What's Causing my Abdominal Pain?

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I see many patients referred to me after an emergency room (ER) visit for abdominal pain.

ER medical professionals are generally very thorough in evaluating these patients.  These doctors see more patients with acute abdominal pain than gastroenterologists do, since patients with severe stomach pain often proceed to the ER as they are ill and understandably seek urgent attention.  In contrast, gastroenterology specialists see more chronic abdominal pain than do other medical specialists.  Many of these patients have had stomach distress for years and we gastroenterologists do our best to help them manage with their condition.

Many patients who are evaluated in the ER for abdominal pain are sent home and advised to follow up with a gastroenterologist to continue the evaluation.  Many of these patients leave the ER without a diagnosis despite an extensive evaluation including sequential physical examinations, imaging studies and labs.  Sometimes, a surgeon or another specialist has been brought in to consult.  Of course, it is frustrating for these patients and their families when all the studies are negative.  Understandably, these folks want to know what is causing the pain.

At times, there have been multiple ER visits which often means that labs and CAT scans have been repeated.

Why does my stomach hurt?

When I see such a patient, he or she often believes that I will crack the case. After all, I am a digestive specialist.  Now, there are times that I have a new angle on a case, or I pursue a new line of questioning that can lead to some clarity.  For example, if I discover that the patient had taken his buddy’s antibiotics, which was not disclosed to the ER personnel, and then went on to develop stomach distress, this may be a highly significant finding.  I do my best to give every patient a fair hearing and to resist the assumption that the symptoms will remain unexplained. 

But I do point out to these patients the limitations I face.  I explain that if a several hour ER visit, with all of the ER’s technical and human assets could not make a diagnosis, that an office visit a week or two later with a gastroenterologist might not be able to decode the enigma.  Yes, I will still do my best to help, but having realistic expectations is highly advised.  And, even if we cannot precisely identify the origin of the pain, often we can still help.