Chronic Abdominal Pain: Possible Causes and Next Steps

Chronic unexplained abdominal pain?

Hello, doctor.
For the past six months, I have frequently experienced abdominal bloating and pain accompanied by cold sweats, nausea, dizziness, and a feeling of wanting to vomit.
The pain is not localized and can be felt from below the ribs to below the navel, often with a sensation of heaviness.
This usually occurs when I am fasting before dinner, but occasionally it persists after a full meal.
The episodes typically last about 1 to 1.5 hours before gradually subsiding, during which I burp continuously (at least 20-30 times).
I have a history of gastroesophageal reflux disease (GERD) for over three years, which has been relatively well-controlled.
Last week, I underwent an upper endoscopy, and the doctor noted mild inflammation in the esophagus but no inflammation in the stomach and no Helicobacter pylori infection.
I was prescribed medication for GERD.
Although the persistent sensation of something stuck in my throat has improved with medication, the frequent abdominal pain persists.

I had a colonoscopy two years ago due to a family history of colorectal cancer on both sides, and at that time, my colon appeared healthy with no issues.
Previously, I would experience pain once or twice a week, but now it has escalated to two or three times a week, with increased frequency in the ten days leading up to my menstrual period.
My diet is generally light, and I only eat out occasionally.
During painful episodes, I often find it difficult to do anything, and it has become quite bothersome.
The doctor I saw last week mentioned the possibility of gallstones, liver issues, or irritable bowel syndrome (my mother has gallstones and hepatitis B).
I would like to ask which direction I should take for further examinations regarding this abdominal pain.
Should I also consider consulting a gynecologist? Thank you, doctor!

Miss Chen, 30~39 year old female. Ask Date: 2023/02/22

Dr. Chen Shidian reply Gastroenterology and Hepatology

Please discuss with a gastroenterologist and implement dietary control along with moderate exercise to reduce stress.
An ultrasound examination may also be considered.

Reply Date: 2023/02/22

More Info

Chronic abdominal pain can be a complex and multifaceted issue, often requiring a thorough investigation to determine its underlying causes. Based on your description, it seems that you have been experiencing significant discomfort, including symptoms such as abdominal bloating, nausea, dizziness, and a sensation of heaviness in the abdomen. These symptoms, particularly when they occur in conjunction with your history of gastroesophageal reflux disease (GERD), warrant a careful evaluation.

Possible Causes of Your Symptoms
1. Gastroesophageal Reflux Disease (GERD): Given your history, GERD could be contributing to your symptoms. The inflammation in the esophagus can lead to discomfort that may radiate to the abdomen. The bloating and belching you experience could be a result of swallowed air or gas buildup in the digestive tract.

2. Irritable Bowel Syndrome (IBS): Your symptoms, including the fluctuating nature of the pain and the bloating, could suggest IBS, a common functional gastrointestinal disorder. IBS can cause abdominal pain associated with changes in bowel habits and is often triggered by stress, diet, or hormonal changes.

3. Gallbladder Issues: The mention of potential gallstones is significant, especially since you have a family history of gallbladder issues. Gallstones can cause episodic pain, particularly after meals, and may lead to complications if not addressed.

4. Hepatic Concerns: Given your family history of hepatitis B, liver-related issues should also be considered. Liver dysfunction can manifest as abdominal pain, especially in the upper right quadrant.

5. Gynecological Factors: Since you noted that your symptoms intensify around your menstrual cycle, it may be worth exploring gynecological causes such as endometriosis or ovarian cysts, which can cause referred pain to the abdomen.

Next Steps for Evaluation
1. Further Imaging Studies: Since gallstones and liver issues are concerns, an abdominal ultrasound or a CT scan could provide valuable information about the gallbladder, liver, and other abdominal organs. This can help identify any stones or abnormalities that may be causing your symptoms.

2. Gastroenterology Follow-Up: Since you have already seen a gastroenterologist, it may be beneficial to return for a follow-up, especially if your symptoms have worsened. Discuss the possibility of further testing, such as a hydrogen breath test for small intestinal bacterial overgrowth (SIBO) or a more detailed evaluation for IBS.

3. Consideration of Gynecological Evaluation: Given the cyclical nature of your symptoms, consulting with a gynecologist may be prudent. They can perform an examination and possibly imaging studies like a pelvic ultrasound to rule out any gynecological issues.

4. Dietary and Lifestyle Modifications: Keeping a food diary to track your diet and symptoms may help identify any food triggers. Additionally, managing stress through relaxation techniques or therapy could also alleviate some of your symptoms, particularly if IBS is a contributing factor.

5. Medication Review: Since you are already on medication for GERD, it may be worth discussing with your doctor whether adjustments are needed or if additional medications could help manage your symptoms more effectively.

Conclusion
Chronic abdominal pain can stem from various sources, and it is essential to approach this issue holistically. Given your symptoms and history, a multidisciplinary approach involving gastroenterology, gynecology, and possibly dietary counseling may yield the best results. It is crucial to communicate openly with your healthcare providers about the persistence and severity of your symptoms to ensure a comprehensive evaluation and appropriate management plan.

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