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HomeAnswersMedical Gastroenterologyabdomen painWhy do I have nausea, abdominal pain, and discomfort?

I have low-grade nausea, abdominal pain, and discomfort for the past few months. 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 January 4, 2021
Reviewed AtNovember 29, 2023

Patient's Query

Hello doctor,

I have ongoing GI issues for three years, almost daily. I have low-grade nausea, abdominal discomfort, stomach pain radiating to mid-back and sometimes between 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 NED. My GP says functional Dyspepsia but the duration and severity are concerning.

Answered by Dr. Ajeet Kumar

Hello,

Welcome to icliniq.com.

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 then irritable bowel syndrome. But before that, there are a specific organic cause of abdominal pain, although rare, that has to be considered before labeling that this is functional pain. I am sure they might have investigated you for those conditions, but I mentioned 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. If not, then get the following tests.

1. Total blood lead level.

2. 24-hour urine for porphobilinogen and coporphpbilinogen.

3. Random serum cortisol level.

4. Serum C1 esterase activity.

5. ESR.

6. LDH.

7. Urine detail report and urine for microalbumin value (and genetic testing for FMF called M694V homozygous/heterozygous, but it is optional if urine for protein appears abnormal).

8. Amylase, lipase, 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 this helps.

Regarding follow up

You can follow using chat, phone, or video consultation as I can explain to you the management plan in more detail.

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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