Diagnostic Yield of Endoscopic Procedures in Patients with Chronic Abdominal Pain

Abstract

Purpose: Abdominal pain is a common presenting complaint in both primary care as well as gastroenterology practices. The causes of abdominal pain are extremely diverse and range from conditions that require urgent surgical therapy to those without serious underlying pathology where the problem either settles spontaneously, or becomes chronic without any abnormalities on laboratory or clinical workup. The purpose of study is to analyze the diagnostic yield of endoscopic procedures in this group of patients. Methods: A retrospective chart review was carried out on patients with chronic abdominal pain who had an endoscopic procedure done based on ICD 10 codes. Significant finding was defined as pain which required therapy within 1 month and they were IBD, colitis, PUD, Barrett's esophagus, cancer, diverticulitis, stricture and obstruction. Odds Ratio (OR) and p values were calculated for factors to see their influence on the diagnostic yield of endoscopic procedures.Table: [1891]Results: A total of 259 patients were identified with chronic abdominal pain of which 29% (n=76) had colonoscopy, 36% (n=92) had endoscopy and 35% (n=91) had both procedures done. Among all the procedures only 18.5% (n=48) had a significant finding. Of the patients who had a significant finding 73% (n=35, OR 0.83, p value not significant) were females, 27% (n=13) were males, average age was 50+16.6 years (p value not significant), average duration of abdominal pain was 14+23 months (p value not significant), average BMI was 28.4+7 (p value not significant). Among the significant findings IBD was 30% (n=15), colitis was 18% (n=9), PUD was 16% (n=8), cancer was 14% (n=7), stricture was 6% (n=3), obstruction was 6% (n=3), diverticulitis was 4% (n=2), Barrett's esophagus was 4% (n=2) and celiac disease was 2% (n=1). Among the total patients 42% (n=109) had an incidental finding of which inflammation (37%, n=53) was the most common followed by hemorrhoids (20%, n=29). Of the presenting symptoms only diarrhea (p<0.05) had a significant influence on procedure outcome. Conclusion: The diagnostic yield of endoscopic procedures in patients with chronic abdominal pain is low. Diarrhea as a presenting symptom had significant influence on procedure outcome but n was only 4.