Right Rib Cage Pain (Gallbladder seems fine)

[alvarado2011]

I was DX with GERD two years ago after three months of burning upper stomach pain. I had a upper endoscopy, CT Scan, bloodwork, and Ultrasound which reveled two small polyps nut everything else is normal. I was put on Dexilant and slowly my symptoms improved over time.

During the last 8 weeks, these symptoms returned with a new symptom, lower right rib cage pain. I had taken myself off my medication for about three months prior, only taking it when I felt I needed too. I was feeling good even without the medication at the time.

One day I woke up in the middle of the night with burning stomach pain and back pain. I went to the ER and they ordered an ultrasound and bloodwork. Ultrasound was normal, my polyps grew just a bit to 4-5mm. Bloodwork normal as well.

I made an appointment with my GI doctor who told me to restart my medication. I told him about the lower right rib cage pain and he immediately ordered a HIDA Scan. The results of the HIDA scan came back normal at 64% down from 71% a year earlier. My doctor told me the symptoms were a combination of the GERD and muscle spams in the back. He is not ready to take out by GB he said.  Before my symptoms appeared, I was excersing 5 days a week doing cardio and weight lifting.

During these past four weeks now, I have been taking dexilant and Sulfate. Symptoms have sort of improve so far. My biggest concern is the aching pain that still exists in the lower right rib cage, sometimes I feel pain on the left side as well sometimes. This happens on and off daily. The pain isn't severe but, I would give the pain a 3 out of 10 on  a scale.

Yesterday, I again felt the pain. During work, I felt my body heat up and kinda sick but the feeling went away.  I eat from McDonald's that night and laid down trying to relax. I fell asleep but woke up from burning sensation up my throat and body felt hot. I haven't slept since and had to miss work today.

Is GERD causing my pain? Thanks

[Christopher R Watters, MD]

Costochondritis can explain focal pain at the costochodrial junction but would not explain the various other symptoms. The polyps should be followed as polyps greater than 10mm are associated with a rising risk of malignancy but, if the symptoms are minimal, I wouldn't have a problem forgoing cholecystectomy and following the polyps with ultrasound at reasonable intervals.

[alvarado2011]

Thanks Dr. Walters for the reply. But I got a question.

I recently went to the ER regarding the lower right rib cage after waking up with pain. The pain isn't severe but went after being stressed out. The ER doctor ordered an x-ray of the chest and rib and told me I have costochondritis, which make sense since I was also having chest discomfort. I told the ER doctor about the possibility that weather my gallbladder was still the problem and she told me the HIDA scan ruled that out.

How is it that between when I was first DX with gerd and found I had these two small polyps two years ago had little or no stomach pain or sickness until most recently?. But even now I have these gerd symptoms under pretty much under control.

As mentioned in my previous post, my symptoms were much worse two years ago when first DX and I was able to improve so much since then.

I am exploring the idea of removing the gallbladder should the gallbladder grow bigger but I agree with my GI doctor since all the test are normal, two hida scans within two years, both normal and two ultrasounds both normal except the polyps.

[Christopher R Watters, MD]

As a surgeon, I am entertained by the comment that your GI doc is not ready to take out your gallbladder - like it's something that he could do if he wanted. Studies of patients with gallbladder polyps reveal that 93% are not actually polyps but gallstones that are stuck to the wall of the gallbladder. I would stress that this is a gallbladder disease not a gallstone disease. If you accept that there is a 93% chance that they have actually documented gallstones and you are definitely describing typical biliary pain, removal of the gallbladder would be indicated not only for potential relief of symptoms but because you would have a lower chance of a premature death. Time to discuss your situation with a surgeon.