Diagnoses after newly-recorded abdominal pain in primary care: observational cohort study

Abstract

Background: Non-acute abdominal pain in primary care is diagnostically challenging. Aim: To quantify the 1-year cumulative incidence of 35 non-malignant diagnoses and 9 cancers in adults after newly-recorded abdominal pain in primary care. Design and setting: Observational cohort study of Clinical Practice Research Datalink records. Methods: Participants (n, %male) aged 40-59 (n=59,864, 50.0%), 60-69 (n=29,461, 49.2%) and ≥70 (n=36,468, 36.9%) had newly-recorded abdominal pain during 01/01/2009-31/12/2013. Age- and sex-stratified 1-year cumulative incidence (95% confidence interval) by diagnosis is reported. Results: Most (>70%) participants had no pre-specified diagnoses after newly-recorded abdominal pain. Non-malignant diagnoses were most common: upper gastrointestinal problems (gastro-oesophageal reflux disease, hiatus hernia, gastritis, oesophagitis, and gastric/duodenal ulcer) in men and urinary tract infection in women. The incidence of upper-gastrointestinal problems plateaued at ≥60 years [40-59: men 4.9% (4.6%–5.1%), women 4.0% (3.8%–4.2%); 60-69: men 5.8% (5.4%–6.2%), women 5.4% (5.1%–5.8%)]. Urinary tract infection incidence increased with age [40-59: women 5.1% (4.8%–5.3%), men 1.1% (1.0%–1.2%); ≥70: women 8.0% (7.6%–8.4%), men 3.3% (3.0%–3.6%)]. Diverticular disease incidence rose with age, plateauing at 4.2% (3.9%–4.6%) in men ≥60, increasing to 6.1% (5.8%–6.4%) in women ≥70. Irritable bowel syndrome incidence was higher in women (40-59: 3.0%, 2.8%–3.2%) than men (40-59: 2.1%, 2.0%–2.3%), decreasing with age to 1.3% (1.2%–1.5%) and 0.6% (0.5%–0.8%) at ≥70. Conclusion: We rank the incidence of diagnoses after newly-recorded abdominal pain by sex and age. While abdominal pain commonly remains unexplained, non-malignant diagnosis are more likely than cancer.