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Thursday, December 12, 2013
Chronic stomach pain immediately after eating
Hi, My 9 year old daughter has been getting stomach aches after eating for over 2 years. It has gotten progressively worse and now occurs with EVERY meal. The pain occurs within 5 minutes of eating, is sometimes mild, occasionally severe, and subsides within 10 to 20 minutes. It occurs with all foods, not just dairy, breads, etc. The doctor prescribed tagamet a month ago, thinkings its acid reflux. It has helped some but not a lot. They did blood and stool tests and they are all "normal", although I am not sure what they are testing for. They are working on a referral to a gastroenterologist but it is taking forever. I am fearing that she has something awful like stomach cancer, please tell me there are many other things that can be wrong. Thanks you!
Recurrent stomach pain is certainly a difficult problem to pin down. as a starting point, I would encourage you to ask your daughter's doctor to review all of her tests so far and explain what conditions the doctor feels have been ruled out. Some of the most common concerns are blood in the stool from bleeding ulcers or obstruction somewhere in the intestine and parasites or bacteria in the stool. Blood tests might rule out parasitic and bacterial infections, anemia due to blood loss, and inflammation due to Crohn's Disease or ulcerative colitis. So, do ask about these problems.
Other causes of persistent upper, mid- abdominal pain , also called epigastric pain, are ulcers, bulging of the top portion of the stomach through the the diaphragm into the chest cavity (hiatal hernia - sounds like high-ay-tal her-knee-a), and infection of the pancreas or pancreatitis. Pancreatitis can occur as a result of gall bladder irritation ans infection. Children do get gall bladder disease although not nearly as often as adults.
Common causes of pain in the lower mid-abdomen include irritable bowel syndrome (IBS), urinary tract infections, and pelvic inflammatory disease (PID). IBS tends to run in families and is believed to represent poor coordination of brain input to intestinal function. It leads to abdominal pain as well as alternating constipation and diarrhea. The good news is that it does not increase the risk for cancer or serious problems such as ulcerative colitis or Crohn's Disease. The bad news is that it is usually a lifelong problem that requires a consistently healthful lifestyle of good nutrition and physical activity to minimize symptoms.
PID is infection of the uterus and ovaries usually as a result of sexually transmitted diseases. This would indicate sexual abuse, something no parent wants to consider, but something critical to identify for the child's safety. However, this is very unlikely given that your child does not have a fever or severe, acute illness.
Other common causes of recurrent abdominal pain are separation anxiety and stress in the child's life. If there is change at home or school, stress at home or school, many children experience this psychological pain as abdominal pain or chronic headaches. These physical pains bring the child to adult attention for help with things they cannot cope with on their own but do not know how to express.
However, the fact that the pain occurs with meals suggests that it is more likely pain due to a physical problem. Without blood in the stool, you can be less anxious about the nature of the problem and need not fear stomach cancer or other serious problems. Stomach cancer occurs very, very seldom in children.
So my best advice is to return your child's doctor, gain a clear understanding of the tests performed and the problems eliminated by the tests, and move forward with the GI consult. You also might ask about an abdominal ultrasound to check for gall bladder problems and a urine test to rule out a bladder infection if these have not already been done.
I hope this information helps.
Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University