Physical Causes and Features of Chronic Abdominal Pain
Cause* |
Common Features† |
Tests‡ |
Disorders of the digestive tract |
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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 Often biopsy of the upper small intestine |
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Cholecystitis (inflammation of the gallbladder), if chronic |
Recurring crampy pain in the upper right part of the abdomen |
Ultrasonography to look for gallstones |
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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) |
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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, including thorough dietary history |
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Recurring episodes of severe pain with fever, loss of appetite, weight loss, and diarrhea |
CT and/or colonoscopy X-rays of the small intestine |
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Gastroesophageal reflux disease (sometimes related to a hiatus hernia) |
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 |
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Hepatitis, if chronic |
Discomfort in the upper right part of the abdomen A general feeling of illness (malaise) Loss of appetite Jaundice (uncommon) Sometimes in people known to have had acute hepatitis |
Blood tests to evaluate the liver and to check for viral, autoimmune, or metabolic causes of hepatitis |
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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 |
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Constant pain in the upper abdomen, often radiating to the back Weight loss Sometimes jaundice |
CT MRCP |
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Pancreatitis, if chronic or accompanied by a pancreatic pseudocyst |
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 MRCP Stool tests |
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Parasitic infections (particularly giardiasis) |
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 |
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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 |
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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 |
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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 |
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Crampy pain with several separate episodes of bloody diarrhea Typically in young adults |
Sigmoidoscopy or colonoscopy Biopsy of the rectum or colon |
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Kidney and urinary tract disorders |
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Frequent urinary tract infections Typically in children |
Intravenous urography or CT Ultrasonography |
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Pain in the side (flank) that comes and goes, often in people known to have stones Sometimes fever Dark or bloody urine |
Urinalysis CT or intravenous urography |
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Reproductive system disorders (in women) |
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Discomfort mainly before or during menstrual periods |
Laparoscopy |
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Vague discomfort in the lower abdomen |
Ultrasonography of the pelvis |
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Bloating Sometimes a mass in the pelvis detected during a doctor's examination |
Ultrasonography of the pelvis |
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Systemic disorders |
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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 |
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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 |
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Symptoms that develop only after eating certain foods such as seafood |
An elimination diet |
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Immunoglobulin A–associated vasculitis (formerly Henoch-Schönlein purpura) |
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 |
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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 |
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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 |
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* 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. |
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† Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present. |
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‡ 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. |
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CT = computed tomography; MRCP = magnetic resonance cholangiopancreatography; NSAIDs = nonsteroidal inflammatory drugs. |
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