Q. I feel tired and get upper abdominal pain if I eat my lunch late. Why?

Answered by
Dr. Ajeet Kumar Lohana
and medically reviewed by Dr. Sneha Kannan
This is a premium question & answer published on Aug 31, 2020 and last reviewed on: May 12, 2021

Hi doctor,

I would like to know some guidance regarding my medical issue which troubles me for six years. Normally, I use to take lunch around 2 pm. If it gets delayed, I start to have tiredness with abdominal pain. It continues for few days. I start to have locking pain while taking deep breathing with abdominal pain. I have done an abdominal CT scan and LFT. There is nothing abnormal shown on it. I do not have acidity or a burning sensation. It hurts me a lot very badly. Kindly help me. Even from childhood, I feel tired when I miss my lunch on time. I start to have acidity and a burning sensation along with it. Now, I do not have acidity or burning sensation. But my pain starts slowly and then it gets increased for a few days. I took tablets for a month to reduce gas-related problems.



Welcome to icliniq.com.

I understand your anxiety and frustration related to your recurrent abdominal pain. The abdomen is a huge compartment comprising various tightly fitting organs including the stomach, pancreas, gall bladder, spleen, liver, and many other tissues. Abdominal pain can occur due to various reasons. It suggests few possibilities. You can have abdominal migraines, acute intermittent porphyria (AIP), duodenal ulcers, and functional abdominal pain syndrome. Abdominal migraine occurs due to problems supplying the blood supply to other organs.

It is similar to more or less migraine. It affects the head causing headaches. In abdominal migraines, the predominant pain site is the abdomen. Acute intermittent porphyria (AIP) is a metabolic disease that occurs due to problems affecting the production of hemoglobin. Excessive by-products left in the blood are called porphyrins and they cause pain when they want. But episodes get triggered by fasting, low sugar, dehydration, and medicines. Duodenal ulcers cause ulcers in the small bowel and it does not cause acidity.

Functional abdominal pain syndrome is a functional problem affecting the nerves supplying the abdomen. It is a kind of hypersensitive abdomen caused due to noxious stimuli contained in food or non-noxious stimuli. Please answer some questions to guide you further. Please mention whether you have weight loss, pain during sleeping and in the middle of the night.

Please mention whether you have stress, anxiety, and sleeplessness. Please mention whether you have any change in the color of the urine while having these episodes. Please mention whether you are taking any medication recently or any sulpha allergy. Please mention whether taking regular meals at times correct your pain. Please mention whether you have taken any medicines to control pain. I suggest you do some investigations mentioned below to guide you further.

The Probable causes:

You can have an abdominal migraine or acute intermittent porphyria (AIP), PUD (peptic ulcer disease), and functional abdominal pain syndrome.

Investigations to be done:

You need to do CBC (complete blood count), urine detailed report, urine for porphobilinogen and coporphobilinogen (24-hour urine collection), serum lead, serum urea, creatinine, and electrolytes, serum calcium, magnesium and phosphorous, serum lactate levels, stool detail report, stool for fecal calprotectin, stool for H pylori (helicobacter pylori) antigen. Kindly share your CT (computed tomography) scan and LFT (liver function test) reports.

Regarding follow up:

Have a follow-up with your investigations.

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