What Does Crohn's and Upper Stomach Pain Indicate?

MedicineNet defines abdominal pain as pain in the area bordered on the top by the lower ribs, on the bottom by the pelvic bone, and by the flanks on each side. This area, the abdomen, contains organs including the stomch, the small intestine, the colon, the liver, the gallbladder, and the pancreas. Sometimes pain that originates elsewhere, such as the lower lungs, the kidneys, or the uterus may be felt in the abdomen; this is called referred pain.

Most abdominal pain felt by Crohn's patients comes from the lower abdomen, where the colon and lower bowels are located. But since unlike ulcerative colitis, Crohn's disease can affect the entire digestive tract, from the mouth to the rectum, upper abdomen pain, or what feels like upper stomach pain, may sometimes be felt.

There are a few possible causes for upper abdomen pain. Pain in the upper left abdomen may be related to the stomach, the colon, the spleen or the gallbladder. In Crohn's patients, pain on the left side of the upper stomach is most often caused by the stomach, or referred pain from the colon. Pain in the upper right abdomen or upper right "stomach," is usually related to the gallbladder, although it too can be referred pain.

Pain in the upper stomach in Crohn's disease can indicate inflammation of the esophagus as it enters the stomach, or esophagitis. In a patient without Crohn's disease, a physician would first consider problems like acid reflux, eating disorders, or a sensitivity to medications, especially non-steroidal anti-inflammatories (NSAIDs) like ibuprofin, naproxin, or aspirin. But in a patient with Crohn's disease, a doctor must also consider that the upper stomach pain is from that Crohn's disease, and it is the inflammation from Crohn's that is causing the esophagitis. Your doctor will probably do some testing to eliminate the most common causes, but if it is determined to be Crohn's, the treatment might include an antibiotic, as sometimes the inflammation from Crohn's is caused by an infection, most often Helicobacter pylori, or H. pylori. If treatment by an antibiotic doesn't stop the pain and/or inflammation, an anti-inflammatory steroid might be used.

Another possibility for upper stomach pain in Crohn's is inflammation of the lining of the stomach, with or without the presence of an ulcer. In this case, the treatment would be the same as for esophagitis; use of an anti-biotic, since recent research has determined that ulcers, Crohn's-related or not, are most commonly caused by H. pylori bacteria, and if that fails to resolve the upper stomach pain, another anti-inflammatory, usually a steroid.

Upper stomach pain in Crohn's patients is likely to be the subject of more tests and different tests than it would be in a patient without a history of Crohn's disease, which might stop with a history of an eating disorder or acid reflux, or a computerized tomography (CT) scan or ultrasound test of the gallbladder. In a Crohn's patient, a flexible fiber optic tube may be inserted through the mouth and down the esophagus, so the doctor can see the tissue and note any bleeding or ulceration, or an X-ray may be done with barium, a thickened contrast dye that will coat the lining of the esophagus and stomach, allowing the radiologist to see if there are any polyps along with the inflammation. Testing of the colon may be done as well, to make sure that the upper stomach pain is not referred pain from the colorectal area.

Both esophagitis and stomach ulcers, the main culprits in upper stomach pain, are painful, and can be accompanied by nausea, acid reflux, and an inability to swallow. If they are treated early, though, they can usually be resolved fairly quickly. They don't usually cause as much distress as inflammation of the colon and/or rectum, which is usually accompanied by diarrhea, often explosive diarrhea, cramping, flatulence, and severe abdominal pain. I've found, though, that whichever one you happen to have is the one that, at the time, you will swear is the worst.

(References include www.medicinenet.com , specifically http://www.medicinenet.com/script/main/art.asp?articlekey=19008&pf=3&page=1 , an article by Dennis Lee, MD; www.genome.gov/pfv.cfm?pageID=25521854 ; www.itzarion.com/pain-symptoms-chart.html ; www.intellihealth.com ; http://www.mayoclinic.com/health/abdominal-pain/DG00013 ; http://www.cdc.gov/ulcer/ )