Complaints & connections · borters.ch
The gap between meal and pain sorts more than any further test — and a normal blood panel contains neither calprotectin nor a valid coeliac test.
Also known as: abdominal pain after eating · unwell after every meal · weeks of belly pain · nothing found · all tests normal · no diagnosis
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
When the belly has hurt after eating for weeks, the blood results are unremarkable and no one has given it a name, that rarely means there is nothing there. It usually means the decisive question has not been asked yet. The single most telling observation is the timing: trouble within minutes points to stomach and gullet, after half an hour to an hour to sugars and carbohydrates that are not absorbed in the small bowel, and hours later to the large bowel. Second, a normal blood panel leaves much out: coeliac disease is screened with tTG-IgA, which only holds if total IgA was measured at the same time and the person was still eating gluten. The iron store can be empty without the haemoglobin changing. And the real inflammation test for the gut is calprotectin in stool — it does not appear in blood at all and therefore slips through every panel. Third: constipation is the most commonly missed explanation, especially in children, and it does not rule out a daily bowel movement. Finally, functional abdominal pain and abdominal migraine are diagnoses in their own right, with their own routes — not what is left over when nothing else fits.
Reliably fifteen to sixty minutes after eating, stronger with larger portions, with fear of eating and weight loss: then the gut is not moving wrongly — it gets too little blood for the work of digestion. Two roads lead there, and both can be treated.
Three mechanisms that exclude each other: too much movement (cramp), too little (stasis) and normal movement felt too strongly. Serotonin from the gut lining is the starting signal for every wave — the gap after eating reveals which of the three roads it is.
Time, what was eaten, how many minutes later it started, how long it lasted, where exactly, plus the daily stool by the Bristol scale. That sheet is worth more at the next appointment than any further test.
tTG-IgA together with total IgA, and crucially while gluten is still being eaten normally. A gluten-free trial before the test makes the result worthless.
A stool test, not a blood test. It separates an inflammatory from a functional cause better than anything else in this situation.
The belly hurts right after eating because the gut reflex fires. The Bristol scale in the diary shows it within days.
Sugar-free sweets, chewing gum, apple and pear juice. Leaving them out for two weeks is a clean test with a clear answer.
Iron tablets and anti-inflammatory painkillers are high on the list — note them with start dates.
Functional abdominal pain and abdominal migraine are diagnoses, not fallbacks. A name opens a route; “nothing found” does not.
One more column, and after two cycles you see whether the bad days cluster around the bleeding. Without it, everything looks like food.
Growth and blood loss coincide. An empty store causes tiredness, poor appetite and irritability long before the blood count moves — and iron tablets themselves cause belly pain, which is easily confused.
Right after waking, before washing and before opening the bowels, a strip of clear tape briefly to the skin. Threadworms are not found in stool, and a single test misses half of them.
The antigen test finds considerably more than microscopy alone, and shedding varies from day to day. One normal stool rules nothing out.
The dossier on threadworms and giardia — with the hygiene round, treating the whole household, and what can linger for weeks afterwards.
If the pain sits low in the belly and worsens around the bleeding, that is a different track from food — and in young girls it is rarely followed early.
Lightly crush a teaspoon of the seeds, pour over hot water, cover and steep for ten minutes.
Filled to hand warmth, wrapped in a cloth, applied for 20 to 30 minutes.
One to two tablespoons of ground linseed or a tablespoon of psyllium husks with at least 250 ml of water, once a day.
Walk ten to fifteen minutes two or three times a day, plus a large glass of lukewarm water in the morning.
The cleaning wave in the small bowel only runs when nothing arrives. Anyone eating something every two hours suppresses it all day. With bloating one to two hours after eating, that is the simplest attempt.
A quiet walk speeds up stomach emptying measurably and eases fullness. Of all the levers here it has the best ratio of effort to effect.
With the cramp pattern peppermint oil relaxes the smooth muscle. The coating is the point: without it the oil is released in the stomach and causes heartburn instead of relief.
If fullness, nausea and old food are in the picture, there is a measurement for it — and several levers: smaller, softer, less fatty portions, liquid instead of solid, the walk, and stopping medicines that brake.
Serotonin, the reflex when eating, the cleaning wave, the oversensitivity of the gut wall and the blood supply — in detail in a dossier of its own, with the hormone axes behind it.
Violent stomach pain with nausea a few hours after sushi, sashimi or marinated anchovies is a picture of its own. Deep-frozen fish is safe, fresh is not always.
Acid blockers help if acid is involved — in functional complaints it often is not, and the difference shows after a four to eight week trial. Antispasmodics and peppermint oil in gastro-resistant capsules act on the gut muscle. What works most reliably in reviews are low-dose tricyclic antidepressants — they damp pain perception in the belly and here work independently of mood.
The timing separates the causes: pain within thirty minutes of eating points to the stomach or the vessels, at one to two hours to gallstones or the duodenum, after several hours to the colon. A treatment trial is judged over four to eight weeks. In about one in three people with this complaint no cause is found despite full investigation — that too is a finding and not a gap.
Points to stomach and gullet: reflux, gastritis, a sluggish stomach. Often with burning, burping or early fullness.
The window of sugars and carbohydrates: lactose, fructose, sorbitol. Sorbitol hides in sugar-free sweets, chewing gum and many juices.
Points to the large bowel: constipation, irritable bowel, fermentation. Constipation does not rule out a daily stool.
This is not a sign of “it is imagined” but information nobody else has — and it belongs in the conversation.
Wandering pain suggests the bowel; a spot that does not move — especially lower right — needs looking at.
Weight loss, a break in the growth curve, waking at night from pain, blood in the stool, repeated vomiting, fever or trouble swallowing change the urgency.
Then there is a second rhythm in the belly. The messengers that contract the womb also act on the gut — cramps, nausea and loose stools in the days before and during come from there and have nothing to do with food.
Threadworms announce themselves as an itchy bottom at night, restless sleep and fidgeting — in girls also as irritation at the front, taken for a bladder infection. Giardia causes loose, very foul-smelling stools, bloating, burping and belly pain after eating, often in waves over weeks, after a mountain stream, travel or nursery.
Five to thirty minutes after the first bite, cramp and an urge to open the bowels: that is the reflex by which the stretching of the stomach sets the large bowel going. In some it turns out much too strong — that is an explanation and not a coincidence.
If food eaten hours before is vomited, or the belly stays full for hours after small portions, it is about the emptying of the stomach — and that has causes of its own: sugar over years, an infection gone through, braking medicines.
If the pain comes at the same interval every time, grows with the portion and weight is lost, the gut is not moving wrongly — it is getting too little blood. An ultrasound of the abdominal vessels answers the question, and the narrowing can be treated.
Lying on the back, press; then lift head and shoulders and press the same point again. Stronger means: from the belly wall, not from the gut. This manoeuvre takes half a minute and spares some people a whole series of investigations.
Only valid together with total IgA and only while gluten is still being eaten — otherwise it can be falsely negative.
About one person in 500 has IgA deficiency. In them the coeliac test is worthless unless you know it.
The real inflammation test of the gut — it does not appear in blood and is therefore missing from almost every “normal” result.
A normal CRP does not rule out gut inflammation — that is what calprotectin is for.
From the first period the iron requirement jumps. Haemoglobin falls last — the store is empty long before.
The value many people look at when parasites are suspected — and which is almost always normal with the two commonest, threadworms and giardia. A normal blood count does not argue against them.
Soluble fibres like psyllium and oats bind water and make the stool supple. Wheat bran and a lot of raw vegetables, by contrast, increase bloating and pain in a sensitive gut — this distinction explains most of the failures.
Fibre without water makes the stool harder instead of softer. The two belong together, and the effect only sets in after some days.
Draws water into the bowel and therefore works with a sluggish stool. The belly shows the upper limit: if the stool gets too loose, the dose at once was too high.
Yoghurt, kefir, sauerkraut and the like bring living cultures with them. Many tolerate them well; with a strongly bloated belly they can also do the opposite in the first weeks.
Where nothing was found and the pain is cramping, this is the best-studied attempt — 4 weeks tell whether it helps.
Offered before the meal for histamine intolerance. The studies are small and the diagnosis itself contested; a kept diary over 2–4 weeks says more, because the amount adds up across the day.
Lactase before dairy is the one case with a clear effect. The broad enzyme blends for everything show no benefit in healthy people.
Effective when deficient; effects on sleep and stress plausible but moderate. Too much causes loose stool.
Released by the duodenum as soon as fat arrives. It makes the gallbladder contract and slows the stomach — which is why the pain after a fatty meal often sits upper right and comes a quarter of an hour to an hour later.
Drives the housekeeping wave that sweeps the small bowel between meals. It only runs on an empty stomach — constant small snacks interrupt it. That explains why gaps between meals often do more for bloating than leaving foods out.
Released from the bowel with a meal and slowing the emptying of the stomach. That is also why weight and diabetes drugs from this group cause fullness, nausea and pain after eating — with this question the medication list belongs looked at.
The hunger signal rises before a meal and falls afterwards. Useful for the distinction: pain that improves with eating and returns on an empty stomach speaks more for the stomach and duodenum than for the bowel further down.
After a very carbohydrate-rich meal the sugar can fall below the starting value one to three hours later. That causes trembling, sweating, ravenous hunger and a hollow feeling in the belly — and is often taken for an intolerance.
Most of the body’s serotonin sits in the wall of the gut. It steers the movement and at the same time how strongly a stretch arrives as pain. That explains why the same amount of food hurts more in tense weeks.
From mast cells in the gut wall and from the food itself. If flushing, palpitations, headache or a blocked nose join the belly pain, this road is worthwhile — it is approached differently from an intolerance to sugars.
Progesterone slows the movement of the bowel in the second half of the cycle; shortly before the bleeding it drops and the bowel speeds up. That is why the day of the cycle goes in the diary — it places a pattern that otherwise looks like an intolerance.
The stress axis works in both directions: it changes the movement and the sensitivity of the gut, and lasting belly pain in turn keeps the axis going. The difference between school days and holidays is therefore real information and no side note.
Released in the lower small bowel, it brakes from behind. This ileal brake explains why a large meal is still felt as pressure hours later.
The relaxing messenger: it opens the section ahead of the wave. Without that slackening there is no forward push but pressure — that is the difference between movement and cramp.
Immediately to 30 minutes points to stomach or gallbladder, 1–3 hours to the small intestine, 4–8 hours to the colon. This one timing in the diary often saves many investigations.
2–6 weeks, then group by group back. In about half the complaints clearly improve — held strictly forever it harms the gut flora.
Studied and effective in functional complaints. More important first is the pattern: how long after eating the pain comes narrows down the site — straight away the stomach, hours later the bowel.