Abstract
This study aimed to investigate consultation outcomes from gastroenterologists to generalist physicians for the diagnostic workup of undiagnosed chronic abdominal pain. This was a single-center, retrospective, descriptive study. Patients were included who were ≥15 years old and consulted from the Department of Gastroenterology to the Department of Diagnostic Medicine, to establish a diagnosis for chronic abdominal pain, at the Dokkyo University Hospital from 1 April 2016 to 31 August 2020. We retrospectively reviewed the patients’ medical charts and extracted data. A total of 12 cases were included. Eight patients (66.7%) were diagnosed with and treated for functional gastrointestinal disorders (FGID) at the Department of Gastroenterology; their lack of improvement under treatment for FGID was the reason for their referral to the Department of Diagnostic Medicine for further examination. After this consultation, new possible diagnoses were generated for eight patients (66.7%). Six of the eight patients (75.0%) were diagnosed with abdominal wall pain (anterior cutaneous nerve entrapment syndrome, n = 3; myofascial pain, n = 1; falciform pain, n = 1; and herpes zoster non-herpeticus; n = 1). Consultation referral from gastroenterologists to generalists could generate new possible diagnoses in approximately 70% of patients with undiagnosed chronic abdominal pain.
Highlights
Abdominal pain is one of the most frequent complaints for which patients seek medical attention
We retrospectively reviewed the subjects’ medical charts and extracted data regarding sex, age at the time of the referral visit, time from the onset of illness to referral, number of institutions or departments visited before referral, details of the histories of abdominal pain, details of the examinations, and the therapeutic interventions performed at the Departments of Gastroenterology and Diagnostic and Generalist Medicine, respectively, the final diagnosis, and the prognosis
We found that new possible diagnoses were generated in 66.7% of 12 patients who were referred from gastroenterologists to generalists for undiagnosed chronic abdominal pain in the setting of a tertiary hospital
Summary
Abdominal pain is one of the most frequent complaints for which patients seek medical attention. Advances in diagnostic technology have made it possible to diagnose the causes of abdominal pain quickly and accurately, there are still patients who have undiagnosed chronic abdominal pain [1]. These patients must visit multiple medical institutions, including tertiary hospitals. Gastroenterology departments in tertiary hospitals usually play a critical role in diagnosing difficult abdominal pain; detailed investigations can provide patients with definitive diagnoses. Because abdominal pain can develop from causes other than gastrointestinal diseases, even after workup by gastroenterology specialists, some patients still require a diagnosis. Since the general internal medicine department is another department where the prevalence of referred patients with undiagnosed abdominal pain is high [2], in such cases, a consulted generalist may assist diagnosis
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