Acute non-traumatic epigastric pain: prevalence of increased transaminases

Epigastric pain is often due to oeso-gastro-duodenal tract lesions. However, pain due to biliary tract lesions is also located in epigastric area in half of the cases. The main outcome measure of this study was to determine the increase in transaminases in patients with epigastric pain, and the second outcome was to determine if the results of transaminases could modify the diagnostic hypothesis of the emergency physician. Methods: Patients aged more than 18 years consulting for epigastric pain in the emergency department were included. At the end of the initial evaluation, one to three diagnostic hypotheses were made by the emergency physician. A new diagnostic evaluation was made after the knowledge of transaminases result. Results: Hundred patients aged 39 +/- 16 years were included. Among them, 26 (26%) had increased transaminases. Transaminases were more frequently increased when nausea and vomiting were associated with pain (P < 0.03). The knowledge of the result of transaminases modified the diagnostic hypothesis in 42% of patients. Conclusion: Transaminases are increased in a quarter of the patients with epigastric pain, and the result of transaminases modifies the diagnostic hypothesis of the emergency physician. This suggests an under-estimation of biliary tract lesions in patients with epigastric pain.