Merck Manual

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Physical Causes and Features of Chronic Abdominal Pain

Physical Causes and Features of Chronic Abdominal Pain


Common Features†


Disorders of the digestive tract

In children, not growing as expected (failure to thrive)

Abdominal bloating and often diarrhea or light-colored, bulky, and unusually foul-smelling stools that may appear oily

Symptoms that worsen when people eat foods containing wheat products (which contain gluten)

Blood tests to measure levels of antibodies produced when people with celiac disease eat foods containing gluten

Biopsy of the upper small intestine

Recurring crampy pain in the upper right part of the abdomen

Usually no discomfort, but if the colon is partially blocked, possibly crampy discomfort

Sometimes blood in stool (blood may be visible or detected during a doctor's examination)

Weight loss

Imaging tests such as CT of the colon after drinking a contrast agent (CT colonography)

Hard, less frequent bowel movements that are difficult to pass

Crampy pain in the lower abdomen that decreases after a bowel movement

Sometimes pain during a bowel movement

A doctor’s examination alone, including thorough dietary history

Recurring episodes of severe pain with fever, loss of appetite, weight loss, and diarrhea


Heartburn (burning pain that begins in the upper abdomen and travels up to the throat, sometimes with an acid taste in the mouth)

Sometimes chest pain

Sometimes a cough, hoarseness, or both

Symptoms sometimes worsened by lying down

Relief with antacids

Often only a doctor's examination plus trying treatment with drugs to suppress acid production (if symptoms are relieved, the cause is probably gastroesophageal reflux disease)

Sometimes endoscopy of the upper digestive tract (examination of the esophagus and stomach using a flexible viewing tube), x-rays of the upper digestive tract after barium is given by mouth (barium swallow), or testing for presence of acid reflux with a pH probe Diagnosis In gastroesophageal reflux disease, stomach contents, including acid and bile, flow backward from the stomach into the esophagus, causing inflammation in the esophagus and pain in the bottom... read more Diagnosis

Discomfort in the upper right part of the abdomen

A general feeling of illness (malaise)

Loss of appetite

Jaundice (uncommon)

Blood tests to evaluate the liver and to check for viral, autoimmune, or metabolic causes of hepatitis

Bloating, cramps, passing of gas (flatulence), and diarrhea after consuming milk products

Sometimes a breath test to detect hydrogen, indicating undigested lactose

A diet that excludes foods containing lactose (elimination diet) to determine whether those foods trigger the symptoms

Constant pain in the upper abdomen, often radiating to the back

Weight loss

Sometimes jaundice



Episodes of severe pain in the upper middle of the abdomen

Sometimes diarrhea and fat in stool

Usually in people known to have had acute pancreatitis

Blood tests to measure levels of an enzyme produced by the pancreas

Imaging tests such as CT or MRI/MRCP

Stool tests (for chronic pancreatitis)

Recent travel to developing countries, ingestion of water from streams or lakes, or contact with people with the infection

Cramps, flatulence, and diarrhea

Examination of stool to check for parasites or their eggs

Stomach pain relieved by eating food and taking antacids

May awaken people at night

May be caused by use of NSAIDs

Endoscopy and biopsy for Helicobacter (H.) pylori (bacteria that can cause peptic ulcers)

Sometimes an H. pylori breath test or a stool test

Scar tissue that develops around the intestines (adhesions) in people who have had abdominal surgery

Crampy discomfort accompanied by nausea and sometimes vomiting

Upper GI series (x-rays taken of the stomach and small intestine after drinking liquid barium) and other x-rays of the small intestine

CT scan

Indigestion or mild pain

Often tiny amounts of blood in stool (detectable only during a doctor's examination)

Typically in older adults

Endoscopy of the esophagus and stomach

Crampy pain with several separate episodes of bloody diarrhea

Typically in young adults

Sigmoidoscopy or colonoscopy

Biopsy of the rectum or colon

Kidney and urinary tract disorders

Typically in children

Intravenous urography or CT


Pain in the side (flank) that comes and goes, often in people known to have stones

Sometimes fever

Dark or bloody urine


CT or intravenous urography

Reproductive system disorders (in women)

Discomfort mainly before or during menstrual periods


Vague discomfort in the lower abdomen

Ultrasonography of the pelvis


Sometimes a mass in the pelvis detected during a doctor's examination

Ultrasonography of the pelvis

Systemic disorders

Recurring attacks of severe abdominal pain and vomiting

Sometimes muscle weakness, seizures, and mental disturbances (such as irritation or agitation)

In some types of porphyria, blistering of the skin when exposed to sunlight

Urine and blood tests to check for substances (porphyrins) produced during the attacks

Persistent nausea, vomiting, and indigestion

Usually develops after longstanding cannabis use

A doctor's examination alone

Urine drug test

Sometimes blood tests

Family members who have the disorder

Episodes of abdominal pain lasting 48 to 72 hours and often accompanied by fever

Starting during childhood or adolescence

Genetic testing

Symptoms that develop only after eating certain foods such as seafood

An elimination diet

A reddish-purple rash of tiny dots (petechiae) or larger splotches (purpura) on the arms, legs, buttocks, and top of the feet

Achy, tender, swollen joints

Nausea, vomiting, and diarrhea

Blood in stool detected during a doctor's examination

Biopsy of affected skin

Crampy abdominal pain

Mental changes such as a reduced attention span, confusion, and altered behavior

Loss of appetite, vomiting, and constipation

Achy joints

Usually only in workers exposed to lead

More often in young children who live in houses over 30 years old, in which lead-based paint (banned in 1978) may have been used

Blood tests to measure the lead level

Severe episodes of abdominal pain lasting over a day

Recurring pain in places other than the abdomen, such as the back, chest, arms, and/or legs

In black children who typically have family members with the disorder

Blood tests to check for sickle-shaped red blood cells and for the abnormal hemoglobin that characterizes sickle cell disease

* Physical causes are responsible for only about 10% of cases of chronic abdominal pain. Most cases are functional abdominal pain. This table does not include all physical causes of chronic abdominal pain.

† Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present.

‡ Although a doctor's examination is always done, it is mentioned in this column only if the diagnosis can sometimes be made by the doctor's examination alone, without any testing.

§ For most people with chronic abdominal pain, doctors typically do basic blood and urine tests such as a complete blood cell count, blood tests to evaluate how the liver and pancreas are functioning, and urinalysis. Other tests are done based on results of these tests and the examination.

CT = computed tomography; MRCP = magnetic resonance cholangiopancreatography; NSAIDs = nonsteroidal inflammatory drugs.