Chronic Abdominal Pain in General Practice

Abstract

Background and Summary. Chronic abdominal pain is a challenging complaint for both primary care providers and gastroenterologists alike, due to a broad differential diagnosis and sometimes extensive and negative workup. In the absence of red flag features that herald more acute conditions, the majority of patients with chronic abdominal pain have a benign cause or a functional disorder (e.g. Irritable bowel syndrome). The costs associated with a diagnostic workup are an expensive burden to healthcare. A systematic approach for evaluating patients and initiating a management plan are recommended in the primary care setting. Undiagnosed abdominal pain should be investigated starting with a detailed history and physical examination. Diagnostic investigations should be limited and adapted according to the clinical features, the alarm symptoms, and the symptom severity. This review will focus on the diagnostic tools which general practitioners (GP) utilize in the evaluation of chronic abdominal pain. Key Messages. The primary role of the general practitioner (GP) is to differentiate an organic disease from a functional one, to refer to a specialist, or to provide treatment for the underlying cause of pain. The functional disorders should be considered after the organic pathology has been confidently excluded. Once a diagnosis of functional pain is established, repetitive testing is not recommended and the patient should be referred to receive psychological support (e.g. cognitive therapy) associated with available pharmacological therapeutic options.

Epidemiology, Comorbidities, and Treatment of Cyclic Vomiting Syndrome in the United States

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Quantitative somatosensory testing of the abdomen: establishing initial reference values across developmental age and biological sex

“…9,46 The most recent cross-sectional survey of U.S. adults with upper gastrointestinal complaints was conducted in 1999 and reported a prevalence of 21.8% in the general population, with women being more likely than men to report chronic abdominal pain. 15,42 The prevalence of pediatric functional abdominal pain was last investigated in 2015 and was reported to be about 14% of children in the United States. 23 Table 1 outlines potential diagnoses for the myriad of causes of chronic abdominal pain, classified by organ system.…”

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