Gastrointestinal Complaints#

Approach to common GI complaints in primary care. Most GI presentations can be managed in the office with appropriate risk stratification—the key is identifying who needs urgent evaluation (GI bleed, obstruction, acute abdomen) versus empiric treatment.

Key Principles#

• Acute vs chronic: Different differentials and urgency; always clarify timeline
• Alarm features: Weight loss, anemia, dysphagia, GI bleeding, age >50 with new symptoms → lower threshold for endoscopy
• Medication review: NSAIDs, PPIs, opioids, antibiotics, and supplements cause many GI symptoms
• Functional disorders: IBS, functional dyspepsia are diagnoses of exclusion but extremely common

Topics#

Pain Syndromes#

• Abdominal Pain (Acute) — <72 hours; rule out surgical emergencies
• Abdominal Pain (Chronic) — >4 weeks; functional vs organic causes

Upper GI#

• Nausea/Vomiting — acute vs chronic; medication-induced vs organic
• Dyspepsia/GERD — empiric PPI vs H. pylori testing vs endoscopy
• Dysphagia — oropharyngeal vs esophageal; always warrants workup

Lower GI#

• Diarrhea (Acute) — infectious vs medication-induced; when to test
• Diarrhea (Chronic) — IBS-D, IBD, malabsorption, microscopic colitis
• Constipation — primary vs secondary; stepwise laxative approach

GI Bleeding#

• GI Bleed — upper vs lower; hemodynamic assessment; when to send to ED

When to Refer to GI#

• Alarm features requiring endoscopy (dysphagia, GI bleed, iron deficiency anemia, weight loss)
• Refractory GERD despite optimized PPI therapy
• Suspected IBD (chronic diarrhea + blood/mucus + systemic symptoms)
• Abnormal imaging requiring further evaluation
• Chronic abdominal pain without clear diagnosis after initial workup