Which finding would most strongly indicate a GI origin for axial pain?

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The main idea here is recognizing when back or axial pain is driven by an abdominal (GI) source rather than a musculoskeletal one. The strongest clue is when the patient has clear GI symptoms that accompany the back pain and there is abdominal tenderness on exam. That combination points to intra-abdominal pathology—such as peptic ulcer disease, pancreatobiliary conditions, or other GI processes—that can refer pain to the back or produce retroperitoneal pain.

Pain related to meals suggests an active GI process linked to ingested food, reinforcing a GI origin for the pain. Abdominal tenderness on examination further localizes the problem to the abdomen, making a GI source more likely than a purely musculoskeletal back issue. In contrast, other findings like rectal bleeding indicate GI disease in the abdomen or rectum but don’t specifically tie the back pain to the GI system; shoulder blade tenderness or visual disturbances are less specific and less diagnostic for GI-related axial pain.

So the option that combines GI complaints with meal-related pain and abdominal tenderness best indicates a GI origin for axial pain.