Pain in left side under ribs

[hwolfy]

I'm a 39 year old male. 157 lbs.  No smoking, no drinking.

I was diagnosed with GERD five months ago.  The diagnosis came through an upper endoscopy and a barium swallow.  The doctor mentioned that I had a sliding small hiatal hernia, quite a bit of reflux plus gastritis and duodenitis. The esophagus appeared normal and the test for H. Pylori was negative.  I was put on Nexium.

About a month after the GERD diagnosis I developed a pain on my left flank.  The pain is maybe 3 inches above my bottom rib but it is difficult to pinpoint an exact location with one finger. It sometimes moves from flank to the left center under ribs.  The pain is always there and is not affected by movement, breathing, eating, or bowel movements.  It seems to be a bit worse when lying down and it invariably wakes me up at night.  The pain has been present for four months and it hasn't gotten any better or worse.  There are some days that are better than others. The pain feels like a dull pulling pain inside my ribs.

I've had a series of tests including scan of the chest, scan of the abdomen, scan of the pancreas, scan of the pelvis, ultrasound of the liver, pancreas and gallbladder, extensive blood work, urine work, d-dimer, pancreatic enzymes, bone scan, colonoscopy, and small bowel series.  Findings included C. Dificil for which I was successfully treated three months ago. Bone scan found small activity on the 7th and 8th spinal vertebrae. (unrelated?).  Everything else was ok.

Have taken metronidazole, chlordiazepoxide/clinidium, dicyclomine,ibuprofen, sucralfate, methylprednisolone, and donnatal.

My doctor now wants me to go for an MRI of the abdomen. At this point I need more ideas than tests. Any comments are welcome.

[Kevin Pho, MD]

There has clearly been a comprehensive evaluation.  Considerations would include a 24-hr pH study to see if the GERD is present despite the Nexium.  If so, then you may want to consider surgery to correct the hiatal hernia and GERD.

If the bone scan shows activity on the vertebrae, this can be further investigated with an MRI.  Any type of injury or lesion can cause a positive bone scan.  

Another thought would be a HIDA scan with CCK stimulation to see if the gallbladder function is normal.

If all the tests continue to be non-revealing, then you may want to consider irritable bowel syndrome as a diagnosis.  Discussion of these possibilities can be made with your personal physician.

Followup with your personal physician is essential.

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.
Medical Weblog:
kevinmd_b

[CAmom]

Try this one:
I have had constant rib pain in my upper right chest for over 10 years. Now I also have it in my lower left rib area. I have had an MRI full chest, abdomen area. The only thing it came up with was that I have a slightly curved spine. Other than that it came up normal. I have been complaining to my doctor for years. He pretty much told me it was stress. Now, I have been reading through many of the questions and answers on this site and it's obvious others suffer the exact same symptons, I'll copy and paste one below. I have been reading your answers and most often it's suggested that people may have GERD and they should get a test. Unfortunately, we don't get the results, so we don't know if your recommendations are accurate. But I would like to help improve your knowledge of this very troubling, and obviously more widespread chest pain phenomenon. My doctor finally after years of my complaints came up with this: SLIPPED RIB. Please look into this, perhaps others can benefit from this type of evaluation. It's basically: Slipped rib syndrome, sometimes known as "Rib subluxation," is a common cause of mid-back, chest, and/or abdominal pain in adults. Its characteristic feature is sharp rib cage pain with deep or heavy breathing. It is frequently confused with rib fracture or disorders of the esophagus, heart, or stomach. This is such a little known syndrome but seems as your "on-line patients" describe it to be a possible culprit. Especially in light of the fact that many people are getting all kinds of tests and everything looks normal. I can only hope this is what's happening to me...

[INeedHelp3625]

I'm having the same pain in my left side under my breast. I will get the pain out of nowhere. Sometimes when I'm laying down or sleeping, others when I"m walking. I have never before had a serious health problem and It scares me that something might be wrong. By any chance would anyone know whats wrong and if it is serious?

[christineuk62]

i have pain in my left ribs that sometimes hurts when i breathe deeply.  i also have pain when i feel my left ribs and i worry about this pain a lot. sometimes i get a sharp stabbing pain thats real painful.

[kassiestarr]

i have been having the same problem of left sideded pains for about a year. Yes i have been trying to
deal with it with otc meds. and tums but recently it has woresened and it is quite scary. My doctor
told me that my guts were ate up from taking too many otcs. Well he put me on Nexium and i have not seen any relief. i go this week for a abd. ultrasound and pelvic exam HELP

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