A Diagnostic Approach to Chronic Abdominal Pain

Abstract

Chronic abdominal pain is a condition routinely encountered in clinical practice. The differential diagnosis for chronic abdominal pain is broad and can be categorized using a location- and character-based approach. The evaluation begins with a thorough history, comprehensive exam, and thoughtful diagnostic approach. If warning signs are absent and no obvious underlying etiology is identified, patients should be stratified into low-risk versus high-risk categories based on age and associated symptoms. Low-risk patients (age <60 years and without alarm symptoms) may be offered empiric pharmacologic and/or psycho-behavioral treatment directed at the principal underlying symptom without further investigation. High-risk patients (age ≥60 years or with alarm features) may require additional evaluation prior to treatment.