Upper abdominal discomfort is sometimes referred to by patients as “gastric pain”. The medical term is dyspepsia, which means pain or discomfort centered in the upper abdomen.
It depends on whether there are “alarm symptoms”. Severity is important. Dyspepsia is not generally excruciating. Severe abdominal pain is an alarm symptom, could be caused by very acute, sometimes emergency conditions such as inflammation of the gall bladder (acute cholecystitis), inflammation of the pancreas (pancreatitis) or perforation of the stomach or small intestine due to a very deep ulcer. Other alarm symptoms include persistent vomiting, loss of appetite or weight, vomiting blood or passing blood with stool or anaemia (low haemoglobin). Such symptoms might be due to cancer, so it is important to have these symptoms checked out.What causes gastric pain / abdominal pain?
Upper abdominal discomfort is only sometimes associated with structural diseases. Half of the time, it is due to the way the digestive tract functions or behaves in response to food or other stimuli (functional problems). In the other half of cases, it could be due to ulcers in the stomach or first part of the small intestine (duodenum), gallstone disease, oesophageal disease or more rarely, a cancer.
Should I see a specialist or a GP?
Patients who are referred for specialist care are a selected group. In the community, General Practitioners would see a greater proportion of patients with functional problems. GPs would make an assessment of the patient and perhaps try some empirical therapy. If the symptoms recur, they might then refer the patient to a Gastroenterologist.
How would a Gastroenterologist diagnose my gastric pain?
In assessing a patient with dyspepsia, a Gastroenterologist would take a detailed history, as an analysis of the pattern of symptoms often give strong clues as to what could be the matter. A physical examination might detect abnormalities such as pallor (paleness which may be due to anaemia), jaundice (yellowness due to accumulation of bile pigments), pain in response to pressure or a lump in the abdomen, which might suggest more serious disease.
Investigations might include a blood test, imaging by way of x-ray pictures, ultrasound scans, computerised tomography (CT scans) or magnetic resonance imaging (MRI) of organs such as liver, gall bladder, pancreas and kidneys and Endoscopy, which for upper abdominal symptoms, is usually Gastroscopy – an examination by a long, thin instrument called and endoscope, of the oesophagus, stomach and upper small intestine or duodenum.
What if the tests don’t show any specific disease?
If no structural disease is found, a functional cause is likely. The good news is that such problems are not dangerous. The bad news is that, not having a specific cause to treat, treatment to modify functional problems can be more difficult, requiring trying different treatments and regular monitoring to adjust treatment as necessary.
What specific diseases might there be?
Specific diseases such as oesophagitis (inflammation of the oesophagus often due to acid reflux) ulcers can mostly be treated by medicine. If the common stomach bacteria Helicobacter pylori is present, this can be treated by antibiotics. If there turns out to be gallbladder disease, often the gallbladder needs to be surgically removed.
This article was written by Dr Tan Chi Chui and originally published in Gastroenterology & Medicine International. To make an appointment with Dr Tan, click here.
by Hridya Anand
A biochemist by education who could never put what she studied to good use, finally found GetDoc as a medium to do what she loved - bring information to people using a forum that is dedicated to all things medical. View all articles by Hridya Anand.