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.
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