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How Many People in the US Have Abdominal Pain and What Do They Do About It?

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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.

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.

Of participants with prior GI pain, 61.5% sought medical care for their symptoms; non-Hispanic Blacks, Latinos, and participants with more education, insurance, a usual source of care, comorbidities, and more severe pain had increased odds for seeking care. Participants who sought care consulted with the following providers: primary care physicians (84.5%), gastroenterologists (39.2%), nurse practitioners or physician assistants (18.6%), obstetricians or gynecologists (8.3%), general surgeons (7.1%), or rheumatologists (3.2%).Most (91.9%) the individuals who had excruciating bouts of pain that lasted more than 1 day sought medical care. Of those who sought care, most went to an emergency room (58.3%) or doctor’s office ( 45.6%), and 17.5% of these individuals were hospitalized for their symptoms.Moreover, 72.4% of healthcare seekers underwent testing to evaluate their pain: cross-sectional imaging (54.2%), colonoscopy (52.3%), upper endoscopy (40.8%), exploratory surgery (6.3%), or capsule endoscopy (5.0%).Physician-diagnosed GI disorders reported by respondents included gastroesophageal reflux disorder (GERD, 18.4%), diabetes (10.9%), gallstones (9.7%), IBS (6.1%), peptic ulcer disease (4.8%), ulcerative colitis (2.5%), Crohn’s disease (1.8%), and celiac disease (1.6%).Lakhoo et al found that 23.4% of individuals with prior abdominal pain have profiles consistent with those of acute hepatic porphyria (AHP). AHP is rare, so clinicians may not be aware of or routinely assess for neuropsychiatric, neurovisceral, and cutaneous symptoms in patients with multiple episodes of excruciating abdominal pain. In multivariable regression, individuals who identified as Latino or other race or ethnicity and who had a usual source of care, comorbidities, lower perceived locus of control, and more severe pain had higher odds for having symptoms resembling those of AHP.Although previous studies have examined the population prevalence of abdominal pain, these studies were limited by the lack of diversity of their cohorts, focus on only upper abdominal pain, or exclusion of participants with physician-diagnosed GI disorders, or were performed decades ago. Furthermore, previous studies did not assess in detail health care use or and diagnostic testing. Lakhoo et al studied persons with pain (not discomfort) anywhere in the abdomen at any point in the past and in the last week, and included all-comers, such as those with physician-diagnosed GI disorders.

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.

 

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Kristine Novak

Kristine Novak

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About The Author:

Dr. Kristine Novak

Dr. Kristine Novak

Dr. Kristine Novak is a science writer and editor based in San Francisco. She has extensive experience covering gastroenterology, hepatology, immunology, oncology, clinical, and biotechnology research discoveries.

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