Upper abdominal pain is a common clinical problem and is usually secondary to gastroenterological disorders. In the assessment of acute abdominal pain, the possibility of an acute abdomen must always be considered in case emergency surgery is required.
Causes of chronic upper abdominal pain
Most patients with chronic upper abdominal pain do not have structural disease. A recent survey of 1 00 such patients referred to gastroenterological clinic showed that functional disease accounted for 68 of all cases (irritable colon 47, non-ulcerdyspepsia 21).Other common causes of pain included: duodenal ulcer 16, gastric ulcer 6, gallstones 5 and carcinoma 4. One patient had upper abdominal pain of cardiac origin. No patient with macroscopic oesophagitis was included in the above study. Some of the patients labeled as non-ulcer dyspepsia may have had oesophageal reflux disease as investigations for oesophageal disease were not performed routinely. Since patients attending a gastroenterological clinic are pre-selected in favour of organic disease, the frequency of functional disease in patients seen in general practice would be considerably higher. Less commonly, chronic upper abdominal pain can arise from the liver, the kidneys, or be musculoskeletal in origin.