I see patients with abdominal pain every day. Over my career, I’ve sat across the desk
facing thousands of folks with every variety of stomach ache imaginable. I’ve listened to them, palpated them,
scanned them, scoped them and at times referred them elsewhere for another
opinion. With this level of experience,
one would suspect that I have become a virtual sleuth at determining the
obvious and stealth causes of abdominal distress.
I wish it were the case.
Some Cases Defy Sleuthing
The majority of cases of chronic abdominal pain that I – and
every gastroenterologist – see will not be explained by a concrete
diagnosis. Sure, I’ve seen my share of
sick gall bladders, stomach ulcers, diverticulitis, bowel obstructions,
appendicitis and abdominal infections, but these represent a minority of my
afflicted patients.
Patients with acute abdominal pain are more likely to
receive a specific diagnosis, such as those listed above. However, patients who have abdominal distress
for years, which constitute most of my stomach pain patients, usually will not
have a specific, explanatory diagnosis even though these patients often feel
otherwise.
Many of these patients come to the office advising me that “their
diverticulitis is acting up” or that “their ulcer is back again”. Usually, this is not the case and they may
never have had diverticulitis or an ulcer in the first place.
Physicians often assign these patients a diagnosis of
irritable bowel disease or functional bowel disease, which is a rather
amorphous entity that cannot be detected on available diagnostic testing. The labs and scans and scopes are all normal
in these folks. I believe that the
condition is real, but it is a frustrating condition that is difficult to
define. It often coexists with other
chronic painful conditions, such as fibromyalgia, chronic pelvic pain and
migraine headaches.
This is tough for patients and a medical profession that
strive to label every symptom numerically and quantitatively. The body does not work this way.
Of course, I may be missing true diagnoses in some of my
chronic pain patients. Medical science
isn’t perfect and neither am I. How many celiac disease patients have I
overlooked? Should I test every
individual who has a cramp now and then for celiac disease so I don’t miss a
single case? If every physician adopted
this approach for celiac disease – and a hundred other conditions – we would
elevate our current practice of overdiagnosis and overtreatment beyond the
stratosphere.
Irritable bowel disease is pleasantly practical. It saves you from the endless physician paper chase.
ReplyDeleteIf you live long enough you might have multiple belly problems but will tests help you or save the doctor from blame.
I found that minor variations from 'Normal' kept me coming back to the doctor at his behest . But no visible benefit to me.
By the way I will be 80 years old come April.
thank you sir .I am very impressed. Very organized and professional article
ReplyDeleteAfter being diagnosed with Celiac Disease in '92 after years of chasing that pain - I am just discovering from reading a paper on sugar substitutes the damage and abdominal pain that they can do.
ReplyDeleteHow many doctors suggest to their patients that they remove sucralose from their diet? Canned pop - especially diet pop? Or even reading the labels on anything?
I know - lead the horse to water - but you can't make it drink it!
Unfortunately - it was a doctor who told me 6 years ago that Splenda was a healthy choice if I was going to go sugar-free. I wish now I had had the foresight to do some research. I've experienced memory loss - fibromyalgia - abdominal pain - and so much more in these last 6 years.
And with Monsanto spraying sugar beets with Roundup - honey, stevia etc. become the few options left.
Worth looking in to though.