The burden of illness and healthcare use associated with abdominal pain is high in the United States, affecting almost half of the population at some point in their lives. However, 40% of persons do not seek care for their abdominal pain symptoms, even though many have undiagnosed and treatable disorders, researchers report in the September issue of Clinical Gastroenterology and Hepatology.
Abdominal pain is the leading gastrointestinal cause of ambulatory visits in the United States, but not much is known about its prevalence and burden in general community—most studies have focused on functional GI disorders such as irritable bowel syndrome (IBS) and functional dyspepsia.
Krutika Lakhoo et al studied the prevalence and characteristics of abdominal pain in a survey of nearly 25,000 adults across the United States. They assessed the epidemiologic, clinical, and health care-seeking features of individuals with abdominal pain and aimed to determine the prevalence of rare abdominal pain symptoms.
To characterize individuals reporting abdominal pain, Lakhoo et al had respondents complete the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) abdominal pain questionnaire, and collected information on pain control, disability related to pain, and perceived etiology of their symptoms. The authors also examined whether respondents experienced episodes of excruciating abdominal pain that lasted more than 1 day and required them to seek urgent medical care.
Overall, 24,929 individuals accessed the survey and 10,300 respondents reported experiencing abdominal pain and completed the questionnaire. Most participants (n=8344, 81.0%) had symptoms in the past week, measured by GI PROMIS. Sixty percent had started experiencing abdominal pain fewer than 5 years ago, 14.8% had pain that started 6–10 years ago, and 24.1% had pain that started more 11 or more years ago (n = 2485, 24.1%), or unknown (n = 111, 1.1%).
Of the overall cohort, 3558 patients (34.5%) stated that they had excruciating abdominal pain that lasted more than a day and required urgent medical attention. Additionally, 4805 (46.7%) of 10,300 individuals reported having been diagnosed by a physician with conditions that affect the GI tract or are commonly associated with GI disorders. Most patients felt that their GI pain was caused by food, although many were unsure of the cause or thought that gas and bloating, constipation, or stress or anxiety were involved.
Lakhoo et al found that individuals with lower locus of control (believe they have less control over events that affect their symptoms) are more likely to seek care for their pain. However, these individuals might be resistant to accepting their physicians’ assessments and recommendations, particularly if these patients receive diagnoses of functional disorders. Studies have shown that patients with IBS that have lower locus of control are less likely to rapidly respond to cognitive behavioral therapy.
Previous studies have shown that racial or ethnic minorities generally use health services at a lower rate vs non-Hispanic Whites, but Lakhoo et al propose that abdominal pain disproportionality affects quality of life for non-Hispanic Blacks and Latinos, causing them to be more likely to seek care. The findings might also reflect cultural factors in reporting specific symptoms to health care providers. Given the decrements to quality of life caused by abdominal pain and the potential for serious underlying pathology, studies are needed to increase our understanding of different attitudes and barriers to health care seeking.