Diagnosis After Newly-Recorded Abdominal Pain Often Remains Unexplained

Sarah J Price, PhD

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.