This is a method of using an endoscope inserted through the mouth to the opening of the bile duct located in the upper part of the small intestine, then injecting a contrast agent into the bile duct. It is used to diagnose, evaluate, and treat diseases related to the biliary system and pancreas, such as bile duct or pancreatic obstruction or narrowing caused by stones, fibrosis, or cancer. Patients usually visit the doctor with symptoms of pain in the area below the xiphoid process and right rib cage, along with jaundice or yellowing of the skin.
The advantage of this method over computed tomography (CT) or magnetic resonance imaging (MRI/MRCP) is that treatment can be performed simultaneously by removing obstructing stones or opening the bile duct and inserting a stent to drain the blocked bile duct without abdominal incisions. This results in less pain for the patient and a shorter hospital stay compared to abdominal surgery.
What diseases can cause chronic abdominal pain?
Abdominal pain is a common symptom in the general population and can present in various forms such as cramping, burning, or bloating. The severity depends on the underlying disease. Most cases are acute and resolve quickly, but if the pain is continuous or intermittent for more than 3 months, further investigation is needed.
Common causes of chronic abdominal pain
- Chronic gastritis mostly results from long-term poor eating habits such as irregular meal times, spicy food, late-night eating, alcohol consumption, and smoking. It may be triggered by stress, anxiety, use of irritating medications like muscle relaxants or painkillers, or Helicobacter pylori infection in the stomach.
The pain may vary in intensity. Severe cases can cause stomach ulcers, leading to intense abdominal pain that does not improve much with short-term medication or presents with chronic anemia, black stools, or blood in the stool.
- Gallstones Most people with gallstones are asymptomatic. A minority experience symptoms such as bloating after meals, especially after large or fatty meals. Early symptoms often resemble gastritis and may improve with antacids, but symptoms tend to become more frequent and severe due to acute inflammation of the gallbladder or bile duct obstruction by stones.
- Chronic pancreatitis often caused by alcohol consumption or stones blocking the bile or pancreatic ducts. Patients may experience severe intermittent abdominal pain radiating to the mid-back.
- Irritable bowel syndrome Patients experience abdominal pain along with abnormal bowel movements, which may be diarrhea or constipation. Symptoms are often related to food intake or stress. Diagnosis is based on symptoms and additional gastrointestinal endoscopy, which usually shows no abnormalities.
- Food allergies Chronic inflammatory bowel disease is uncommon in Thai people and usually presents with chronic diarrhea and mucus or blood in the stool.
- Chronic infections such as parasitic infections or tuberculosis, often accompanied by diarrhea.
- Intestinal adhesions commonly found in patients with a history of abdominal surgery. Symptoms include bloating, intermittent severe abdominal pain, and difficulty passing stool.
- Chronic appendicitis
- Gastrointestinal cancers such as stomach, liver, pancreas, and colon cancer. Symptoms depend on the cancer location.
- Other systemic diseases outside the gastrointestinal system such as kidney stones or chronic urinary tract infections causing abdominal pain.
Other causes include menstrual pain, endometriosis, uterine fibroids, or ovarian cysts.
There are many causes of chronic abdominal pain. In the early stages, pain from different diseases may appear similar and may improve with similar medications. However, if the patient notices increasing severity and frequency of pain, poor response to medication, or other abnormalities such as fever, decreased appetite, nausea, vomiting, weight loss, anemia, or changes in bowel habits, they should see a doctor for diagnosis. Diagnosis may involve history taking, physical examination, blood tests, and special investigations such as X-rays, ultrasound, CT scans, and endoscopy of the stomach or colon to ensure proper treatment.
Dr. Natthiwut Wattanarakskul
Gastroenterology Specialist
Gastrointestinal and Liver Center, Phyathai 2 Hospital
