GI Telehealth

Abdominal Pain Evaluation

Chronic abdominal discomfort, IBS, and functional GI disorders are well-suited for telehealth. We are honest about what telehealth can and cannot assess — your safety comes first.

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CRITICAL: These Abdominal Symptoms Require Immediate Emergency Care — Do NOT Use Telehealth

Telehealth is appropriate for chronic, mild-to-moderate, or functional abdominal pain. However, the following presentations represent potential surgical or life-threatening emergencies that require in-person evaluation and cannot be assessed safely via video. Call 911 or go to the nearest ER immediately for:

Abdominal pain evaluation — when stomach pain needs medical attention

Appendicitis Signs

• Sudden pain starting around navel, migrating to right lower quadrant
• Fever, nausea, vomiting with right lower abdominal tenderness
• Rebound tenderness (pain that worsens when pressure is released)

Bowel Obstruction

• Severe crampy abdominal pain with distension
• Inability to pass gas or stool
• Vomiting (may be feculent)
• Abdominal bloating that is rapidly worsening

Ruptured Ectopic Pregnancy

• Sharp unilateral pelvic/abdominal pain in any person who could be pregnant
• Shoulder tip pain (diaphragmatic irritation from blood)
• Dizziness, syncope, rapid heart rate

Abdominal Aortic Aneurysm (AAA)

• Sudden severe tearing or ripping abdominal/back pain in older adults
• Pulsating abdominal mass
• Signs of shock: pale, sweating, weak pulse

Acute Abdomen / Peritonitis

• Rigid, board-like abdomen
• Severe pain that worsens with any movement
• High fever with severe diffuse abdominal pain
• Signs of shock
• Hematemesis or melena (blood in vomit or stool)
• Pain after known or suspected abdominal trauma

IF IN DOUBT — GO TO THE ER. It is always better to be evaluated in person and sent home than to delay treatment for a surgical emergency.

Telehealth Is Appropriate for These Abdominal Conditions

Once serious, acute causes have been excluded (see above), many abdominal pain conditions are genuinely well-suited to telehealth evaluation and management:

Irritable Bowel Syndrome (IBS)

Functional dyspepsia

GERD and acid reflux (see dedicated page)

Gas, bloating, and dietary-related symptoms

Constipation management

Known Crohn's disease or ulcerative colitis (mild flare, established diagnosis)

Irritable Bowel Syndrome (IBS) — Rome IV Criteria

IBS is the most common functional GI disorder, affecting 10–15% of adults. It is diagnosed using the Rome IV criteria — a symptom-based diagnostic framework that does not require invasive testing in most cases.

Rome IV Diagnostic Criteria for IBS

Recurrent abdominal pain, on average at least 1 day/week in the last 3 months, associated with 2 or more of the following:

Related to defecation (pain improves or worsens with bowel movements)
Associated with a change in stool frequency
Associated with a change in stool form (appearance)

Criteria must be present for the last 3 months, with symptom onset at least 6 months prior to diagnosis.

IBS-C

Constipation-predominant

IBS-D

Diarrhea-predominant

IBS-M

Mixed bowel habits

IBS Management — Dietary & Pharmacologic Approaches

Low-FODMAP Diet

The low-FODMAP diet is the best-evidenced dietary intervention for IBS, with clinical trials showing symptom improvement in 50–86% of patients. FODMAPs are fermentable carbohydrates that pull water into the intestine and are rapidly fermented by gut bacteria. The diet involves a 4–8 week elimination phase followed by systematic reintroduction to identify personal triggers.

Antispasmodics for Cramping

Hyoscyamine (Levsin) and dicyclomine (Bentyl) are the primary antispasmodic agents used for IBS-related abdominal cramping. They work by reducing smooth muscle contractions in the gut. Use is typically as-needed before meals or with cramping episodes. Side effects include dry mouth, blurred vision, and urinary retention — use with caution in elderly patients.

Fiber Supplementation

Soluble fiber (psyllium/Metamucil) is helpful for both IBS-C and IBS-D — it normalizes stool consistency. Insoluble fiber may worsen symptoms in IBS. Introduce gradually to minimize gas and bloating.

Lab & Imaging Ordering via Telehealth

For appropriate patients, your provider can order laboratory and some imaging tests to evaluate abdominal symptoms or rule out organic pathology:

H. pylori Testing

Urea breath test (preferred) or stool antigen test — ordered as lab referral for patients with epigastric pain, early satiety, or dyspepsia

CBC & CMP

Complete blood count and comprehensive metabolic panel — to screen for anemia, liver disease, electrolyte abnormalities

Lipase

Pancreatic enzyme — ordered if epigastric pain radiating to the back with nausea/vomiting raises concern for pancreatitis

Celiac Serology

Anti-tTG IgA + total IgA — appropriate for patients with diarrhea, bloating, and IBS-like symptoms

Imaging such as abdominal ultrasound or CT typically requires an in-person referral. your provider will provide appropriate referrals when imaging is indicated.

Medical Disclaimer: This page is for informational purposes only and does not constitute medical advice. A licensed provider evaluation is required for diagnosis and treatment. Acute abdominal pain requires in-person or emergency evaluation.

Abdominal Pain — Frequently Asked Questions

Chronic, recurrent, or functional pain that has been stable and is not associated with alarm features (fever, significant weight loss, bloody stools, severe acute onset) is generally appropriate for telehealth. New, sudden, severe, or rapidly worsening abdominal pain always warrants in-person evaluation. When in doubt, go to urgent care or the ER — we would rather you be safe than risk missing a surgical emergency.

Yes. Established IBS is an excellent candidate for telehealth management. We can review your current management, discuss low-FODMAP dietary strategies, prescribe or adjust antispasmodics, and help manage IBS-related anxiety or quality of life impact. If your symptoms have significantly changed or worsened, we will ensure appropriate evaluation is coordinated.

Functional dyspepsia refers to persistent epigastric discomfort (upper abdominal pain, bloating, early satiety, nausea) without a structural cause identified on endoscopy. It is defined by Rome IV criteria and affects approximately 10% of adults. Management includes H. pylori testing and eradication if positive, PPI or H2 blocker therapy, and dietary modification. It is treatable through telehealth in most cases.

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