Pain remains after much evaluation

[ally'smom]

I'm a 39 yr old female, started having abdominal pain in August.  At first it was on both left and rt sides of upper abdomen.  First thought was ulcers due to a history, but EGD showed none.  Had abdominal ultrasound to rule out gallbladder problems, showed gallbladder, pancreas, liver etc to be normal.  To be "cautious", dr sent me for a CT with contrast - again normal.  Last test was a colonoscopy (3 polyps removed but still have same pain, and dr did not think the polyps would have caused my symptoms).  Pain has become more localized on my upper left side radiating to my back.  Tried an antispasmodic (Donnatal) to determine if it could be a motility issue - did not help.  I also have a lot of gas and bloating (which is why my dr thinks possible IBS, I guess).  According to my regular dr and the gastroenterologist, they feel I have had a very thorough eval.  (Have also had blood tests which were normal.)  GI dr. suggested it could be a group of nerves which is overly sensitive and suggested a very mild anti-deppresant is effective to help with this.  I reluctantly agreed to try this, but am wary of waiting a month or two for that to kick in and see if it has an effect.  As you know, there's lots of info on the internet for medical problems and I can't seem to quit worrying that it could be a pancreatic problem that the CT and ultrasound missed.  Should I push for an MRI and how unusual is it to order one based on the above?

[Kevin Pho, MD]

You have had a comprehensive set of tests, including upper and lower endoscopies and an abdominal CT scan.  Many of the major GI disorders will be found with those tests.



You can consider more specialized tests - such as a 24-hr pH study, esophageal motility testing, or blood tests looking for celiac disease.  



The left upper quadrant includes the spleen and pancreas.  Upper GI disorders also can present in that area as well.  The CT would evaluate many of these conditions.



If the tests remain negative, optimizing treatment for IBS can be considered.



These options can be discussed 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.

kevinmd_