Chronic abdominal pain does not impose the urgency that acute abdominal pain does. However, the challenge for the physician is to differentiate organic pain resulting from a specific pathologic process from functional from a specific pain.
The location and characteristics of already discussed, serve as important guides, as do other accompanying symptoms. The presence of postprandial nausea and vomiting suggests chronic peptic ulcer, disorders of gastric emptying, or outlet obstruction. The documentation of weight loss dictates the search for cancer must be ruled out, particularly in elderly patients.
If no cancer can be found and if all objective tests are normal, the possibility of a chronic depressive state must entertained. The most frequent causes of chronic abdominal pain are. functional. The distinction between dyspepsia and irritable bowel syndrome is sometimes unclear. However, dyspepsia is characterized by chronic intermittent epigastric discomfort with or without heartburn and with or without nausea. Irritable bowel syndrome is a very common disorder. It is estimated that 15% of Americans suffer from it on a regular basis and that 40 to 50% of referrals to gastroenterologists are related to irritable bowel. The syndrome manifests itself by abdominal distention, flatulence and disordered bowel function. The abdominal pain of irritable bowel syndrome tends to be in the left lower quadrant but can be and elsewhere or be more generalized. Weight loss other serious symptoms are usually absent. In spite of a tendency for constipation or diarrhea, rectal bleeding is not reported. A limited work-up to rule out colonic obstruction and, in some cases, inflammatory bowel disease is generally sufficient. Patients are reassured counseled and treated with agents and bowel softeners. The more challenging clinical problem is the one of benign chronic abdominal pain syndrome. This term describes a condition in which the pain has been present for months or years. The patient is likely to be a woman who has undergone numerous examinations and diagnostic studies with negative findings and, in many cases, surgical operations without any relief.
Lengthy or repeated diagnostic work-ups are counterproductive and only convince the patient that one more test is what is needed to determine the source of the pain. The physician must establish that organic disease is not present. The physician must also realize that the pain is real: that the patients are not malingerers in spite of the fact that the pain does not fit any familiar pattern.
Depression may be the result rather than the cause of the pain.