I have low-grade nausea, abdominal pain, and discomfort for the past few months. Please help.

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.