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Rib and Gas Pain

I am a 45 year old female who has been experiencing rib pains on both my left and right sides for close to a year now.  I used to feel mild pain when I just pushed in on my right side, but it was barely noticable.  I did have endoscopic gall bladder surgery around this time last year and it wasn't long after that when I started to notice the rib pain more.  Again, it was more on my right side, but now I am feeling it on my left side as well.  Most of the time my ribs don't even bother me unless I press in or where a bra that is too tight and digs in, but it is just something I am aware of.  I also sometimes feel a discomfort, although not really pain, usually in my right shoulder blade at times.  I always thought that indicated a GB problem or maybe a problem with the liver.  I have spoken to my internist and surgeon who removed my GB about this problem, and they both feel it is excess gas causing the symptoms.  I tend to believe that is true since the discomfort I feel seems to travel around, sometimes not always being in the same spot on my ribs or other areas.  I am trying to figure out if eating makes it worse and from what I can tell it does seem to affect me sometimes.  I did notice I seem to be pretty gassy a lot of the time, but I am not sure why this is happening since my bowel movements are pretty regular.  Sometimes when I lay in bed at night I could actually hear the gas rumbling in my stomach.  Very rarely will my stomach actually hurt me and most of the pain I feel seems to be in my rib area, which I realize is close to the colon where the excess gas must be.  

Can an acid reflux problem cause rib pain?  Sometimes I feel I have this even though I don't get heartburn that much.  Sometimes I feel like I have to burp but it kind of gets stuck in my chest until it eventually comes up.  Can a hiatal hernia cause the problems I am having?  I know hiatal hernias are common, especially with people that have also had GB problems.

I have read various postings on the boards and see that rib pain isn't that uncommon, but there are different reasons for it ranging from a GI problem to something muscular.  Sometimes I think it is both in my case, but I can't say for sure.  From your experience, what are the most common reasons a person would feel pain in their ribs?  I have researched rib pain, but most of the time the information I find is confined to either left sided rib pain or right sided rib pain and doesn't talk about when you have both.  Before I had my GB surgery last year I did have a complete blood workup, echocardiogram and abdominal sonogram and nothing abnormal was found other than the stones in my GB.

Thank you for any information you may supply me.

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Acid reflux and a hiatal hernia leading to reflex can result in these symptoms.  Other possible causes would include an ulcer, inflammation of the esophagus, stomach or small intestine, or irritable bowel syndrome (this is less likely with your regular bowel movements).  

I would suggest an upper GI series and/or upper endoscopy to investigate the upper digestive tract.  A test for H Pylori - a bacteria that is associated with ulcers and inflammation - would also be recommended.  

If these tests are negative, you may want to consider a 24-hr pH study to investigate whether acid reflux is the cause.  This test is the most comprehensive test to diagnose GERD.  

If the GI tests are negative, then other potential areas to look at include musculoskeletal, cardiac and pulmonary causes.  

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.
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