Abdominal Pain Attacks

I've suffered from abdominal pain attacks for about 10 years (I'm 39).  I get anywhere from 2-5 attacks per year.  The pain is located under my right rib cage so it is closest to my gallbladder.

Attacks always start mildly and ALWAYS after lunch such that by about 2-4 pm, I can start to feel mild pain/discomfort in my abdomen and I know that an attack is imminent.  Severe pain sets in around 6-9 pm that evening.  It feels like knives slicing into me and the pain undulates over about a 2-3 hour period.  I'm usually fine by 10-11 pm and good for several months until another attack.  I don' t eat anything during an attack but I do try to drink water but when the pain subsides and my attack is completed, I can eat right away and normally--and I usually do since I'm hungry!

I have no other symptoms other than sharp pain.  I have no gas, no diarhhea, no headache and no other pain elsewhere during an attack that I'm aware of.  While attacks certainly appear related to food, I cannot figure out if certain foods cause it.  I've eaten certain things for many years with no issues but then WHAMMO!, an attack hits me.  Between attacks, I have eaten plenty of fatty meals that could cause issues; I've eaten way too much food that could cause issues; and I've eaten normally and carefully.  I can discern no relationship to the food I eat or the amount or the type and an attack.

I've finally found something that helps: Manuka Honey.  If I take this when I feel an attack coming on, it seems to stave off the attack early and I don't suffer the severe pain: only mild discomfort one might think is just indigestion.  This has worked on the last 3 attacks.  Now, of course, I don't know if the attacks would have gone "full bore" but they sure felt like my classic GI attacks that I've had for years.

Two ultrasounds are normal.  PTT, PT, Comp metabolic panel, and CBC w/diff blood test drawn during attack are normal.  I saw a program on GIST last night...symptoms sound familiar.

[Kevin Pho, MD]

The ultrasound is a reasonable study to evaluate the liver and gallbladder.

Refractory symptoms need more specialized tests to evaluate the gallbladder function.  I would consider a HIDA scan with CCK stimulation.  A low gallbladder ejection fraction can lead to the symptoms you describe.  

Other tests to consider would be an upper endoscopy to evaluate for stomach and esophagus disease, as well as blood tests looking for celiac disease.

These options can be discussed with a GI physician.

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.
www.kevinmd.com