Long-Term Abdominal Soreness

  For about 4 years, I have had increasing levels of soreness in the center of my abdominal area about the size of a large fist right above my navel and below my first row of ribs.  The soreness is fairly constant throughout the day and is usually present most days.  I have not been able to attribute the pain to any particular type of food I eat.
  OTHER SYMPTOMS: Occasional stomach gas - antacids (Tagamet) taken for several weeks per doctor, but pain did not subside.
                  Started to notice middle back pain about 6 months ago (not sure if this is related to lower back injury I suffered about 10 years ago).
                  Frequent fatigue.
  
  OBSERVATIONS:  Recently, when the soreness seems pretty bad and I urinate, the soreness seems to subside slightly, but does not go away (I don't know if this is just my mind playing tricks on me).
                 Increased or decreased levels of stress do not seem to make a difference in the soreness.
  OTHER: I smoke about 5-8 cigarettes per day (when I smoke a few more, it seems like someone is stepping on my chest).  I quit for 6 months, but the abdominal soreness did not subside.
         I drink 1-2 glasses of domestic read wine every day.
         My diet is fairly healthy with a low to moderate fat content.
         I have been eating gluten-free foods for about one year (my half sister is definitely a ceoliac, and my mother is quite sure she is.  I had a blood test done, and my doctor said there were no signs of the disease in me (perhaps I have a mild case).  The soreness still has not subsided with this change in diet.
  TESTS: Cholestoral ok.
         Upper GI and lower bowel series done recently, with no abnormalities found.
        
  At this point, I don't know what to tell my doctor to help him pinpoint the problem.  As the soreness gets worse, I get more and more fatigued and am able fewer of the things I like to do.  My wife is very concerned, and we don't want to start a family until this is resolved.  Any comments are appreciated.
  -Mike-  
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Dear Michael,
It is difficult to attribute your pain symptom to a specific organ because of the fact that many diseases can produce the same pattern of pain.  The UGI with small intestine X-ray excludes many of the common causes.  It is possible that the abdominal pain that radiates to the back may represent pancreatitic inflammation.  Pancreatitis is usually caused by either alcohol or common bile duct stones.  Ask your doctor if the blood amylase and lipase have been checked and whether a CT scan of the abdomen should be ordered.  Celiac disease does not present with the symptoms that you describe.  I do not think that you need continue the gluten free diet. It is possible, however, that some ofyour symptoms are due to reflux esophagitis.  For this reason, an upper endoscopy should be considered.
This information is presented for educational purposes only.  Always consult your personalphysician for specific medical questions.
HFHSM.D.-rf
*keywords: abdominal pain, pancreatitis
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