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Dr. Andrew Rynne

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Upper abdominal pain with red spots in saliva. Are they related? Worrisome

Answered by
Dr. Ram Choudhary

Internal Medicine Specialist

Practicing since :2001

Answered : 2272 Questions

Posted on Tue, 29 Jan 2013 in Abdominal Pain
Question: Hi, Thank you for answering my question.
I am 39 years old, and live in Morocco. I do have red spits in the morning once in a while (saliva with red spots sometimes more pronounced). However I do not cough (beside I have asthma since I was as a child). For a year and on I have had little pain in the upper abdomen (near the stomack and liver area). I have done all kind of check up such as blood tests, chest x XXXXXXX echography of my abdomen (liver, pancreas...), and heart check up but everything seems normal. I haven't done the fibroscopy and coloscopy yet but the doctor believe its not urgent. The doctor attributes the bleeding to my throat congestion (possible since when bleeding happened I had dry throats and loose coughs), and my pain in the upper abdomen attributed to muscke strain (I exercice body workout regularly). I have had some red wine yesterday night, and this morning without any throat aches of any kind, I have red blood spits again. I had some asthma during the night but no problem with my throat. I am worried since I still can't explain why this blood in the saliva happen again (since no problem appears this time with my throat)? and if it can be related to upper abdomen pain?
Thank you for your time and kind recommandations.
Answered by Dr. Ram Choudhary 48 minutes later
Welcome to healthcare Magic!
The blood in spitting and the pain in upper abdomen are two separate diseases and not related to each other by any reference.
The cause for blood in the saliva in your case can be from three sources-
1. any ulcer/raw area in the mouth or tongue.
2. If you use a tongue scrapper then may be you are causing small scratches on the tongue surface which is the cause of the blood streaks.
3. You may be having gingivitis, a local gum infection when gums become swollen and friable and bleed when you create a negative pressure in mouth before spitting which sucks blood from the gums.
Please concentrate on these points and let me know if these scenarios fit in your case as such.
Throat congestion does not seem to be a putative cause to me for the bleed.
About the pain abdomen, it seems it is not related to your exercise but it is due to acid peptic disorder. You should take tablet Rabeprazole 20 mg empty stomach in the morning once a day with strict regularity for two months in continuum.
Avoid Coffey, smoking and alcohol.
Take dinner 3hour prior to going to bed.
I hope the advise would be informative and useful for you.
Welcome back.
Please tell me if you have any doubts.

Take Care!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Ram Choudhary 6 days later
Hi, thank you for your feedback.
My question is :
1) how do you recognize an ulcer/ raw area in the mouth?
2) no I have never used a tongue scrapper.
3) i XXXXXXX t believe i have gingivitis.
But to make sure i a seeing a dentist this afternoon to look for
Possible sources of bleeding in the mouth.
In fact I Had blood saliva this saturday around 5 am in the morning.
Should i do some other kind of Check up such as fibroscopy/ colposcopie to look
For other reasons If the dentist do not find a bleeding source in the mouth ?
Now concerning the abdominal pain, stress could be a cause à long with muscle pain since when i pût my finger at a spécific area, the pain intensifies. Also what Check Ups could Help me identify exactly the reason of the pain (pain which is light but continuous)?? Also, i a m not sure it's acidity since I XXXXXXX t feel any reflux.
Thank you again for your kind feedback .
Answered by Dr. Ram Choudhary 2 hours later
Welcome back to Healthcare Magic Physician's Desk!
The ulcer or raw area can be seen with naked eye examination during local examination by your ENT/Dentist doctor. It can be recognised by noticing a breach in the oropharyngeal mucosa.
These clinician would also confirm/refute whether you have gingivitis as a cause for the bleeding.
The other confounding thing may be that blood may when you cough, it falsely seems to come from saliva actually the source may be the respiratory passage.
In that case Fibreoptic Brochoscopy and an High Resolution CT scan chest, CT angiogram lungs may be helpful to pick up the source of bleed.
The dyspepsia symptoms do not necessary need to have reflux symptoms.
I think a visit to a physician and a physical examination and a trial treatment is sufficient because the investigation Upper GI endoscopy is an uncomfortable investigation in my view to prove this purpose.
Wish you a great health!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Ram Choudhary 1 hour later
Thank you again for your prompt feedback.

I am seeing the dentist in an hour and I will get back to you concerning the ulcer and gingivitis to confirm or refute this hypothesis.

Concerning the hypothesis of the respiratory passage, it is true that I have had asthma since a child and that I have been breathing since through my mouth which seems to irritate my oesophage channel during winter/cold and dry time. But I do not cough much. Plus I have done lung Xray in November which showed nothing. Do you believe I should still do a high Resolution scan chest??
Please know that end of november, the ORL doctor have done a bronchoscopy on my larinx and trachea area (in French : "fibroscopie nasopharyngo laryngee") and it was found some polyp inflammation which could help explain the bleeding. Since then I have used "Rhinocort" treatment, Muxol syrop and maxilase. It seems not to be sufficient since the bleeding has repeated early december, end of december, last week and this saturday. The last week bleeding which made me consult your health care magic services (contrary to the other days bleeding) had nothing to do with inflammatory throats since I did not feel any unconfortability with my throat on that day.

What kind of physician for physical examination since I have already seen an internist, a gastro and a ORL for these symptoms without having a pausible explaination for the abdominal pain (beside muscular, psychologic reason). If the fibroscopy and coloscopy is not necessary what other investigation may be possible to explain my abdominal pain?
I saw the Dentist and he says there:

1) No Ulcer or breach in the oropharyngeal mucosa (visible from the eyesight)

2) No problem of gingivitis

But maybe a little cavity located at the wisdom tooth which may cause a little inflammation.

My feeling is that the bleeding comes from the inflammation of the oesophage in the larynx or trachea area as the ORL said, or may come from some other kind of inflammation from the abdominal area ? as asked earlier should I still do a high resolution scan test?

Also what other investigations are necessary to help me explain my abdominal pain? What kind of physician should I see for that purpose?

Thank you again for your kind and precious feedback.
Answered by Dr. Ram Choudhary 24 hours later
Thanks for writing back.
The polyp and inflammation in the past laryngoscopy is important feedback.
Polyps are frequent source of the benign bleeding from airway because there surface may ulcerate and bleed.
A good approach would be to consult a Respiratory physician and get the area of polyp reviewed by bronchoscopic examination.
You have consulted the right doctors uptil now to start with basic evaluation, just get an appointment with Respiratory physician.
Your abdominal pain issue can be sorted out with Esophagogastroduodenoscopy if you definitely do want a diagnosis before taking a trial of treatment of acid peptic disorder.
I hope this advice would help you in the decision making
Wish you a great health!
Above answer was peer-reviewed by : Dr. Aparna Kohli

The User accepted the expert's answer

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