Why am I having long-term abdominal pain and nausea?

Question

Hello doctor,

I have had ongoing GI issues for three years, almost daily. I have low-grade nausea, abdominal discomfort, and stomach pain radiating to the mid-back and sometimes between the shoulder blades. Some days it is pretty severe. But it is there almost every day for months. I have had periods for months where it has been nonexistent as well.

I have had the abdominal US twice, abdominal CT with contrast, and Readi cat twice. I have an upper and lower scope, multiple blood panels, including CEA and CA 19-9. All came back normal or NED. One of the CT scans and abdominal MRI, I had recently, both scans were NED. My GP says functional Dyspepsia, but the duration and severity are concerning.

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern

Well, you are right that the duration and severity are concerning. However, functional causes of abdominal pain are essentially important and should be considered here, particularly functional abdominal pain syndrome, abdominal migraine, and irritable bowel syndrome. But before that, there are specific organic causes of abdominal pain, although rare, that have to be considered before labeling this as functional pain. I am sure they might have investigated you for those conditions, but I mentioned them here for review.

Acute intermittent porphyrias (AIP), lead poisoning, Addison's disease, familial mediterranian fever (FMF), Angioedema, and C1 esterase deficiency. All these do not show up on the CT (computed tomography) scans and or on endoscopy. They should be tested through blood and urine tests. If already done, then share the reports.

I would suggest the following measures:

Total blood lead level.
24-hour urine for porphobilinogen and coproporphyrinogen.
Random serum cortisol level.
Serum C1 esterase activity.
ESR.
LDH.
Urine detail report and urine for microalbumin value (and genetic testing for FMF called M694V homozygous or heterozygous, but it is optional if urine for protein appears abnormal).
Amylase, lipase, and stool for pancreatic elastase 1.

If the above workup is unremarkable, we can consider giving some empirical low-dose pain modulator medications such as tricyclic antidepressant (TCA) medications. This will control the pain of functional syndrome, as mentioned earlier.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.