Evening Abdominal Pain: Causes and Diagnostic Steps - Gastroenterology and Hepatology

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Understanding evening abdominal pain can be quite complex, especially when the symptoms are intermittent and only occur at specific times, such as in the evening. Based on your description, it seems that you have been experiencing discomfort primarily in the upper abdomen, which may be related to various gastrointestinal issues.
The fact that your pain occurs predominantly in the evening and is relieved by taking a specific medication suggests that it could be related to your eating habits or digestive processes. Since you mentioned that the pain sometimes feels like it originates from the stomach and at other times from just below the stomach, this could indicate a few potential causes.

1. Gastritis or Peptic Ulcer Disease: These conditions can cause pain that worsens with certain foods, especially spicy or fatty meals. The timing of your pain could be related to your eating patterns throughout the day.

2. Gallbladder Issues: Although your ultrasound did not show gallstones, gallbladder dysfunction (such as biliary dyskinesia) can still cause pain, particularly after eating fatty meals. The fact that you were advised to avoid heavy meals aligns with this possibility.

3. Functional Dyspepsia: This is a common condition characterized by chronic or recurrent pain in the upper abdomen without any identifiable cause. It can be exacerbated by stress, certain foods, or eating habits.

4. Irritable Bowel Syndrome (IBS): This condition can cause abdominal pain that is often relieved by bowel movements. It can also be influenced by diet and stress.

5. Esophageal Reflux or GERD: If the pain is related to your esophagus, it may be aggravated by lying down after eating, which can happen at night.

Given that your symptoms do not occur during the day, it may be beneficial to keep a detailed food diary to track what you eat and when the pain occurs. This can help identify any specific triggers related to your diet.


Diagnostic Steps
1. Endoscopy: If gastritis or peptic ulcer disease is suspected, an upper endoscopy (EGD) may be warranted to directly visualize the stomach lining and esophagus.

2. 24-Hour pH Monitoring: If GERD is suspected, this test can help determine if acid reflux is contributing to your symptoms.

3. Further Imaging: If gallbladder issues are still a concern, a HIDA scan can assess gallbladder function more accurately than an ultrasound.

4. Gastric Emptying Study: If functional dyspepsia is suspected, this test can evaluate how quickly food leaves your stomach.

5. Stress and Lifestyle Assessment: Since you mentioned that the pain occurs in the evening, consider evaluating your stress levels and daily routines, as stress can significantly impact gastrointestinal health.


Conclusion
It is essential to communicate your symptoms clearly to your healthcare provider, especially regarding the timing and nature of the pain. Since your symptoms are not present during the day, you might consider asking your doctor about a referral to a specialist who can conduct tests during evening hours or suggest a home monitoring approach. Keeping a symptom diary that includes your food intake, pain episodes, and any other relevant factors can also provide valuable information for your healthcare team.
In summary, while evening abdominal pain can stem from various causes, a thorough evaluation, including dietary habits and potential diagnostic tests, will be crucial in identifying the underlying issue and guiding appropriate treatment.