Acute Upper Abdominal Pain from Cold Medicine: Causes and Solutions

Acute upper abdominal cramping caused by cold medication?

Hello Dr.
Chen, last week I neglected to space out my cold medication between dinner and bedtime by 4-6 hours.
I was feeling very unwell, so I only waited an hour before taking the bedtime medication and went to sleep.
As a result, I was awakened in the middle of the night by severe upper abdominal cramping.
Taking the antacid prescribed by the clinic did not improve my condition, and the upper abdominal pain persisted.
This week, I hurried to the hospital for a consultation, and the doctor prescribed me two weeks' worth of "Bai Yi Zi" (a medication for gastric issues) and "Xitong Jiayin" (acetaminophen).
I was informed that if I do not improve after two weeks, I should return for an appointment to schedule an endoscopy.
I would like to ask, for a patient with symptoms like mine, is it likely that taking the medication for two weeks will lead to recovery? Will my stomach suffer any permanent damage because of this? Should I urgently get an endoscopy? Thank you, Dr.
Chen.

Ian, 20~29 year old female. Ask Date: 2023/04/26

Dr. Chen Shidian reply Gastroenterology and Hepatology

The need for an urgent gastroscopy depends on the visible medication response; it is not always necessary.
However, if black or tarry stools are observed, indicating gastrointestinal bleeding, then an emergency visit is required.

Reply Date: 2023/04/26

More Info

Acute upper abdominal pain can be a distressing experience, especially when it arises unexpectedly after taking medication, such as cold medicine. In your case, it seems that the pain began after a misstep in the timing of your medication, which can lead to various gastrointestinal issues. Let's explore the potential causes of your symptoms, the implications of your medication use, and the recommended steps for management.

Causes of Acute Upper Abdominal Pain
1. Gastric Irritation: Cold medications often contain ingredients that can irritate the stomach lining, especially if taken on an empty stomach or in close succession without adequate time in between doses. This irritation can lead to gastritis, which is characterized by inflammation of the stomach lining and can cause pain, nausea, and discomfort.

2. Acid Reflux: Taking medications without proper intervals can exacerbate acid reflux or gastroesophageal reflux disease (GERD). This condition occurs when stomach acid flows back into the esophagus, leading to symptoms such as heartburn and upper abdominal pain.

3. Peptic Ulcers: If there is a history of using non-steroidal anti-inflammatory drugs (NSAIDs) or certain cold medications that can irritate the stomach, there is a risk of developing peptic ulcers. These are sores that develop on the lining of the stomach or the first part of the small intestine and can cause significant pain.

4. Medication Side Effects: Some cold medications can have side effects that include gastrointestinal discomfort. If you took multiple medications in a short period, the cumulative effect could lead to increased stomach irritation.

Management and Treatment
1. Medication Review: It is crucial to follow the prescribed dosage and timing of medications. If you are experiencing persistent pain despite taking the medications prescribed by your doctor, it is essential to communicate this with your healthcare provider. They may need to reassess your treatment plan.

2. Gastroprotective Agents: The medications you were prescribed, such as "百抑漬" (likely a proton pump inhibitor or similar), are designed to reduce stomach acid and protect the stomach lining. Taking these as directed for the full two weeks is important, as they may help heal any irritation or inflammation.

3. Dietary Modifications: During this period, it may be beneficial to avoid spicy, acidic, or irritating foods that could exacerbate your symptoms. Eating smaller, more frequent meals can also help reduce the burden on your stomach.

4. Monitoring Symptoms: Keep a close eye on your symptoms. If the pain worsens, or if you experience additional symptoms such as vomiting, significant weight loss, or blood in your stool, you should seek medical attention promptly.

5. Endoscopy Consideration: If your symptoms do not improve after two weeks of medication, your doctor may recommend an upper gastrointestinal endoscopy (gastroscopy). This procedure allows for direct visualization of the esophagus, stomach, and duodenum, helping to identify any underlying issues such as ulcers or severe gastritis.

Long-term Considerations
Regarding your concern about potential permanent damage to your stomach, it is essential to understand that while acute irritation can lead to discomfort, most cases of gastritis or mild irritation can heal with appropriate treatment. However, chronic issues, such as untreated ulcers or ongoing acid reflux, can lead to more significant complications if not addressed.

In conclusion, while it is possible that your symptoms may resolve with the prescribed treatment, it is crucial to remain vigilant and proactive in your healthcare. If there is no improvement, further investigation through endoscopy may be warranted to ensure that any underlying conditions are identified and treated appropriately. Always communicate openly with your healthcare provider about your symptoms and concerns to receive the best care possible.

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