Chronic abdominal wall pain: clinical features, health care costs, and long-term outcome

Chronic abdominal wall pain (CAWP) often is misdiagnosed. We evaluated CAWP patients regarding diagnosis accuracy, clinical features, comorbidity, referral frequency, use of care, and long-term outcome.

We reviewed the records of all outpatients referred to a gastroenterologist in 5 years, recorded referral indications, and identified patients initially diagnosed with CAWP or irritable bowel syndrome (IBS). Charts of all CAWP patients were reviewed, and direct costs were estimated for abdominal pain-related physician visits and imaging studies during the 12 months before and 12 months after consultation. We appraised long-term pain status by telephone.

Of 2709 patients, CAWP was diagnosed by physical examination in 137 patients; the diagnosis remained unchanged after 47.3 +/- 17.7 (mean +/- SD) months in 133 (97.1%) patients. Women predominated over men 4 to 1, pain was usually upper abdominal, had lasted 25.3 +/- 46.3 months, and obesity and painful comorbidities and depression were common. CAWP and IBS comprised 7.8% and 16.3% of symptomatic referrals, respectively. Prereferral, physicians rarely suspected CAWP and often prescribed therapy for acid-peptic disease. Postconsultation, primary care, emergency and specialist visits, and radiologic examinations markedly decreased (P < 0.001), and estimated annual costs decreased from $1133.87 +/- 953.37 to $541.33 +/- 989.04 (P < 0.0001). Therapy varied, and 44 (47.3%) patients had no pain at follow-up evaluation.

CAWP is a common underrecognized disorder. Comorbidities are frequent, and health care use is high. Diagnosis is accurate and reduces health care costs. Over the long term, pain disappearance and persistence occurs in approximately equal proportions of patients.