Which tests are needed to diagnose chronic abdominal pain?

Question

Hello doctor,

I am a 23-year-old man, and I have been experiencing continuous stomach-related issues for the past three months. I am suffering from stomach pain and cramping that increase after eating and worsen at night, especially after dinner. The pain usually starts about five minutes before I need to pass stool and reduces slightly after a bowel movement. I also have frequent burping throughout the day, both on an empty stomach and after eating. Occasionally, I feel a burning sensation or tightness in my stomach. In addition to this, I sometimes experience mild bloating and restlessness.

I have consulted three doctors so far. One suspected colitis, another mentioned stomach swelling, and a government doctor said it might be a stomach infection. I took the prescribed medications each time, but none of them led to any improvement. I have had a sonography, and the report was normal. However, I have not had a colonoscopy, endoscopy, or stool test yet.

The symptoms tend to worsen after eating, while lying down, and just before going to the toilet. I do feel some relief after passing stool. I have not experienced vomiting blood, blood in stool or black stool, high fever, or sudden weight loss.

I would like to request your guidance on the next steps. Could you please suggest the necessary tests to identify the cause of my symptoms? I would like to know if a stool test (to check for infection, occult blood, or parasites), blood tests (CBC, CRP, ESR, H. pylori), and a colonoscopy or endoscopy would be helpful.

Kindly help.

Thank you.

Answer 1

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern.

Your scan shows mild inflammation in the lower part of your large intestine and some enlarged lymph nodes in the abdomen. This pattern can be caused by infections, inflammatory bowel disease, or certain chronic conditions like tuberculosis.

To identify the exact cause, we need further tests, such as stool examination, blood tests, and possibly a colonoscopy with biopsy. Once we confirm the cause, we can start targeted treatment. The good news is that your prostate is normal, and there is no immediate surgical emergency.

The probable causes can be:

Infectious colitis: Bacterial (Salmonella, Shigella, Campylobacter, Escherichia coli), parasitic (Entamoeba histolytica), and viral.
Inflammatory bowel disease (IBD): Ulcerative colitis, Crohn’s disease.
Ischemic colitis: Reduced blood flow to the colon, more common in elderly or vascular disease patients.
Tubercular colitis: Intestinal tuberculosis (TB), especially in high tuberculosis prevalence areas.

Investigations to be done are as follows:

Blood tests: Complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), liver function test (LFT), renal function test (RFT).
Stool tests: Routine microscopy, culture, and acid-fast bacillus (AFB) stain if tuberculosis is suspected.
Mantoux test or tuberculosis quantiferon (TB quantiferon) (if tuberculosis is possible in your area).
Colonoscopy with biopsy (gold standard for colitis diagnosis).
Computed tomography (CT) abdomen (for better lymph node characterization and bowel wall assessment).

Preventive measures are as follows:

Food and water hygiene.
Drink only safe, filtered, or boiled water.
Avoid raw or undercooked meats, unwashed fruits, and vegetables.
Maintain strict kitchen hygiene to prevent foodborne infections.
Wash your hands thoroughly with soap before eating and after using the toilet.
Carry alcohol-based sanitizer when outside.
Avoid roadside food from unhygienic vendors.
Refrigerate perishable foods promptly.
Be cautious with milk and dairy; use pasteurized products.
Ensure good ventilation at home and the workplace.
Prompt diagnosis and treatment of tuberculosis contacts.
Avoid sharing utensils with tuberculosis patients until they are non-infectious.
Follow a balanced diet rich in fiber (unless in acute flare, when a low-residue diet may be needed).
Limit processed foods, excess red meat, and high-fat junk food.
Manage stress and ensure adequate sleep.
Regular physical activity is good for bowel motility and immunity.
Periodic health checks are recommended if there is a family history of bowel disease or cancer.
Vaccinations were applicable (e.g., hepatitis A, typhoid in high-risk areas).

I hope this helps.

Kindly follow up if you have more doubts.

Thank you.