Re: Upper Abdominal Pain

Posted By Darci on July 07, 1999 at 09:01:54
I am a 26 year old female and have been having upper abdominal pain for some time - progressively increasing in frequency and in intensity in the last few months.  Pretty much every day there is pain.  The pain is most often a stabbing pain - mild to very sharp, comes and goes, can last from minutes to hours, and can occur at any time - morning, noon, and night.  The pain occurs on both of my sides, under the rib cage on both right and left sides, and the upper center of my abdomen.  Predominantly, it is on the right both under the rib cage and on the side.  In the last couple of weeks my breathing has been accompanied by stabbing pain in the epigastrium region, which comes and goes.  I also have some lower abdominal pain, severe GERD, mid and lower back pain, some bowel fluctuations, headaches and migraines, and dizziness and vertigo.
Last November I had an ultrasound and in December a HIDA scan.  Because my gallbladder was not visualized in either test, I was diagnosed with cholelithiasis and sent to a surgeon.  The surgeon wanted to be sure that I had a gallbladder rather than a choledoctal cyst before opening me up so he sent me to a gastroenterologist to have a diagnostic ERCP performed in January.  Neither a gallbladder nor a cyst were visualized.  A CT scan was performed; gallbladder not visualized and all other was unremarkable.  A gastroscopy was performed; ulcerative esophogitis and a moderate sized hiatal hernia were seen.    In February, a second ERCP was done to perform a sphincterotomy.  I then tried Levbid, Bentyl, and Librax with no relief.  In April, a colonoscopy was performed; nothing abnormal showed.  The doctor then put me a low dose of Zoloft, which I continue to take although there has been no relief.  Since January, my ALTs have been fluctuating as well.  He tested my porphyrins; the serum porphyrins came back ok but one of the urine porphyrins came back elevated.  He sent me to another doctor.
In June, the second doctor ordered a second porphyrins test, metals test, ALTs and some other blood work.  The porphyrins, metals, and other blood work came back negative and the ALTs were still elevated.  He also ordered an ultrasound and a CT scan.  A gallbladder was not visualized and all else was unremarkable.  The doctors diagnosed gallbladder agenesis and are attributing the abdominal pain to IBS and the elevated ALTs to the ERCPs.  The first time my ALTs were ever tested was four days before the first ERCP and they were normal.
1/7   Normal 1/11   ERCP 1/14   High 1/19   High, CT Scan   1/26   Normal, Gastroscopy 2/10   ERCP 2/22   Normal 3/16   High 4/13   High 6/3   High
I have been taking Prilosec since the end of January and it works about 90%.  When I'm not on it, pretty much everything I eat and drink causes the heartburn.  It's the worst in the late evening and at night.  I have cut out all cafinated beverages (none since mid-December) and have also cut down on fatty and acidic foods.  I have increased my fiber and water intake.  I've also lost approximately 30 -lbs since the beginning of January.  My appetite has been up and down.
I'm not satisfied with the diagnosis of  IBS as the cause of all my abdominal pain.  Any ideas?

[HFHSM.D.-rf]

Posted By HFHSM.D.-Gastro-RF on July 11, 1999 at 10:52:24
Dear Darci,
The list of possible causes for abdominal pain is quite extensive.  Although you have some specific diagnoses e.g. esophagitis, and other functional diagnoses e.g. irritable bowel syndrome, there is a lack of a unifying diagnosis to explain all your symptoms. The elevated liver tests and weight loss are objective abnormalities that may require specific diagnostic interventions e.g. liver biopsy, workup for intestinal diseases that can cause malabsorption.
I think that you should discuss with your doctors the possibility of additional tests.
This information is presented for educational purposes only.  Ask specific questions to your personal physician.  If you wish a second opinion, we would be happy to see you in the Division of Gastroenterology of Henry Ford Health System. You can arrange an appoinment with dr. Fogel, one of our experts in Gastrointestinal Disease, by calling our Physician Referral Line at [phone].
HFHSM.D.-Gastro-RF
*keywords: abdominal pain, weight loss, irritable bowel syndrome
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