Diagnoses after newly recorded abdominal pain in primary care: observational cohort study

Abstract

Background: Non-acute abdominal pain in primary care is diagnostically challenging. Aim: To quantify the 1-year cumulative incidence of 35 non-malignant diagnoses and 9 cancers in adults after newly-recorded abdominal pain in primary care. Design and setting: Observational cohort study of Clinical Practice Research Datalink records. Methods: Participants (n, %male) aged 40-59 (n=59,864, 50.0%), 60-69 (n=29,461, 49.2%) and ≥70 (n=36,468, 36.9%) had newly-recorded abdominal pain during 01/01/2009-31/12/2013. Age- and sex-stratified 1-year cumulative incidence (95% confidence interval) by diagnosis is reported. Results: Most (>70%) participants had no pre-specified diagnoses after newly-recorded abdominal pain. Non-malignant diagnoses were most common: upper gastrointestinal problems (gastro-oesophageal reflux disease, hiatus hernia, gastritis, oesophagitis, and gastric/duodenal ulcer) in men and urinary tract infection in women. The incidence of upper-gastrointestinal problems plateaued at ≥60 years [40-59: men 4.9% (4.6%–5.1%), women 4.0% (3.8%–4.2%); 60-69: men 5.8% (5.4%–6.2%), women 5.4% (5.1%–5.8%)]. Urinary tract infection incidence increased with age [40-59: women 5.1% (4.8%–5.3%), men 1.1% (1.0%–1.2%); ≥70: women 8.0% (7.6%–8.4%), men 3.3% (3.0%–3.6%)]. Diverticular disease incidence rose with age, plateauing at 4.2% (3.9%–4.6%) in men ≥60, increasing to 6.1% (5.8%–6.4%) in women ≥70. Irritable bowel syndrome incidence was higher in women (40-59: 3.0%, 2.8%–3.2%) than men (40-59: 2.1%, 2.0%–2.3%), decreasing with age to 1.3% (1.2%–1.5%) and 0.6% (0.5%–0.8%) at ≥70. Conclusion: We rank the incidence of diagnoses after newly-recorded abdominal pain by sex and age. While abdominal pain commonly remains unexplained, non-malignant diagnosis are more likely than cancer.

Acute abdominal pain

“…As clinicians, we should always accept that a patient is feeling pain, regardless of a lack of pathophysiological findings (Steeds, 2016). This is particularly important in general practice, where no cause is identified for approximately a third of all patients complaining of abdominal pain, and they are labelled as having 'functional' or non-specific abdominal pain (Price et al., 2022).…”

Iatrogenic Chronic Abdominal Pain in a Geriatric Patient: A Case Report

“…The aetiologies of chronic abdominal pain can be categorised as abdominal wall pain (e.g., postherpetic neuralgia, intercostal neuralgia), abdominal pain of visceral origin (e.g., peptic ulcer disease, renal cancer), abdominal pain syndromes of generalised diseases (e.g., abdominal migraine), functional gastrointestinal disorders (e.g., functional dyspepsia, irritable bowel syndrome) (Sabo et al, 2021). Unexplained or non-specific diagnoses are common among patients with abdominal pain (Viniol et al, 2014;Price et al, 2022). This article presents a geriatric patient who had suffered from chronic abdominal pain for more than 10 years and was referred to a geriatric clinic.…”