Telemedicine Triage for Chronic Post-Prandial Abdominal Pain, Food Intolerance, and Suspected Gastrointestinal Bleeding in a Young Adult

Patient Voice

“I’m hungry, but I know if I eat rice or something, it might trigger it.”

Patient narrative during teleconsultation

Background and Context

Chronic, meal-triggered abdominal pain with recurrent hospital visits is frequently labeled as gastritis or ulcer without definitive diagnostic closure. In low-resource settings, fragmented investigations, repeated antibiotic courses, and poor access to lab reports can prolong morbidity and increase cost burden.

DocMary supports structured telemedicine history-taking, risk flagging such as possible gastrointestinal bleeding, and rapid organization of stepwise investigations to reduce diagnostic delay and improve patient trust.

Key Telemedicine Friction Observed

Early in the session, the patient experienced call-joining and microphone or unmute difficulties, delaying clinical engagement. The consultation proceeded effectively once audio stabilized, but the case highlights the importance of reliable meeting setup for time-sensitive clinical encounters.

Patient Information

Presenting Complaints

The patient presented with long-standing gastrointestinal symptoms affecting daily nutrition and quality of life.

I. Long-standing abdominal pain triggered by eating since childhood, with symptom recall from approximately age five.

II. Food intolerance pattern, worse with meat, fish, and flour-based foods, with variable triggers.

III. Poor appetite and reduced oral intake, accompanied by concern about inability to gain weight.

Symptom Pattern and Narrative Highlights

The patient described a consistent post-prandial cascade in which food intake was followed by abdominal pain with autonomic symptoms including heat, chills, and sweating, then an urge to stool, brief relief, and subsequent recurrence. She reported avoiding meals due to fear of triggering symptoms.

Pain was predominantly located on the left upper to lower abdomen, extending from below the rib cage toward the pelvic and waist region. At times, pain radiated toward the back. Daily pain severity ranged from 5 to 6 out of 10, with flares reaching up to 9 out of 10.

Prior Workup and Treatment as Reported

The patient reported undergoing upper gastrointestinal endoscopy on two occasions, recalling that findings were described as normal.

She described multiple prior tests including Helicobacter pylori testing and blood counts, which were often reported as negative or fine, though she did not have printed reports.

There was repeated medication exposure including proton pump inhibitors such as omeprazole, antacids, and multiple antibiotics including clarithromycin, ciprofloxacin, and metronidazole.

The patient reported that iron and zinc supplements worsened symptoms, leading her to discontinue them.

Clinician Impression From Telemedicine Assessment

The clinician noted that the symptom pattern suggested a cluster of gastrointestinal conditions with a high likelihood that a key diagnosis had been missed due to incomplete evaluation of the full gastrointestinal tract.

Primary differentials discussed included inflammatory bowel disease, specifically Crohn’s disease and ulcerative colitis.

Possible gastrointestinal bleeding was raised as a concern due to reports of dark stools.

Celiac disease or food sensitivity was discussed as a later diagnostic pathway if structural or inflammatory causes were ruled out.

Investigations Ordered and Proposed

Immediate Laboratory and Stool Tests

Definitive Evaluation Pathway

Upper and lower gastrointestinal endoscopy including gastroscopy and colonoscopy were emphasized as priority investigations.

Biopsies were to be obtained if abnormalities were found.

Additional imaging such as CT or MR enterography was to be considered if required, though endoscopy was emphasized as the primary next step.

Initial Therapeutic Plan From Teleconsultation

Acid suppression was adjusted by switching from omeprazole to rabeprazole 20 mg twice daily for 7 to 14 days, taken 20 to 30 minutes before meals.

An antacid regimen of Stomocaine 15 mL three times daily for 7 days was recommended.

A short steroid trial of prednisolone 30 mg daily for 3 to 4 days was proposed to observe clinical response.

Pain relief was discussed with a cautious approach, as the patient reported avoiding frequent pain medications.

Impact: What Telemedicine Achieved in This Case

The telemedicine consultation converted a long-standing, repetitive gastritis and ulcer care loop into a structured differential diagnosis and rule-out plan.

Bleeding risk was flagged and investigations were prioritized accordingly.

Fecal calprotectin was introduced as a practical triage tool to guide endoscopy decisions.

Patient barriers including missing laboratory reports, cost concerns, and fear of repeat procedures were addressed directly.

Patient Feedback and Product Insight

The patient confirmed she felt listened to and that her condition was clearly explained.

A key improvement suggestion related to AI scheduling was raised. The patient reported that the AI frequently indicates doctors are available, but patients later discover they are not. When this mismatch is reported, the AI acknowledges and apologizes.

As an actionable fix, engineers of the DocMary platform integrated real-time clinician availability into booking workflows and next-step guidance when availability changes.

Outcome Measures