HomeAnswersMedical Gastroenterologyabdomen painWhat could cause chronic abdominal pain with stomach burn and fever?

I am feeling feverish due to abdominal pain, stomach burn and headache. Please help.

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Ajeet Kumar

Medically reviewed by

Dr. Vinodhini J.

Published At June 5, 2020
Reviewed AtNovember 30, 2023

Patient's Query

Hi doctor,

I am suffering from abdominal pain for the past two months. I have done tests like CT scan, stool test, and blood test. Now I am feeling feverish, headache, stomach burn, and severe pain.

Answered by Dr. Ajeet Kumar

Hello,

Welcome to icliniq.com.

It would have been great if you could have shared the report of CT (computed tomography) scan and blood tests to tell you about your problem.

The symptoms you mentioned can be due to various causes namely peptic ulcer disease, irritable bowel syndrome, small intestinal bacterial overgrowth, and many others.

For now, I suggest you to take capsule Esomeprazole 40 mg once daily before breakfast since you have pain, which seem to be secondary to peptic ulcer disease or acidity.

Patient's Query

Thank you doctor,

I have attached the file.

Answered by Dr. Ajeet Kumar

Hello,

Welcome back to icliniq.com.

The reports have not been upladed yet. You should try again in response to this message. Make sure the files are uploaded completely before you click submit.

Patient's Query

Thank you doctor,

I have attached the files. Now I am having a severe stomachache and feeling feverish.

Answered by Dr. Ajeet Kumar

Hello,

Welcome back to icliniq.com.

The reports were little blurred, somehow I managed to see the findings (attachment removed to protect patient identity).

So after all my understanding about you, considering your symptoms for the past two months, given raised level of fecal calprotectin in stools, and CT scan showing small bowel thickening makes me think it is an ulcerative jejunoileitis. In common words, it is inflammation of your small bowel. The underlying causes could by typhoid or any other bacterial infection (the most likely cause) and Crohn's disease. You have your typhi dot test which is negative. Nowadays we do not usually recommend this testing, instead, we do blood culture for confirmation of typhoid.

I would start by giving you an antibiotic course of a duration of 7 to 10 days and would see if you improve on that. For example, at the end of your antibiotic course, you do not have any improvement I would recommend other testing including a colonoscopy (endoscope of the large bowel) and/or enteroscopy (endoscopy of the small bowel) with biopsies. I strongly feel that you have an infection with possibly typhoid or with other bacterial infections. And this infection shall resolve with the medications I prescribe you.

The fever, abdominal pain, and pain over the stomach are part of this overall problem, and I expect that all symptoms will go away once you start the treatment and once underlying inflammation starts resolving. The antibiotic I prescribe would not trouble you in terms of side effects, however, Metronidazole can cause metallic taste in the mouth, with some nausea and loss of appetite. But these side effects are temporary and once the course of antibiotic is completed the side effects will go away by itself.

Lastly, I want you to understand that pain and fever will settle in the coming two to three days if not sooner because antibiotics will take time to show effects in terms of improvement of symptoms.

The Probable causes

Ulcerative jejunoileitis secondary to small bowel infection. ? Crohn's enteritis.

Investigations to be done

Stool culture and sensitivity. Blood for culture and sensitivity. Serum CRP (C-reactive protein).

Differential diagnosis

Autoimmune enteropathy. Small bowel lymphoma.

Probable diagnosis

Ulcerative jejunoileitis secondary to small bowel infection.

Treatment plan

Capsule Cefixime 400 mg twice daily for 10 days, tablet Metronidazole 400 mg thrice daily for seven days, tablet Panadol 500 mg two tablets whenever body temperature is more than 101 F or for pain. Maximum number of tablets not more than 8 (4000 mg) daily, capsule Esomeprazole 40 mg half an hour before meals. Take some blendarized diet instead of formed meals. Take plenty of water.

Regarding follow up

Follow up in one week with reports.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Ajeet Kumar
Dr. Ajeet Kumar

Medical Gastroenterology

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