several evaluations, including an endoscopy and consultations with urology and family medicine, it is essential to take a systematic approach to identify the underlying cause of her symptoms.

Recommended Steps for Diagnosis
1. Gastroenterology Consultation: Since your friend has already seen a gastroenterologist and had a gastroscopy, it may be beneficial for her to return to this specialist. However, she should specifically request a comprehensive evaluation of her lower gastrointestinal tract, which may include a colonoscopy. This is particularly important if she has not had this procedure yet, as it can help rule out conditions such as inflammatory bowel disease (IBD), polyps, or other structural abnormalities in the colon.

2. Consideration of Functional Disorders: Given that her pain seems to correlate with eating (either shortly after meals or when hungry), it may be worth exploring functional gastrointestinal disorders such as Irritable Bowel Syndrome (IBS). IBS can present with abdominal pain, bloating, and changes in bowel habits, and it often requires a different approach to management compared to structural issues.

3. Evaluation by a Pain Specialist: If the gastroenterological evaluations do not yield a clear diagnosis, consulting a pain management specialist may be beneficial. They can help assess whether her pain might be neuropathic or related to other non-gastrointestinal sources, such as musculoskeletal issues or nerve entrapments.

4. Imaging Studies: If not already performed, imaging studies such as an abdominal ultrasound or a CT scan may provide additional insights into her abdominal organs and help identify any abnormalities that may not have been visible during previous examinations.

5. Psychological Evaluation: Chronic pain can sometimes be exacerbated by psychological factors. If her symptoms persist without a clear physical cause, a referral to a psychologist or psychiatrist specializing in chronic pain may be beneficial. They can help address any anxiety or stress that may be contributing to her pain experience.

Additional Considerations
- Dietary Assessment: It may also be helpful for her to keep a food diary to identify any potential dietary triggers that could be contributing to her symptoms. Certain foods can exacerbate gastrointestinal discomfort, and identifying these can be a crucial step in management.

- Follow-Up on Previous Conditions: Since she has a history of bladder infections, it may be worth revisiting this area to ensure that there are no lingering issues, such as interstitial cystitis, which can sometimes present with abdominal pain.

- Holistic Approach: Encourage her to consider a holistic approach that includes lifestyle modifications, such as stress management techniques, regular physical activity, and a balanced diet, which can all contribute to improved gastrointestinal health.

In summary, your friend should consider returning to a gastroenterologist for further evaluation, including a colonoscopy if not already done, and possibly consult with a pain specialist or psychologist if her symptoms persist without a clear diagnosis. It’s essential to approach chronic abdominal pain from multiple angles to ensure a comprehensive evaluation and effective management.

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