I posted in Oct 2012 - below is updated case w/questions:
I started having URQ pain 5 months ago-a cramp/dull ache under right ribs. The pain comes and goes-here for a day, gone for several, here for a day. On a scale of 1-10, pain's been between 1-4. Pain sometimes feels like it's wrapping around my right back a little, but I also have a back injury. Occasional pain to the right of my belly button and rarely a pinching in ULQ under ribs. Pain seems unrelated to eating. I'm having a lot of gurgling after eating in URQ and above belly button. No blood in stool, no vomiting, no shoulder pain, no nausea, rare mild heartburn. I was diagnosed with IBS 15 yrs ago, but my IBS presents as LRQ pain.
Tests within the last 5mo:
1) Two rounds of bloodwk - CMP, amylase, lipase, CBC - all normal
2) Abdominal ultrasound - normal
3) HIDA scan with EF - normal (50%). Some pressure/pinching in URQ after the CCK injection but didn’t really reproduce my symptoms. Infused over 30mins.
4) Upper endoscopy: Biopsies showed mild irritation in stomach.
Since endoscopy in Nov, GI put me on Prilosec 1xday. GI believes stomach acid is cause of pain. Prilosec seemed to help a little-I'd have more days without pain but the pain would still occur.
Over the last week pain has jumped to a 6 on 1-10 scale. Pain is constant aching - might wane for an hour then return. GI still thinks it's acid, increased Prilosec to 2xday and 40mg Pepcid/day. I think I feel a little relief after taking Pepcid but not a lot.
1)Do you agree with diagnosis of stomach acid given location/nature of my pain? Can stomach acid result in fairly localized URQ pain? I'd expect acid to result in more diffuse pain.
2)What additional/repeat tests if any should I get? If a CT-scan, I have already had 2 CT-scans in my life. Would you recommend a 3rd CTscan to your wife/daughter given radiation risks?
It sounds as though you have had a thorough evaluation to rule out structural or inflammatory causes. I do agree that a CT scan should be dne if you haven't had one since the pain started to be complete. If this were negative, you are most likely hving symptoms as a result of a "functional" problem. This could be IBS or biliary dyskinesia. I am assuming that, at some point, you have been given medicine to minimize the IBS symptoms. These would typically be in the form of smooth muscle relaxants. I am also assuming that celiac disease has been ruled out. If the answer to both of these is no it might be time for a second opinion from another gastroenterologist.
Thank you for your response. I have not had a CT scan yet for this problem. Do you believe a CT-scan would be better than getting an abdominal MRI and MRI enterography? I am very worried about having the radiation from the CT scan since this would be my 3rd CT scan. What are the risks of having 3 CT scans? I do not want to replace one problem with another by potentially causing myself cancer down the line due to the CT radiation. Celiac disease has been ruled out.
As a general screen in the situation of upper abdominal pain CT is the way to go. MRI is better at giving information about mass lesions sch as a liver or pancreatic mass. My general philosophy is that the radiation risk is justified when the test is truly indicated - the risk is minimal.
The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. MedHelp is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. We offer this Site AS IS and without any warranties. By using this Site you agree to the following Terms and Conditions. If you think you may have a medical emergency, call your physician or 911 immediately.