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Gastroenterology (Expert Forum)

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Lower Abdominal Pain-Please help!

Answered by

Kevin Pho, MD - Internal Medicine

Kevin Pho, MD Boston - MA

This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/ Diverticulosis, Digestive Disorders, IBS, Stomach Pain.

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MedHelp Member's Question

Lower Abdominal Pain-Please help!

by Pauli, Aug 16, 2004 12:00AM

Tags: abdominal, biopsy, celiac, negative, test, abdominal pain, Stomach Conditions

I am a 35-year old woman who has been experiencing lower abdominal pain since 7-3-04. (It began suddenly.) The pain is localized below the navel. (The area is about the size of a closed palm centered below the navel and extending downwards.) The first two weeks the pain was UNBEARABLE, and I was unable to sleep. The pain was more intense in the early a.m. hours. The pain went away completely for about 5 days and then came back. Then it was manageable for several days. (Pain was periodic.) But- for the last 3 days the pain has been constant and quite painful. If pain is present, it�s almost always present in the morning. My stomach will also sometimes make gurgling noises. When the pain was at it�s worst, the noises were loud. I have NO other related symptoms, such as fever, constipation, diarrhea, or nausea. My bowel movements and appetite are fine. I was in China on vacation for 1 week in late May.

I went to the ER on 7-11-04 and the docs concluded that fibroids were causing my pain. (I had a 7 cm. ovarian cyst surgically removed in 04/2003). I�ve seen several obgyn�s and had urine/blood tests, CT-Scan, ultrasounds, and an MRI. All the tests came out negative. The MRI did show small fibroids, but the last obgyn concluded that fibroids are not the cause of my pain. (My uterus is fine.)

I�ve been taking ibuprofen, Naproxen, and Darvocet for the pain. I�ve also been taking Pepcid for 1 week. I�m REALLY frustrated b/c my pain continues and my docs haven�t found the source.

-What could be causing my pain????

-What additional tests should be done??

Thank you,

Paula

Doctor's Answer

by Kevin Pho, MD

, Aug 16, 2004 12:00AM

With a negative CT scan, MRI and ultrasounds, then most of the major causes (i.e. diverticulitis, appendicitis, GYN causes) would be excluded.

You may want to consider evaluation to look inside the bowel.  This would include a colonoscopy to evaluate for any inflammation, polyps or masses that may not be seen during the imaging studies.  If you have been overseas, then stool tests for infection, ova, parasites, and C Difficile should all be done.

If everything is negative, the irritable bowel syndrome can be considered.  If this is suspected, treatment by increasing fiber in the diet as well as antispasmodic agents can all be considered.

A referral to a GI specialist can be considered for further discussion.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.

Medical Weblog:

kevinmd_b

Member Comments

by Suziepie20, Aug 19, 2004 12:00AM

Definately get a colonoscopy done but also have them check for elevated iga/igg gliadin antibody. This would mean you are gluten intolerant. My daughter suffered with the same pain and we sought a diagnosis that took 2 years. Finally she was diagnosed with Celiac Sprue Disease. 95 percent of celiac's go undiagnosed because here in the U.S. it is tested as a last resort. My daughters test turned up positive for elevated igg and the biopsy that was done during an endoscopy came back negative. The biopsy didn't come back positive because she didn't have villa atrophy. In other words the villa in her small intestines weren't affected at the time. A negative biopsy does not negate gluten intolerance. If the blood test comes back positive then you have it. Good Luck and please get checked out for this.

by acol, Oct 16, 2004 12:00AM

To: Suziepie20

my daughter, who is a type 1 diabetic, recently indicated an elevated igg in a routine screening exam. celiac is one of the many conditions covered at this routine screening since like type 1 diabetes, it is actually a problem in the body's immune system and it is therefore accompanies juville diabetes (type 1) 8% of the time. because the screening indicated the liklihood of celiacs, we proceeded to a specialist for a more specific blood test, which also came back positive. we then, at his advice, proceeded to the next step (what we were told was the only conclusive test for celiac) which was the biopsy. we just learned 2 days ago that the biopsy was negative. the doctor took 5 samples at varying locations within the intestine - none produced evidence of celiac. the doctors have told us to continue to delay taking her off of wheat/gluten and are debating whether to apply "watchful waiting" approach or to do further testing. i was curious at your comment that a negative biopsy was not as conclusive as the blood test as this is the opposite of what our doctor told us. could you share any other information you have? thanks,

acol

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