Abdominal Pain

[ColeridgeFan]

Hi.  I am a 26 year old female.  For about a year i have had reoccuring abdominal pain.  it started just left of my navel and would come and go suddenly for a couple of days at a time.  six months into these bouts, i had a sudden constant pain in my upper left quandrent under the rib cage.  It was very intense.  i finally saw a doctor, who told me i had an ulcer and prescribed Nexium.  three weeks later i took a blood H. Pylori test which came out negative.  i then had an upper GI barium swallow, which came out normal.  the pain wouldn't go away so i continued getting tests.  I had a CT which also came out  normal and an ultrasound of my gallbladder, liver, pancreas, and spleen.  Everything normal.  I am about to have an endoscopy and i am guessing it will come out normal too.  I am on painkillers (hydrocodone and tramadol) that i have to take in order to get through the day (i am a full time student and work full time as well).  After the endoscopy, what tests are left?  I imagine i will have an MRI, but if that comes out normal, what is there left for me to do?

[Matthew007]

two things that i'm thinking...

probably should do a HIDA scan just to check for function of the gallbladder.  I had zero stones and it turned out mine wasn't working.  You could do blood tests to check pancrease/liver to see if they're elevated (usually the pancrease is scanned via ct scan or mri)

Also I have upper left abdominal pain that also is in the upper left back..one test you could try is celiac, i've been tested a bunch also and that's my only real possible solution I think..everything else was ruled out..  many people have it and you could take gluten out of your diet (along with others like soy) *after* you've been tested.  I came up negative but the blood tests are not the most accurate.  I don't think an MRI is worth much if you're done a ct scan (not sure if you have..) probably either a stool study to check for bugs or to see if you have any microscopic blood or white blood cells indicating a problem and then maybe colonoscopy but a food elimination diet would be worth doing in the meantime.

[JDS2805]

Hope everything gets better. If not, I would look into a colonoscopy to rule out IBS, Crohns, and Ulcerative Colitis. I'm not sure what an MRI of the abdomen would do but you've had some of the best tests out there. Wishing you all the best!

[Banned1]

Hi Jessica:

I wish you a speedy recovery.  Hopefully dietary changes will make a world of difference for you.  If you think of it - especially if you are feeling better - could you let me know how you are doing from time-to-time?

All the best,

Sam

[ColeridgeFan]

Thanks for the help.  i have a history of gallbladder issues in my family, but my specialist only did the ultrasound at my request.  i had my endoscopy yesturday and he biopcied (sp?) something.  but the pictures look normal (my father has really bad pics from his endoscopy so i could compare).  I think ill try the pancreatic enzymes you talked about because i think my symptoms point to pancreatitis, even if my doc doesn't think so.  i have noticed if i eat something extremely high in fat that the pain is worse, so i might try the low fat diet.  I will deffinatly start a journal about intake and outtake with pain levels, i wonder why i didn't think of that myself.  i'll keep trying.  my GP claimed i just may have "chronic pain".  i think that is a foolish thought.  the pain has to come from somewhere, and i am more determined than ever to find it.  Thanks for the response.

Cheers,
Jessica

[Banned1]

I'm so sorry you are suffering.  I'm not a doctor and know nothing about medicine.  Also, my chronic pain is right-sided.  Many of the people in my yahoo! webgroup suffer from left-sided pain, though.  Search yahoo! groups for "Sphincter", you will find quite a few groups.  Michele's and Maddi's are worth joining.  There is a lot of great information there that might help you.  Since many of us are relatively house-bound or bedridden, this also provides a much-needed social outlet.

Your symptoms could be SO many things including microscopic sludge/stones in the common bile duct, gallbladder, Sphincter of Oddi Dysfunction, Small Bowel Bacterial Overgrowth, pancreatitis, etc.

The next test would likely be a HIDA Scan to see if your gallbladder ejection fraction rate is above 35%.  If not, that could be your problem and they might recommend removal.

There are some less invasive tests such as the Endoscopic Ultrasound (EUS) and MRCP-S (Secretin) which can image the pancreas and ductal system.  The EUS does require sedation and is similar to an upper endoscopy.  Once you have a Gastroenterologist, they might be willing to try an EUS or MRCP-S to determine what is causing your symptoms.   I would try that before I risked an ERCP, given the risk factors.  Right now, EPISOD studies are being conducted in the United States which might be a way to get to the bottom of your symptoms without the cost if you qualify and can't afford health care.   The EUS is the gold standard test for identifying problems in this area and I sincerely wish I could have one.

Metamucil or a similar daily fibre product is a great help for MANY people with abdominal pain.   It does not make you go, it makes you regular by adding fibre to the watery stools, making them firm.   It may or may not help but it can't hurt to try it for a month.  If it doesn't do anything for you, you're out $20 tops.

Many people have great success with digestive enzymes and pancreatic enzymes.  This is something you can talk to your primary Doc about.  I'm told that they won't do any harm so really - unless you have side effects - why not give them a try?  Your Doc might even have samples.  This is something you can do now and it reduces the amount of work the pancreas has to do which will also reduce any damage to the pancreas.  You can get them at the health food store, too, but make sure they only have proteases, amlyase and lipase.

A low-fat, fibre-rich diet can make a BIG difference.  Eliminate fried foods from your diet and start with bland foods, you may get to a point where you have no pain.  Then you can add new items to see how you feel.  Less than 30 grams of fat per day is a great starting point.  Of course, alcohol is a bad idea but when you're sick, you're probably not drinking.

Keep a log of everything that goes into or comes out of your body as well as how you feel.  This will help you identify patterns and you might have a Eureka! moment when you realize something is causing your pain.

You are not alone!  Try to stay positive and reach out for support when you need it.  Talk to your Doctor, family, friends, co-workers, church or social service volunteers or anyone you feel safe with.  

Take care of yourself.  God bless, good luck and Godspeed.  All the best,

Sam