What treatment is needed for abdominal pain and vomiting?

Treatment for Abdominal Pain and Vomiting

For abdominal pain and vomiting, treatment should target the predominant symptoms with antispasmodics for pain and antiemetics for vomiting, while investigating for underlying causes. 1

Initial Assessment and Management

• Perform a focused history to determine if symptoms are acute (≤7 days) or chronic (≥4 weeks), as this guides treatment approach 2
• Obtain blood tests including electrolytes, renal function, blood gas, and lactate levels to assess for dehydration and potential bowel ischemia 1
• Plain abdominal radiography during an acute episode is recommended to exclude bowel obstruction and other abdominal pathology 1

Medication Management for Abdominal Pain

• For abdominal pain, especially when exacerbated by meals, antispasmodic (anticholinergic) medications are recommended as first-line treatment 1
• If pain is frequent or severe, consider tricyclic antidepressants (TCAs) at low doses, which can help reduce visceral hypersensitivity 1
• For patients with psychological comorbidities and abdominal pain, selective serotonin reuptake inhibitors (SSRIs) at therapeutic doses may be more appropriate than low-dose TCAs 1

Management of Nausea and Vomiting

• For nausea and vomiting, antiemetics targeting dopaminergic pathways (metoclopramide, prochlorperazine) are first-line options 1
• Ondansetron (5-HT3 receptor antagonist) can be added as a second agent when first-line medications fail to control symptoms 1, 3
  • Typical dosing: 8 mg orally 30 minutes before meals for adults 3
• For patients with severe vomiting, ensure adequate hydration and electrolyte replacement 2

Dietary and Lifestyle Modifications

• Recommend small, frequent meals and avoidance of trigger foods 2
• For mild symptoms, dietary modifications and lifestyle changes may be sufficient 1
• Consider a low FODMAP diet for patients with moderate to severe gastrointestinal symptoms 1

Treatment Based on Symptom Severity

Mild Symptoms

• Education, reassurance, and simple treatments not requiring prescription medication 1
• Dietary modifications and lifestyle changes 1

Moderate Symptoms

• Pharmacological treatments directed at altered gut physiology 1
• Antispasmodics for pain and antiemetics for nausea/vomiting 1

Severe and Refractory Symptoms

• Consider antidepressant treatment (TCAs or SSRIs) 1
• Psychological treatments and support 1
• In severe cases, referral to a multidisciplinary pain center may be beneficial 1

Special Considerations

• If symptoms persist despite initial treatment, reevaluate in 3-6 weeks and consider additional studies based on symptom subtype 1
• Be cautious with antiemetics in patients with potential bowel obstruction, as they may mask progressive ileus 3
• For patients with chronic symptoms, consider psychological factors and treatments such as cognitive-behavioral therapy or hypnosis 1

Common Pitfalls to Avoid

• Failing to rule out serious underlying conditions like bowel obstruction or ischemia before symptomatic treatment 1
• Using opioids for abdominal pain, which can worsen gastrointestinal motility and lead to dependency 1
• Overlooking medication side effects as potential causes of symptoms 2
• Neglecting psychological factors that may contribute to or exacerbate symptoms 1