Diagnosis After Newly-Recorded Abdominal Pain Often Remains Unexplained

April 29, 2022
Connor Iapoce

Connor Iapoce is an associate editor for HCPLive and joined the MJH Life Sciences team in April 2021. He graduated from The College of New Jersey with a degree in Journalism and Professional Writing. He enjoys listening to records, going to concerts, and playing with his cat Squish. You can reach him at ciapoce@mjhlifesciences.com.

The most common diagnoses were found to be non-malignant, including upper gastrointestinal problems in men and urinary tract infections in women.

A recent study ranked the incidence of diagnosis after newly-recorded abdominal pain by sex and age, finding abdominal pain commonly remains unexplained in this patient population.

Investigations observed the most common diagnoses are non-malignant, including upper gastrointestinal problems in men and urinary tract infections in women which may help inform appropriate testing strategies.

“Notably, over 70% of participants at all age groups did not have a pre-specified diagnostic code in the year after their index date, suggesting that their abdominal pain remained unexplained,” wrote study author Sarah J Price, PhD, University of Exeter Medical School.

Differential diagnoses of abdominal pain are determined by a patient’s history and examination, wherein symptoms can be acute or chronic. Despite the potential of an apparent diagnosis, severity of a condition drives management of that condition.

The current study aimed to follow-up a cohort of patients for 1 year after newly-recorded abdominal pain in primary care. Investigators quantified the 1-year cumulative incidence of pre-specified malignant and non-malignant differential diagnoses of abdominal pain in adults aged >40 years.

The Clinical Practice Research Datalink (CPRD GOLD) primary care database provided participants with at ≥1 abdominal pain code between January 2009 - December 2013. The index date was considered the date of the first abdominal pain code in the period.

Participants were aged ≥40 years on the index date and had continuous CPRD records meeting up-to-date standards from ≥1 year before the index date and throughout their 1-year follow-up period.

The study outcome was the 1-year cumulative incidence of pre-specified medical diagnoses in the year after newly-recorded abdominal pain, reported with 95% confidence intervals for men and women in age bands 40 - 59 years, 60 - 69 years, and ≥70 years.

A total of 125,793 participants were included in the study. Data show most (>70%) participants in all age groups did not have a pre-specified diagnosis after newly-recorded abdominal pain.

At least one condition was diagnosed in 4,952/29,944 (16.5%) and in 6,489/29,920 (21.7%) women. In men, non malignant diagnoses were most common, including upper gastrointestinal problems, gastro-oesophageal reflux disease, hiatus hernia, gastritis, oesophagitis, and gastric/duodenal ulcer. In women, urinary tract infection was the most common.

The incidence of upper-gastrointestinal problems was noted to plateau at ≥60 years [40 - 59 years: men 4.9%, women 4.0%; 60 - 69 years: men 5.8%, women 5.4%). Meanwhile, the incidence of urinary tract infection increased with age [40 - 59 years: women 5.1%, men 1.1%; ≥70 years, women 8.0%, men 3.3%].

Additionally, diverticular disease incidence increased with age and plateaued at 4.2% in men aged ≥60 years and increased to 6.1% in women ≥70 years. The incidence of irritable bowel syndrome was higher in women (40 - 59 years: 3.0%) than men (40 - 59 years: 2.1%), and decreased with age to 1.3% and 0.6% at ≥70 years.

The study, “Diagnoses after newly-recorded abdominal pain in primary care: observational cohort study,” was published in the British Journal of General Practice.