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Gastroenterology (Expert Forum)
Chronic Pain in upper right/center abdomen and chest
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/ Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Chronic Pain in upper right/center abdomen and chest
by SK7, Mar 16, 2007 12:00AM
I'm a 32 year old male -- 5'11" 160 pounds.
For the last two years or so, I've been experiencing pain in my lower chest and upper abdomen, sometimes in the middle and sometimes on my right side. The pain occasionally radiates to my back or shoulder blade.
The pain comes on slowly, stays constant for several weeks, and then remits for a week or so. It seems to be accompanied with frequent belching, loose stools and a feeling of fullness near my lowest rib on the right that effects my breathing. The pain/fullness does not seem to be associated with eating.
Since I'm a former smoker (I quit several months ago), my doctor did a complete lung work up start, including X-ray, chest CT, and spirometry. All tests came back normal.
I then had a gall bladder ultrasound and a HIDA scan. Both were normal. I've had blood tests for liver and pancreas problems as well as celiac disease; all were normal. I also had an endoscope which revealed only "mild gastritis." It was negative for H-Pylori. My doctor prescribed Protonix, which has had little effect, so now he's a little baffled.
So my questions are:
Could my symptoms be caused my "mild gastritis"? If so, is there any other treatment I should consider since Protonix doesn't appear to be working? Are there any other tests I should request from my doctor?
For the last two years or so, I've been experiencing pain in my lower chest and upper abdomen, sometimes in the middle and sometimes on my right side. The pain occasionally radiates to my back or shoulder blade.
The pain comes on slowly, stays constant for several weeks, and then remits for a week or so. It seems to be accompanied with frequent belching, loose stools and a feeling of fullness near my lowest rib on the right that effects my breathing. The pain/fullness does not seem to be associated with eating.
Since I'm a former smoker (I quit several months ago), my doctor did a complete lung work up start, including X-ray, chest CT, and spirometry. All tests came back normal.
I then had a gall bladder ultrasound and a HIDA scan. Both were normal. I've had blood tests for liver and pancreas problems as well as celiac disease; all were normal. I also had an endoscope which revealed only "mild gastritis." It was negative for H-Pylori. My doctor prescribed Protonix, which has had little effect, so now he's a little baffled.
So my questions are:
Could my symptoms be caused my "mild gastritis"? If so, is there any other treatment I should consider since Protonix doesn't appear to be working? Are there any other tests I should request from my doctor?
Doctor's Answer
by Kevin Pho, MD, Mar 17, 2007 12:00AM
, Mar 17, 2007 12:00AM
Gastritis is possible. Comprehensive tests have already been done to rule out any of the other major causes.
More specialized testing can be considered. This would include a 24-hr pH study to evaluate definitively for GERD, an esophageal motility study to rule out motility disorders, and a gastric emptying scan to evaluate for gastroparesis.
The liver, gallbladder, and pancreas would have been evaluated with the tests you already had.
If the symptoms continue despite non-revealing testing, irritable bowel syndrome can be considered.
These options can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
More specialized testing can be considered. This would include a 24-hr pH study to evaluate definitively for GERD, an esophageal motility study to rule out motility disorders, and a gastric emptying scan to evaluate for gastroparesis.
The liver, gallbladder, and pancreas would have been evaluated with the tests you already had.
If the symptoms continue despite non-revealing testing, irritable bowel syndrome can be considered.
These options can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
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You might also ask your doctor for a different drug to help the GERD. I tried Protonix without any success at all. I take Nexxium now and it has really helped with the GERD issues. I still have pain like you described, but the throat irritation and other issues associated with the GERD have all but disappeared.