Abstract
Abdominal pain is a frequent chief complaint for primary care physician. It explains 1% of outpatient visits ranking 9th in the office and 2nd
in the emergency room. Chronic pain, rarely needs surgical management but declines quality of life. An anatomic and physiophatologic
approach result in a correct diagnosis and treatment by the physician. This work aims to review the major elements for the study of chronic
abdominal pain and to propose a clinical diagnostic algorithm in these cases. MÉD.UIS. 2018;31(1):47-55.
References
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2. Ibarra E. Una Nueva Definición de “Dolor”: Un Imperativo de
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In: Sleisenger and Fordtran’s Gastrointestinal and Liver Disease:
Pathophysiology, Diagnosis, Management. 10th ed. Canada:
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4. Wall PD, McMahon SB, Koltzenburg M. Wall and Melzack’s
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5. Gatchel RJ, Okifuji A. Evidence-based scientific data documenting
the treatment and cost-effectiveness of comprehensive pain
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6. Greenbaum DS, Greenbaum RB, Joseph JG, Natale JE. Chronic
abdominal wall pain: Diagnostic validity and costs. Dig Dis Sci.
1994; 39(9):1935–41.
7. Cid J, Andrés JD, Díaz L, Parra M, Leal F. Dolor abdominal crónico
(1a parte). Rev Soc Esp Dolor. 2005; 12(8):505–24.
8. Zackowski SW. CHRONIC RECURRENT ABDOMINAL PAIN.
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9. Otero W, Ruiz X, Otero E, Gómez M, Pineda LF, Arbeláez V. Dolor
crónico de la pared abdominal: una entidad poco reconocida con
gran impacto en la práctica médica. Rev Colomb Gastroenterol.
2007; 22(4):261–71.
10. Henschke N, Kamper SJ, Maher CG. The epidemiology and
economic consequences of pain. Mayo Clin Proc. 2015;
90(1):139–47.
11. Camilleri M, Williams DE. Economic burden of irritable
bowel syndrome: Proposed strategies to control expenditures.
PharmacoEconomics. 2000;17(4):331–8.
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430. Disponible en: https://www.minsalud.gov.co/sites/rid/Lists/
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15. Drossman DA. Chronic functional abdominal pain. Am J
Gastroenterol. 1996;91(11):2270–81.
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patients with functional bowel disorders. Am J Gastroenterol.
2000;95(5):1195–2000.
17. Mayer E. The neurobiology of stress and gastrointestinal disease.
Gut. 2000;47(6):861–9.
18. Ungaro R, Mehandru S, Allen PB, Peyrin-Biroulet L, Colombel
JF. Ulcerative colitis. Lancet Lond Engl. 2017;389(10080):1756-
1770.
19. Zizic TM, Classen JN, Stevens MB. Acute abdominal
complications of systemic lupus erythematosus and polyarteritis
nodosa. Am J Med. 1982;73(4):525–31.
20. Whitehead WE, Palsson O, Jones KR. Systematic review of the
comorbidity of irritable bowel syndrome with other disorders:
what are the causes and implications? Gastroenterology.
2002;122(4):1140–56.
21. Clemens JQ, Meenan RT, O’Keeffe Rosetti MC, Kimes TA, Calhoun
EA. Case-control study of medical comorbidities in women with
interstitial cystitis. J Urol. 2008;179(6):2222–5.
22. Sieper J, Braun J, Dougados M, Baeten D. Axial spondyloarthritis.
Nat Rev Dis Primers. [Interntet] Julio 2015;1:15013. Disponible
en: https://www.nature.com/articles/nrdp201513
23. Mayer EA, Gebhart GF. Basic and clinical aspects of visceral
hyperalgesia. Gastroenterology. 1994;107(1):271–93.
24. Petrie KJ, Müller JT, Schirmbeck F, Donkin L, Broadbent E, Ellis
CJ, et al. Effect of providing information about normal test results
on patients’ reassurance: randomised controlled trial. BMJ.
2007;334(7589):352.
25. Astin M, Griffin T, Neal RD, Rose P, Hamilton W. The diagnostic
value of symptoms for colorectal cancer in primary care: a
systematic review. Br J Gen Pract. 2011;61(586):231-243.
26. Jackson PG, Raiji MT. Evaluation and management of intestinal
obstruction. Am Fam Physician. 2011;83(2):159–65.
27. Juliao Baños F, Fernando C, Sánchez MT, García Duperly R,
Bonilla DA, et al. Guía de práctica clínica para el diagnóstico
y tratamiento de la colitis ulcerativa en población adulta. Rev
Colomb Gastroenterol. 2015;30:75–88.
28. Shannahan S, Leffler DA. Diagnosis and Updates in Celiac
Disease. Gastrointest Endosc Clin N Am. 2017;27(1):79–92.
29. Saini S. Imaging of the Hepatobiliary Tract. N Engl J Med.
1997;336(26):1889–94.
30. Xue M, Chen X, Shi L, Si J, Wang L, Chen S. Small-bowel
capsule endoscopy in patients with unexplained chronic
abdominal pain: a systematic review. Gastrointest Endosc.
2015;81(1):186–93.
31. Pasha SF, Fleischer DE. Capsule endoscopy for abdominal pain
- is it of value or just another test for doctors to do?. Endoscopy.
2007;39(7):650–2.
32. Ching HL, McAlindon ME, Sidhu R. An update on small bowel
endoscopy. Curr Opin Gastroenterol. 2017;33(3):181-8.
33. Möschler O, May A, Müller MK, Ell C, German DBE Study
Group. Complications in and performance of double-balloon
enteroscopy (DBE): results from a large prospective DBE database
in Germany. Endoscopy. 2011;43(6):484–9.
34. Buscaglia JM, Dunbar KB, Okolo PI 3rd, Judah J, Akerman PA,
Cantero D, et al. The spiral enteroscopy training initiative: results
of a prospective study evaluating the Discovery SB overtube
device during small bowel enteroscopy (with video). Endoscopy.
2009;41(3):194–9.
35. May A, Nachbar L, Wardak A, Yamamoto H, Ell C. Double
balloon enteroscopy: preliminary experience in patients with
obscure gastrointestinal bleeding or chronic abdominal pain.
Endoscopy. 2003;35(12):985–91.
36. Bielefeldt K, Davis B, Binion DG. Pain and Inflammatory Bowel
Disease. Inflamm Bowel Dis. 2009;15(5):778–88.
37. Acosta S. Epidemiology of mesenteric vascular disease: clinical
implications. Semin Vasc Surg. 2010;23(1):4–8.
38. Rits Y, Oderich GS, Bower TC, Miller DV, Cooper L, Ricotta JJ
2nd, et al. Interventions for mesenteric vasculitis. J Vasc Surg.
2010;51(2):392–400.e2.
39. Hohenwalter EJ. Chronic Mesenteric Ischemia: Diagnosis and
Treatment. Semin Intervent Radiol. 2009;26(4):345–51
40. Harnik IG, Brandt LJ. Mesenteric venous thrombosis. Vasc Med.
2010; 15(5):407–18.
41. Balwani M, Desnick RJ. The porphyrias: advances in diagnosis
and treatment. Blood. 2012; 120(23):4496–504.
42. Ripamonti C. Management of bowel obstruction in advanced
cancer. Curr Opin Oncol. 1994; 6(4):351–7.
43. Barkun A, Leontiadis G. Systematic review of the symptom
burden, quality of life impairment and costs associated with
peptic ulcer disease. Am J Med. 2010; 123(4):358–366.e2.
44. Sonnenberg A. Temporal trends and geographical variations of
peptic ulcer disease. Aliment Pharmacol Ther. 1995; 9(2):3–12.
45. Steer ML, Waxman I, Freedman S. Chronic Pancreatitis. N Engl J
Med. 1995; 332(22):1482–90.
46. Sotgiu G, Sulis G, Matteelli A. Tuberculosis-a World Health
Organization Perspective. Microbiol Spectr. 2017; 5(1).
47. Aguado JM, Pons F, Casafont F, San Miguel G, Valle R. Tuberculous
peritonitis: a study comparing cirrhotic and noncirrhotic
patients. J Clin Gastroenterol. 1990 ;12(5):550–4.
48. Sanai FM, Bzeizi KI. Systematic review: tuberculous peritonitis--
presenting features, diagnostic strategies and treatment. Aliment
Pharmacol Ther. 2005 15;22(8):685–700.
49. Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Thompson
WG, et al. U.S. householder survey of functional gastrointestinal
disorders. Prevalence, sociodemography, and health impact. Dig
Dis Sci. 1993 ;38(9):1569–80.
50. Drossman DA. Severe and Refractory Chronic Abdominal Pain:
Treatment Strategies. Clin Gastroenterol Hepatol. 2008; 6(9):978–
82.
51. Macaluso CR, McNamara RM. Evaluation and management of
acute abdominal pain in the emergency department. Int J Gen
Med. 2012; 5:789–97.
52. Tack J, Talley NJ, Camilleri M, Holtmann G, Hu P, Malagelada
J-R, et al. Functional gastroduodenal disorders. Gastroenterology.
2006 Apr;130(5):1466–79.
53. Cid J, Andrés JD, Díaz L, Parra M, Leal F. Dolor abdominal crónico
(1a parte). Rev Soc Esp Dolor. 2005 Dec;12(8):505–24.
54. Berbel-Tornero O, Clemente-Yago F, García-Rodríguez C,
Pereda-Pérez A. Dolor abdominal crónico y recurrente. En:
Junta Directiva de la SEGHNP, coordinadores. Protocolos de
Gastroenterología, Hepatología y Nutrición pediátrica. 2da ed.
Madrid: Ergón S.A.; 2010. p. 29-35.
55. Talley NJ, Zinsmeister AR, Van Dyke C, Melton LJ. Epidemiology
of colonic symptoms and the irritable bowel syndrome.
Gastroenterology. 1991 Oct;101(4):927–34.
56. Swarbrick E, Bat L, Hegarty J, Williams C, Dawson A.Site of
pain from the irritable bowel. Lancet Lond Engl. 1980 Aug
30;2(8192):443–6.
57. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin
F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006
Apr;130(5):1480–91.
Descriptions of Chronic Pain Syndromes and Definitions of Pain
Terms. IASP Press; 1994. 244.
2. Ibarra E. Una Nueva Definición de “Dolor”: Un Imperativo de
Nuestros Días. Rev Soc Esp Dolor. 2006;13(2):65–72.
3. Feldman M, Friedman LS, Brandt LJ. Chronic Abdominal Pain.
In: Sleisenger and Fordtran’s Gastrointestinal and Liver Disease:
Pathophysiology, Diagnosis, Management. 10th ed. Canada:
Elsevier Health Sciences; 2015.
4. Wall PD, McMahon SB, Koltzenburg M. Wall and Melzack’s
Textbook of Pain. Churchill Livingstone: Elsevier; 2006.
5. Gatchel RJ, Okifuji A. Evidence-based scientific data documenting
the treatment and cost-effectiveness of comprehensive pain
programs for chronic nonmalignant pain. J Pain Off J Am Pain
Soc. 2006; 7(11):779–93.
6. Greenbaum DS, Greenbaum RB, Joseph JG, Natale JE. Chronic
abdominal wall pain: Diagnostic validity and costs. Dig Dis Sci.
1994; 39(9):1935–41.
7. Cid J, Andrés JD, Díaz L, Parra M, Leal F. Dolor abdominal crónico
(1a parte). Rev Soc Esp Dolor. 2005; 12(8):505–24.
8. Zackowski SW. CHRONIC RECURRENT ABDOMINAL PAIN.
Emerg Med Clin. 1998; 16(4):877–94.
9. Otero W, Ruiz X, Otero E, Gómez M, Pineda LF, Arbeláez V. Dolor
crónico de la pared abdominal: una entidad poco reconocida con
gran impacto en la práctica médica. Rev Colomb Gastroenterol.
2007; 22(4):261–71.
10. Henschke N, Kamper SJ, Maher CG. The epidemiology and
economic consequences of pain. Mayo Clin Proc. 2015;
90(1):139–47.
11. Camilleri M, Williams DE. Economic burden of irritable
bowel syndrome: Proposed strategies to control expenditures.
PharmacoEconomics. 2000;17(4):331–8.
12. Asociación Colombiana de Empresas de Medicina Integral
(Acemi). Cifras e indicadores del Sistema de Salud EPS asociadas
a Acemi [Internet]. Bogotá 2015 [consultado 10 Oct 2016] p.
430. Disponible en: https://www.minsalud.gov.co/sites/rid/Lists/
BibliotecaDigital/RIDE/INEC/ACEMI/salude_en_cifras-2013.pdf
13. Encuesta Nacional de Salud 2007: resultados nacionales.
Bogotá: Ministerio de la Protección Social, Colciencias, Cendex,
S.E.I.S.A. y Pontificia Universidad Javeriana; 2009.
14. Alvarez Echeverri T. Semiología del dolor. Iatreia. 2002;15(3):200–
206.
15. Drossman DA. Chronic functional abdominal pain. Am J
Gastroenterol. 1996;91(11):2270–81.
16. Fass R, Fullerton S, Tung S, Mayer EA. Sleep disturbances in clinic
patients with functional bowel disorders. Am J Gastroenterol.
2000;95(5):1195–2000.
17. Mayer E. The neurobiology of stress and gastrointestinal disease.
Gut. 2000;47(6):861–9.
18. Ungaro R, Mehandru S, Allen PB, Peyrin-Biroulet L, Colombel
JF. Ulcerative colitis. Lancet Lond Engl. 2017;389(10080):1756-
1770.
19. Zizic TM, Classen JN, Stevens MB. Acute abdominal
complications of systemic lupus erythematosus and polyarteritis
nodosa. Am J Med. 1982;73(4):525–31.
20. Whitehead WE, Palsson O, Jones KR. Systematic review of the
comorbidity of irritable bowel syndrome with other disorders:
what are the causes and implications? Gastroenterology.
2002;122(4):1140–56.
21. Clemens JQ, Meenan RT, O’Keeffe Rosetti MC, Kimes TA, Calhoun
EA. Case-control study of medical comorbidities in women with
interstitial cystitis. J Urol. 2008;179(6):2222–5.
22. Sieper J, Braun J, Dougados M, Baeten D. Axial spondyloarthritis.
Nat Rev Dis Primers. [Interntet] Julio 2015;1:15013. Disponible
en: https://www.nature.com/articles/nrdp201513
23. Mayer EA, Gebhart GF. Basic and clinical aspects of visceral
hyperalgesia. Gastroenterology. 1994;107(1):271–93.
24. Petrie KJ, Müller JT, Schirmbeck F, Donkin L, Broadbent E, Ellis
CJ, et al. Effect of providing information about normal test results
on patients’ reassurance: randomised controlled trial. BMJ.
2007;334(7589):352.
25. Astin M, Griffin T, Neal RD, Rose P, Hamilton W. The diagnostic
value of symptoms for colorectal cancer in primary care: a
systematic review. Br J Gen Pract. 2011;61(586):231-243.
26. Jackson PG, Raiji MT. Evaluation and management of intestinal
obstruction. Am Fam Physician. 2011;83(2):159–65.
27. Juliao Baños F, Fernando C, Sánchez MT, García Duperly R,
Bonilla DA, et al. Guía de práctica clínica para el diagnóstico
y tratamiento de la colitis ulcerativa en población adulta. Rev
Colomb Gastroenterol. 2015;30:75–88.
28. Shannahan S, Leffler DA. Diagnosis and Updates in Celiac
Disease. Gastrointest Endosc Clin N Am. 2017;27(1):79–92.
29. Saini S. Imaging of the Hepatobiliary Tract. N Engl J Med.
1997;336(26):1889–94.
30. Xue M, Chen X, Shi L, Si J, Wang L, Chen S. Small-bowel
capsule endoscopy in patients with unexplained chronic
abdominal pain: a systematic review. Gastrointest Endosc.
2015;81(1):186–93.
31. Pasha SF, Fleischer DE. Capsule endoscopy for abdominal pain
- is it of value or just another test for doctors to do?. Endoscopy.
2007;39(7):650–2.
32. Ching HL, McAlindon ME, Sidhu R. An update on small bowel
endoscopy. Curr Opin Gastroenterol. 2017;33(3):181-8.
33. Möschler O, May A, Müller MK, Ell C, German DBE Study
Group. Complications in and performance of double-balloon
enteroscopy (DBE): results from a large prospective DBE database
in Germany. Endoscopy. 2011;43(6):484–9.
34. Buscaglia JM, Dunbar KB, Okolo PI 3rd, Judah J, Akerman PA,
Cantero D, et al. The spiral enteroscopy training initiative: results
of a prospective study evaluating the Discovery SB overtube
device during small bowel enteroscopy (with video). Endoscopy.
2009;41(3):194–9.
35. May A, Nachbar L, Wardak A, Yamamoto H, Ell C. Double
balloon enteroscopy: preliminary experience in patients with
obscure gastrointestinal bleeding or chronic abdominal pain.
Endoscopy. 2003;35(12):985–91.
36. Bielefeldt K, Davis B, Binion DG. Pain and Inflammatory Bowel
Disease. Inflamm Bowel Dis. 2009;15(5):778–88.
37. Acosta S. Epidemiology of mesenteric vascular disease: clinical
implications. Semin Vasc Surg. 2010;23(1):4–8.
38. Rits Y, Oderich GS, Bower TC, Miller DV, Cooper L, Ricotta JJ
2nd, et al. Interventions for mesenteric vasculitis. J Vasc Surg.
2010;51(2):392–400.e2.
39. Hohenwalter EJ. Chronic Mesenteric Ischemia: Diagnosis and
Treatment. Semin Intervent Radiol. 2009;26(4):345–51
40. Harnik IG, Brandt LJ. Mesenteric venous thrombosis. Vasc Med.
2010; 15(5):407–18.
41. Balwani M, Desnick RJ. The porphyrias: advances in diagnosis
and treatment. Blood. 2012; 120(23):4496–504.
42. Ripamonti C. Management of bowel obstruction in advanced
cancer. Curr Opin Oncol. 1994; 6(4):351–7.
43. Barkun A, Leontiadis G. Systematic review of the symptom
burden, quality of life impairment and costs associated with
peptic ulcer disease. Am J Med. 2010; 123(4):358–366.e2.
44. Sonnenberg A. Temporal trends and geographical variations of
peptic ulcer disease. Aliment Pharmacol Ther. 1995; 9(2):3–12.
45. Steer ML, Waxman I, Freedman S. Chronic Pancreatitis. N Engl J
Med. 1995; 332(22):1482–90.
46. Sotgiu G, Sulis G, Matteelli A. Tuberculosis-a World Health
Organization Perspective. Microbiol Spectr. 2017; 5(1).
47. Aguado JM, Pons F, Casafont F, San Miguel G, Valle R. Tuberculous
peritonitis: a study comparing cirrhotic and noncirrhotic
patients. J Clin Gastroenterol. 1990 ;12(5):550–4.
48. Sanai FM, Bzeizi KI. Systematic review: tuberculous peritonitis--
presenting features, diagnostic strategies and treatment. Aliment
Pharmacol Ther. 2005 15;22(8):685–700.
49. Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Thompson
WG, et al. U.S. householder survey of functional gastrointestinal
disorders. Prevalence, sociodemography, and health impact. Dig
Dis Sci. 1993 ;38(9):1569–80.
50. Drossman DA. Severe and Refractory Chronic Abdominal Pain:
Treatment Strategies. Clin Gastroenterol Hepatol. 2008; 6(9):978–
82.
51. Macaluso CR, McNamara RM. Evaluation and management of
acute abdominal pain in the emergency department. Int J Gen
Med. 2012; 5:789–97.
52. Tack J, Talley NJ, Camilleri M, Holtmann G, Hu P, Malagelada
J-R, et al. Functional gastroduodenal disorders. Gastroenterology.
2006 Apr;130(5):1466–79.
53. Cid J, Andrés JD, Díaz L, Parra M, Leal F. Dolor abdominal crónico
(1a parte). Rev Soc Esp Dolor. 2005 Dec;12(8):505–24.
54. Berbel-Tornero O, Clemente-Yago F, García-Rodríguez C,
Pereda-Pérez A. Dolor abdominal crónico y recurrente. En:
Junta Directiva de la SEGHNP, coordinadores. Protocolos de
Gastroenterología, Hepatología y Nutrición pediátrica. 2da ed.
Madrid: Ergón S.A.; 2010. p. 29-35.
55. Talley NJ, Zinsmeister AR, Van Dyke C, Melton LJ. Epidemiology
of colonic symptoms and the irritable bowel syndrome.
Gastroenterology. 1991 Oct;101(4):927–34.
56. Swarbrick E, Bat L, Hegarty J, Williams C, Dawson A.Site of
pain from the irritable bowel. Lancet Lond Engl. 1980 Aug
30;2(8192):443–6.
57. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin
F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006
Apr;130(5):1480–91.
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