A gentleman recently came to the clinic stating that he was very nauseous and had vomited several times that morning.  On further questioning, it appeared that he had been non- specifically ill for several months with abdominal pain for the past several weeks.  He had lost about 15 lbs but indicated that there was something unusual about that because he wasn’t even trying.   An x-ray of the stomach demonstrated that his stomach was very full and seemed to not be emptying.  A tube was passed down into his stomach and about 2 ½ quarts of fluid was removed.  Normally the stomach has a volume of about one quart immediately after a meal and this empties within 2-4 hours.  Because he had a much greater stomach content than normal, further evaluation was indicated.

    An endoscope is a special kind of telescope that is made like a rubber rope.  It can be passed through the mouth down into the stomach with a light on the end so the inside of stomach can be examined.  There is also a pair of pinchers on the end of this rubber rope telescope that allows the physician to bite off a little piece of the stomach to exam for the possibility that there might be a cancer present.  An endoscope was passed into this gentleman’s stomach and it was seen that the outlet from stomach was completely blocked off by a hard mass of irritation tissue around an ulcer.  There was just no way for fluid to get out of the stomach except to vomit.

     After several days of intravenous feedings, he was felt ready for surgery and a partial removal of the stomach was carried out to unblock the intestinal canal.  It was seen that he had a classical ulcer but fortunately no cancer was seen.

 Adult abdominal pain comes in many forms.  It can be due to cancers, gallstones, ulcers, inflammation of the pancreas or infections of the intestinal tract.  In most studies, adults with abdominal pain will not be found to have a structural abnormality such as gallstones, ulcers, cancers, etc.  As strange as it may seem, 7 out of 10 people that come to the doctor because of abdominal pain will not be found to have an abnormality to explain the pain.  This isn’t at all satisfying for the doctor and it sure is not satisfying for the patient.  Treating the demonstrated causes of abdominal pain such as gallstones is relatively straight forward.  The gallstones need to be removed and the problem will be solved.  If the person has a demonstrated ulcer, there are many medications that can be used to help that.  The so called PPI’s (proton pump inhibitors) are a very potent group of medications that stop stomach acid production.  The products available on the market today include Aciphex, Prilosec, Prevacid, Protonix, and Nexium.  These are all very expensive but also very effective at turning off stomach acid.  They would generally lead to immediate relief of problems caused by ulcers or esophageal reflux causing heartburn.  Cancers generally have to be treated surgically and then with chemotherapy.

     But how do we help those 7 out of 10 people who don’t have an abnormality when X-rays and blood tests and endoscopies are done and there is no demonstrated abnormality.  Frequently these individuals are provided with a trial of therapy.  This means we give a medication that will treat a certain condition and see if the problem resolves.  The most common medication tried is one of the products named above under the PPI’s.    When these medications are started, the person’s stomach acid is absolutely turned off.  If the problem completely resolves with this step, that is presumptive evidence that the cause of the person’s abdominal pain is too much acid the stomach.  This is an effective and safe step to take in the right circumstance.

     Another step that can be taken in those individuals who have abdominal pain but no specific diagnosis is to treat with one of the products used for “irritable bowel syndrome”.  Individuals with irritable bowel syndrome have intermittent abdominal pain, a bowel irregularity with diarrhea or constipation, a bloating sensation and no relief when one of the PPI’s above is tried.  For these individuals, there are several products on the market, the most recent of which is called Zelnorm.  These products change the rate and rhythm in which the bowel contracts.  When the bowel is slowed and relaxed by these medications, the abdominal pain problem and bloating often resolves quite dramatically.

     For that individual who is overweight, a smoker, diabetic, hypertensive, and with a high blood cholesterol, abdominal pain after meals may represent their expression of a heart attack getting ready to happen.  Thus depending on the person’s characteristics and a description of their pain problem, there are diagnoses other than abdominal diseases that may explain the problem.

     Abdominal pain in adults is one of the most common problems that the primary healthcare providers encounter.  Your local clinics deal with this problem every day and are well versed on the most economical and least intrusive methods of helping the problem.  Sometimes a more extensive workup is involved but most of the time, a “trial of therapy is the most effective, least expensive and least intrusive method of dealing with the problem”.