Abdominal Pain: What Lies Behind the Symptom and How to Help?

The Diversity of Causes of Abdominal Pain: From Mild to Urgent

Abdominal pain is one of the most common symptoms everyone encounters. It can be acute or chronic, dull or sharp, localized or diffuse. The variety of its manifestations is due to the huge number of organs located in the abdominal cavity, as well as systemic diseases that can cause discomfort. From trivial overeating to life-threatening conditions, the spectrum of causes is extremely wide, making accurate diagnosis critically important.

Often, abdominal pain is associated with relatively harmless conditions such as indigestion, gas, constipation, or mild food poisoning. However, sometimes it can be a sign of serious problems requiring immediate medical attention. It is important to understand that even familiar diseases, such as inflammatory bowel disease (IBD), can manifest with pain not only during periods of exacerbation but also in remission, complicating their diagnosis and treatment [5].

When Abdominal Pain Signals Serious Problems

Gastrointestinal Complications

Certain GI conditions require emergency intervention. For example, gastric outlet obstruction is a rare but dangerous complication that can occur after bariatric procedures such as intragastric balloon placement. In one case, a 35-year-old woman developed severe nausea, vomiting, electrolyte imbalance, and even chest pain just two weeks after the procedure, leading to intensive care admission. This highlights the importance of thorough preoperative assessment and postoperative monitoring in obesity management [2]. Such symptoms, especially after invasive interventions, should always raise concern.

Inflammatory Bowel Disease (IBD)

IBD, such as Crohn's disease and ulcerative colitis, are chronic systemic inflammatory conditions where abdominal pain is a very frequent symptom [5]. This pain can occur both during active inflammation and in periods of remission, often baffling even experienced gastroenterologists [5]. Furthermore, patients with IBD have an increased risk of developing cardiovascular complications, including myocardial infarction, which emphasizes the systemic nature of the disease and the need for a comprehensive treatment approach [3].

Systemic Diseases

Abdominal pain can be a manifestation of systemic diseases affecting the entire body. For instance, systemic lupus erythematosus (SLE) is an autoimmune disease that can affect various organs, including the abdominal organs. Although one report describes a case of myocardial infarction in a child with SLE accompanied by chest pain [4], this illustrates that systemic diseases can cause diverse pain syndromes, including abdominal pain, through inflammation or vascular involvement.

Heart failure can also manifest with abdominal symptoms such as bloating, discomfort, or pain associated with blood stasis in the liver and other abdominal organs [7].

Non-Obvious Causes: When Pain "Deceives"

Sometimes the source of abdominal pain may be non-obvious or even located outside the abdominal cavity. This phenomenon is known as radiating or referred pain. For example, pain from a myocardial infarction can radiate to the upper abdomen, mimicking stomach problems. Similarly, certain neurological conditions can cause pain that is perceived as abdominal or chest pain [1].

Although one study examines neurological causes of chest pain, such as migraine, epilepsy, and multiple sclerosis [1], this emphasizes that pain in the torso can have unusual origins not directly related to internal organs. Such cases often lead to prolonged periods without an accurate diagnosis due to the difficulties in recognizing symptoms as part of a neurological disease [1]. This serves as a reminder of the need for a broad diagnostic search in cases of unclear abdominal pain.

The Impact of Lifestyle and Comorbidities

Lifestyle and the presence of chronic diseases play a significant role in the development and exacerbation of abdominal pain.

• Obesity: Is a global epidemic and a major risk factor for numerous conditions that can cause abdominal pain. It is associated with chronic liver disease [6], gallstone disease, and can exacerbate the course of IBD. Complications from bariatric surgery, as mentioned earlier, can also be a cause of acute abdominal pain [2].
• Diet: Poor nutrition rich in processed foods can contribute to inflammation and GI dysfunction. Conversely, a balanced diet, such as the Mediterranean diet, can help reduce inflammation and improve quality of life in patients with chronic diseases [8]. Although study [8] focuses on atrial fibrillation, the principles of an anti-inflammatory diet are universal and important for gut health.
• Stress: Psycho-emotional state strongly affects the digestive system, exacerbating symptoms of functional disorders such as irritable bowel syndrome.

What to Do for Abdominal Pain: An Action Algorithm

When abdominal pain occurs, it is important to act deliberately. Self-medication can be dangerous, especially if the cause of the pain is unknown.

When to immediately see a doctor or call an ambulance:

• Sudden, very severe, "knife-like" pain.
• Pain accompanied by high fever or chills.
• Severe vomiting (especially with blood) or diarrhea (especially with blood or black stools).
• Abdominal muscle rigidity ("board-like abdomen").
• Inability to have a bowel movement or pass gas.
• Pain after abdominal trauma or surgery.
• Fainting or confusion.

When you should make an appointment with a doctor:

• Chronic or recurrent pain.
• Pain accompanied by weight loss or changes in appetite.
• Changes in bowel habits (constipation, diarrhea).
• Persistent discomfort or heaviness in the abdomen.

Diagnostics and Treatment:

The physician will conduct a thorough examination, take a medical history, and order necessary tests:

• Laboratory blood, urine, and stool tests.
• Instrumental methods: abdominal ultrasound, X-ray, CT, MRI.
• Endoscopic examinations: gastroscopy, colonoscopy.

Treatment will depend on the identified cause and may include drug therapy, diet and lifestyle modifications, and in some cases, surgical intervention.

Sources

1. Neurological Causes of Chest Pain. https://pubmed.ncbi.nlm.nih.gov/33760994/
2. Emergent Management of Gastric Outlet Obstruction Post-Intragastric Balloon: A Case Report Highlighting the Importance of Preoperative Assessments and Postoperative Monitoring in Obesity Management. https://pubmed.ncbi.nlm.nih.gov/38308432/
3. Comparative Outcomes After Index Myocardial Infarction in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. https://pubmed.ncbi.nlm.nih.gov/42044218/
4. Myocardial infarction in a child with systemic lupus erythematosus. https://pubmed.ncbi.nlm.nih.gov/41763661/
5. AGA Clinical Practice Update on Pain Management in Inflammatory Bowel Disease: Commentary. https://pubmed.ncbi.nlm.nih.gov/38639677/
6. Obesity management for the hepatologist-What to do, how to do it and why? https://pubmed.ncbi.nlm.nih.gov/37725761/
7. Current state of heart failure management by home health-care professionals. https://pubmed.ncbi.nlm.nih.gov/40904448/
8. Implementing a Mediterranean Diet App in Patients With Atrial Fibrillation. https://pubmed.ncbi.nlm.nih.gov/41945364/

Disclaimer: The information provided in this article is for reference purposes only and is not intended for self-diagnosis or self-treatment. Always consult a qualified medical professional for diagnosis and treatment.