Mysterious Abdominal Pain...

I have been suffering from mysterious abdominal pain.  The pain isn't localized - it tends to move around if that makes sense.  It is frequently in the upper left (under the ribs) or upper right (under the ribs) but can and will appear anywhere in the abdominal area. One thing I have noticed is that the pain in the upper left (under the ribs) occurs relatively consistently if I start to do moderate aerobic exercises - similar to a "side stitch" but more pronouced.  The pain in general comes and goes but will usually assert itself after eating.  There have been some days when I have had no pain at all.

I have noticed that if I have a few pain-free days and then hit the gym (lifting weights), then the pain will start to re-occur within two days.  But even if I stop the gym completely, the pain still comes and goes randomly.

My GI has done the standard battery of tests and is stumped.  CT Scan, Ultrasound, ERCP, Colonoscopy including the camera, Upper Endoscopy and Hida Scans were all done.  The only items found were an infection of H.Pylori (treated), a slight elevation in Amylase Levels and a small hiatal hernia.  For medication, we have tried the usual Acid-Redux medications regimen (nexium, prilosec etc).

My GI has said that he sees about 10 patients every year whose symptoms cannot be explained and that 8 out of 10 of those feel better after their gall-bladders are removed.  He cannot recommend that I do that one way or another because he cannot diagnose with certainty a problem with the gall bladder.

I have read the symtoms (symptoms) for gall-bladder and prancrease related issues and I do not have most of the symptoms mentioned in the research I've done.

My questions then are as follows:

1.  What other causes can there be for this kind of randomly occuring, non-localised abdominal pain?

2.  Does removing the gall bladder make sense absent another diagnosis?

3.  What other "tests" or exploratory surgery should I consider talking to my GI about given the brief description I have outlined here?

BTW - I'm 38 years old.  My bowel movements have not changed for years though they are a bit abnormal relative to others (i.e.: 1 every 2 days or so instead of daily).

Thanks in advance for suggestions.

[Kevin Pho, MD]

To answer your questions:
1) You have been through a pretty comprehensive evaluation which would have caught many of the major GI disorders.  

2) I would obtain another opinion if a cause can't be found.  Ensure that the HIDA scan was done with CCK stimulation.  If the gallbladder ejection fraction is found to be low, removing the gallbladder may help with the symptoms.  

3) I would consider more uncommon testing, including a gastic emptying scan, esophageal motility study, as well as blood tests for celiac disease.

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_

[Kalio1]

Have you had your liver checked out? Gabladder problems can be associated with liver issues. I'd have a complete liver evaluation before I did anything else. Have your enzymes checked

[bggbob]

I think it could be muscle spasms the reflux medication didn't help (prilozec, nexium), almost everything came back normal I think its just abdominal muscle spasms. good luck

[krepta]

I have almost the EXACT same thing. Pain/discomfort bouncing around the stomach, but mostly on the left, under the ribs. Some days fine. Others, consistent all day long. Not affected in any way by activity, though, except more likely to start up when I'm weaker (hungry or tired). But also had past periods of nausea and vomiting once or twice.  Cough, too. But all that went away weeks ago. All that's left is the pain.  Under the ribs, the most disturbing & uncomfortable. So, really curious about any updates.  My PP and GI don't have a clue.