The gastroenterologist's approach to pelvic and abdominal pain

This article examines the knowledge base and understanding of pathophysiology as applied by gastroenterologists in the evaluation of patients with pelvic and abdominal pain. The neuroanatomy of the gastrointestinal (GI) tract and the pathophysiologic basis of pain, the features in a patient's history that are particularly important to a gastroenterologist, the important clues found during a physical examination, the differential diagnosis for pain in the GI tract, and the strength and limitation of diagnostic testing as applied to the evaluation of pelvic and abdominal pain are reviewed. Unfortunately, the work-up of many patients may result in a lack of diagnosis or therapeutic options. With empathy and trust, however, a working relationship between doctor and patient may limit the effects of pain.