Abdominal Pain

What is tummy ache?

“Tummy ache” is a person’s description of abdominal discomfort. Other common terms include bloating, wind, poor digestion or a pulling abdominal discomfort. When assessed by a physician, “tummy ache” is to be differentiated from colic (a squeezing pain) and inflammatory pain within specific organs (for e.g. acute appendicitis or acute cholecystitis).

Symptoms of tummy ache include dyspepsia and less commonly, intestinal colic.

Dyspepsia literarily means “poor digestion”. This is a common symptom affecting many individuals. It can occur under normal circumstances should an individual overeat, experience dietary indiscretion or experience irregular meals. Dyspepsia may be “ulcer-like” or “dysmotility-like” in presentation.

• “Ulcer-like” type dyspepsia is the burning sensation that one experiences during meals. Historically, it was assumed to be related to ulcers in the stomach or duodenum. With the advent of upper gastrointestinal endoscopy, it is seen that ulcers occur only in a small proportion of cases, with non-ulcer dyspepsia occurring predominantly. In situations where the stomach acid refluxes into the esophagus, symptoms of “heartburn” dominate.
• “Dysmotility-like” type dyspepsia is commonly encountered. Locally, this symptom is commonly described as “wind”, a sensation of “bloating”, abdominal distension or “cannot digest”. Dysmotility symptoms can occur with disorders in the stomach or large colon. Less commonly, it occurs with disorders of the biliary tree or pancreas.

When dyspepsia is poorly characterized, it is important for sinister causes to be addressed especially in elderly individuals who are at higher risk of systemic and malignant disease.

Tummy ache is caused by a variety of factors. Broadly speaking, these factors can be divided into two distinct groups:

• Problems within the digestive tract or “digestive tract diseases”.
• Problems involving important organs in the body or “systemic diseases”.

In the digestive tract, functional digestive disorders remain the commonest cause of tummy ache. Of significant concern, however are ulcers of the stomach, colorectal malignancies or pancreatic cancers. Although the latter causes are less common, they remain a cause of significant health concerns when symptoms of tummy ache occur.

Functional digestive disorders remain the commonest cause of tummy ache. In Non-ulcer Dyspepsia (NUD) and Irritable Bowel Syndrome (IBS), the problems involve disordered function of the stomach and colonic function respectively.

NUD is commonly related to irregular meals and dietary indiscretion. In a small proportion of patients, Helicobacter pylori contribute to symptomatic disease. The cause of Irritable bowel syndrome is multifactorial in origin. In functional digestive disorders, psychological factors play an important role in driving the health seeking behavior. It is important that the role of psychological factors be understood and appropriately addressed in functional digestive disorders.

Systemic diseases are important and significant causes of symptoms troubling the digestive system. As an example, patients with diabetes mellitus often experience poor digestion due to poorly controlled diabetes. Alternatively, patients experiencing insomnia will experience daytime somnolence which will potentially manifest as poor appetite. Lastly, patients with heart failure will experience poor digestion when symptoms of shortness of breath occur.

It is important that the diagnosis of functional digestive disorders not be assumed. Rather, a positive diagnosis is important in ensuring that significant medical conditions like thyroid disorders, celiac disease or chronic pancreatitis be appropriately managed.

The etiological diagnosis of “tummy ache” is difficult because of its many underlying causes. It is therefore important that a physician be consulted when significant symptoms occur. Often, symptoms of “tummy ache” resolve spontaneously within a period of a few hours or days. An appropriate assessment by a family or general physician is needed should prolonged symptoms occur. A referral is made for specialist care when deemed necessary by a primary care physician.

The diagnosis requires a detailed clinical history and physical examination. Laboratory test are requested to assist in the diagnostic process. The use of radiology and endoscopy assist in visualizing the internal organs. Finally, endoscopic assessment allow for biopsies to be taken to confirm certain medical conditions like Helicobacter Pylori infection.

The treatment of “tummy ache” is divided into “symptomatic treatment” and “definitive treatment”.

The majority of cases of “tummy ache” resolve spontaneously. In such cases, “symptomatic treatment” is adequate in alleviating the discomfort related to the illness. This can be achieved with mild analgesics or anti-spasmodic medications. As an example, should “tummy ache” occur following an episode of food poisoning, gut rest and fluid replacement therapy would suffice over one or two days. Alternatively, abdominal bloating following a heavy meal would resolve within the day.

In cases where “tummy ache” does not resolve spontaneously or raise concern, further assessment and investigation will reveal a “definitive cause” or etiology. Such cases include non-ulcer dyspepsia, gastric ulcers, duodenal ulcers, symptomatic gallstone disease and irritable bowel syndrome. A positive diagnosis is important in ensuring appropriate management and treatment.