Persistent Upper Abdominal Pain: Next Steps for Diagnosis and Management - Gastroenterology and Hepatology

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Persistent upper abdominal pain can be a complex issue, especially in the context of a history of Crohn's disease and ongoing treatment with biologic agents. Given your symptoms and medical history, it is essential to approach this situation systematically to identify the underlying cause of your discomfort.


Understanding Your Symptoms
1. Nature of the Pain: You mentioned that the pain is persistent and does not change with palpation, which can sometimes indicate a non-specific or visceral pain rather than a localized issue. The fact that pain persists despite the use of analgesics (like Utraphen) suggests that it may not be solely related to inflammation or irritation that typical pain medications would alleviate.

2. Impact on Appetite: The pain affecting your appetite is significant. In gastrointestinal conditions, pain that leads to reduced food intake can exacerbate nutritional deficiencies, especially in patients with Crohn's disease, where malabsorption is already a concern.

3. Previous Investigations: You have undergone both upper endoscopy (gastroscopy) and colonoscopy, which did not reveal any new issues apart from the known ulcers associated with Crohn's disease. This is a good starting point, but it also indicates that we need to consider other potential causes of your symptoms.


Next Steps for Diagnosis and Management
1. Consultation with a Gastroenterologist: Given your history of Crohn's disease and the current symptoms, it would be prudent to follow up with your gastroenterologist. They can provide a comprehensive evaluation of your condition, considering both the Crohn's disease and the new symptoms.

2. Imaging Studies: Since your previous endoscopic evaluations did not reveal new issues, imaging studies may be warranted. A CT scan of the abdomen can help visualize the intestines and surrounding structures, potentially identifying complications such as strictures, abscesses, or other abnormalities that might not be visible through endoscopy.

3. Consider Functional Disorders: Sometimes, patients with inflammatory bowel disease can develop functional gastrointestinal disorders, such as irritable bowel syndrome (IBS), which can cause persistent abdominal discomfort. Discussing this possibility with your doctor may lead to additional management strategies.

4. Nutritional Assessment: Since your appetite is affected, it may be beneficial to consult with a dietitian who specializes in gastrointestinal disorders. They can help ensure you are meeting your nutritional needs, especially if you are experiencing weight loss or other complications related to your Crohn's disease.

5. Review of Medications: Since you are on biologic therapy, it is essential to review your medications with your healthcare provider. Some medications can have gastrointestinal side effects that may contribute to abdominal pain. Your doctor may consider adjusting your treatment regimen if necessary.

6. Monitoring Symptoms: Keep a detailed diary of your symptoms, including the timing, intensity, and any associated factors (like food intake or stress). This information can be invaluable for your healthcare provider in determining the next steps.


Conclusion
Persistent upper abdominal pain in the context of Crohn's disease requires a thorough evaluation to rule out complications and other potential causes. Engaging with your healthcare team, particularly your gastroenterologist, and considering imaging studies and nutritional support will be critical in managing your symptoms effectively. Remember, timely intervention can help prevent complications and improve your quality of life.