Like physicians in all specialties, Rakesh Gupta, M.D., gastroenterologist, treats patients for acute as well as chronic abdominal pain. Chronic abdominal pain – which Dr. Gupta defines as at least two weeks in duration, sometimes months or years -can seem mysterious, even sinister.

Identifying and treating sources of chronic abdominal pain can be frustrating for both physician and patient. Diagnosis can be elusive; treatment, oftentimes, can seem ineffective.

Over the years of his practice, Dr. Gupta has encountered many cases of difficult-to-pinpoint chronic abdominal pain. He discussed his insights and experiences recently with HEALTH SCENE.

"As physicians, we're traditionally taught to look for one disease that causes various symptoms. My experience with chronic abdominal pain is that this single-cause theory doesn't work. Actually, a complex combination of factors may be the culprit," Dr. Gupta says.

Factors

"There are two main types of factors to consider. The first type is disease. Diseases tend to be well-defined clinical entities, such as cancer, ulcer, diabetes or tuberculosis. These have well-defined management guidelines.

"The other factor is the mechanism. Mechanisms are generally not as well defined as diseases.

A mechanism is a method by which the body carries out a particular job, e.g., digesting food, eliminating feces or urine, discarding gas, etc. When there is a problem with a mechanism, the body is just not functioning in a normal way."

Examples of mechanism-related problems include spastic colon, lactose intolerance, sphincter incoordination, and aerophagia (swallowing an excess amount of air).

"In most patients, the cause ofchronic abdominal pain is a combination of disease and failure of normal mechanisms," Dr. Gupta says.
Pursuing a Diagnosis

Attempting to understand the right combination of factors is what presents the challenge. "The specifics of how you approach this vary from case to case and are dictated by experience. But the reason diagnosis can be so elusive is that we sometimes seek a simple solution to a complex problem. Although we have part of the answer, we need to pursue until we find solutions or explanations for all the systems involved", Dr. Gupta says.


When pursuing a diagnosis, you have to know when to stop. But you also have to know when not to stop.

"What I'm saying to those with chronic pain is, 'You're not crazy.' There is probably an answer. We have to strive for unlocking the right combination. And there's an excellent chance that we can do that successfully."
A Complex Combination

According to Dr. Rakesh Gupta, most patients suffer from chronic recurrent abdominal pain as a result of a complex combination of diseases and / or mechanisms. Systemic diseases

    Diabetes
    Adrenal dysfunction
    Renal dysfunction
    Thyroid dysfunction
    Anemia

Organ system diseases

    Intra-abdominal
    Extra-abdominal
    Chest
    Spine
    Neurogenic

Mechanisms

    Aerophagia (air hunger)
    Reduced pain threshold
    Spastic bowel
    Abdominal wall rheumatism
    Depression / anxiety
    Behavioral disorder
    Hypotonic bowel
    Gastric emptying problems
    Gallbladder and common bile duct dysomtility
    Specific food intolerance / non-specific food intolerance
    Bacterial overgrowth


GALLSTONE
TREATMENTS COMPARED
 
•  Only effective on cholestorol stones.

•  Doesn’t work on larger stones.
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•  Cannot be used for patients with more than three stones.

•  Salts will be effective only if the gallbladder is functioning normally.

•  The success rate is only 30 percent. Of this 30 percent, stones will recur in half the patients.

•  Treatment is a temporary solution to the problem. Surgery is more definitive.

•  Treatment takes from 12 to 18 months to dissolve the stones.

•  The treatment doesn’t necessarily cost less than surgery. Medication may run to $3,000 per year.

•  Long-term safety risks with continued usage are unknown.

   

•  Technique is not optimally perfected and is approved only in certain testing centers.
•  There is significant risk of damage to the intestine or lungs.

•  Only 25 percent of patients are acceptable for lithotripsy, due to risk factors, locations of stones, etc.

 

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