Disease Description (Causes and Symptoms)
- Definition summary: Stomach cramps refer collectively to symptoms of severe, squeezing pain in the epigastric (upper abdominal) area after eating or suddenly, rather than the stomach itself actually having a “cramp.” They are a symptom of various abdominal diseases rather than a disease on their own.
- Main causes: Gallstones (biliary spasm/gallstone attack caused by gallbladder stones), acute pancreatitis, gastric ulcer·duodenal ulcer, acute gastritis, and other upper abdominal lesions (biliary obstruction, cholecystitis, etc.).
- Pathophysiology (briefly): Inflammation, obstruction, or irritation of upper abdominal organs (the stomach, biliary tract, pancreas, etc.) is transmitted as severe visceral pain through the autonomic nervous system, causing excruciating pain along with sympathetic nervous system responses (pallor, cold sweats, nausea·vomiting, etc.).
- Main symptoms: Sudden, squeezing pain in the epigastric area (upper abdomen), nausea·vomiting, cold sweats·pallor; physical examination findings often do not remain after the pain subsides.
Treatment Methods
- Emergency and symptomatic treatment
- Rest and fasting (in cases of severe vomiting·pain), establishment of intravenous access and fluid replacement (correction of dehydration·electrolyte imbalance).
- Painkillers: Initially, Tylenol (acetaminophen) or weak painkillers may be used at the physician’s discretion. NSAIDs should be used with caution because they may worsen suspected gastric ulcers. Opioid painkillers may be necessary for severe pain (as directed by a physician).
- Antiemetics (e.g., metoclopramide) and antispasmodics (e.g., Buscopan [scopolamine-class antispasmodic]) may be used to relieve symptoms.
- Standard treatment by cause (treating the cause is key)
- Gallstones (gallbladder·biliary tract disease): Pain control, fluids, and antiemetic treatment during an acute gallstone attack. Laparoscopic cholecystectomy may be considered for recurrent symptoms or complications (cholecystitis, biliary obstruction). If common bile duct obstruction is suspected, ERCP (endoscopic retrograde cholangiopancreatography) may be necessary.
- Acute pancreatitis: Hospitalization for fasting (NPO), aggressive fluid therapy, pain control·nutritional management, and additional treatment according to the cause (such as gallstones; gallstone removal when caused by gallstones)
- Gastritis·gastric ulcer·duodenal ulcer: Acid-suppressing medication (PPI), testing for Helicobacter pylori and eradication therapy (if necessary), discontinuation of NSAIDs, etc.
- Lifestyle management and precautions
- Severe pain·persistent vomiting·jaundice·high fever·bloody stool, or fainting·low blood pressure are emergency situations requiring an immediate visit to a medical institution.
- Manage risk factors for gallstones·pancreatitis, such as gout·hyperlipidemia·obesity·excessive alcohol consumption (weight control, limiting alcohol consumption, etc.).
- Avoid NSAIDs, alcohol, and irritating foods (especially important when gastric ulcer or pancreatitis is suspected).
Checklist Before an Outpatient Visit (Including Example Questions)
- Items/documents to prepare
- List of medications currently being taken (including prescription·nonprescription medications and herbal medicines), history of allergies
- Previous diagnoses and surgical history (especially whether gallbladder-related surgery was performed)
- Recent test results (liver function, blood tests, abdominal ultrasound, CT, and copies of upper endoscopy results, if available, may be useful)
- Symptom record: when the pain began·frequency·condition at onset (after eating·on an empty stomach)·nature of the pain (squeezing/like being cut with a knife)·accompanying symptoms (fever·jaundice·vomiting·bloody stool, etc.) and factors that relieve·worsen the pain
- What to explain to the doctor first during the outpatient visit
- The exact location·severity of the pain (pain score), time·frequency of occurrence, and recent food·medication·alcohol consumption history
- Photos taken when symptoms occurred (jaundice·pallor, etc.), and whether you recently received emergency-room treatment or were hospitalized
Examples of General Questions to Ask the Doctor
- “What are the possible causes of this pain? What tests are needed?”
- “What are the side effects and precautions of the medication you plan to prescribe?”
- “What is the prognosis? What lifestyle changes should I make to reduce recurrence?”
Examples of Condition-Specific Questions
- When gallstones are suspected as the cause: “If gallstones are seen on the ultrasound, is surgery needed immediately? In what cases is observation appropriate?”
- When peptic ulcer disease/gastritis is suspected: “Will I need an upper endoscopy? Do I need Helicobacter pylori testing and eradication treatment?”
(Additional recommendation) If severe pain·shortness of breath·altered consciousness·low blood pressure·high fever·persistent vomiting·black stool, or jaundice occurs, please visit an emergency room immediately.