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Left upper abdominal pain by bottom of to cage

I have been in an extreme amount of pain for the past 3 months. I have a pain in the upper left side of my abdomen, right but the lower part of my rib cage. The area of pain is also visibly swollen and bigger than the right side. I have seen my general practitioner, a GI doctor, a second general practitioner, a surgeon, and been to the er 3 times and no one seems to know what's wrong. I've had cts of the area in pain, an MRI of that area as well as my spine, and an upper endoscopy with all negative results. Only finding in any of the tests was that the area is in pain had an elevated rib cage compared to my right side. Doctors said I was born that way but I have never felt this l
Pain before. I've also had other scans throughout my life as I have a history of lymphoma and nothing regarding my ribs was ever brought to me attention. I've been diagnosed with shingles and acid reflux which never ended up
Being a true diagnosis for the pain. What could this possibly be?
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replied February 2nd, 2014
Good day!
Thank you for asking. you have a diagnosis. GERD and rib cage mal alignment. The pain is a visceral pain refered to the left hypochondriac pain. It is a reflux issue and it always present this way. Lymphoma and other histories are not significant except the fact that the mass you mentioned could be spleen which reduces the space for stomach and further makes the reflux worsen.
Now with all the work ups have come clear means it is GERD. get 24 hour PH monitoring and esophageal manometry. See if there is correctionable etiology for this reflux. The pain will go away once the issue is fixed.
80 % issues get fixed by
Losing weight (if overweight)
Avoiding alcohol, chocolate, citrus juice, and tomato-based products
Avoiding peppermint, coffee, and possibly the onion family[8]
Eating small, frequent meals rather than large meals
Waiting 3 hours after a meal to lie down
Refraining from ingesting food (except liquids) within 3 hours of bedtime
Elevating the head of the bed 8 inches
Avoiding bending or stooping positions
rest 18 percent get relief with medicines like
H2 receptor antagonists (eg, ranitidine, cimetidine, famotidine, nizatidine)
Proton pump inhibitors (eg, omeprazole, lansoprazole, rabeprazole, esomeprazole, pantoprazole)
Prokinetic agents (eg, aluminum hydroxide)
Antacids (eg, aluminum hydroxide, magnesium hydroxide)
and the only two remaining percent get relieved by surgery. Fundoplication by different techniques and Electromagnetic esophageal rings recently approved by FDA.
Consult with your doc for further management.
Good Luck
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replied February 2nd, 2014
My GI doctor never mentioned anything about GERD. Is it still a possibly diagnosis even when my upper endoscopy came out normal? I've tried reflux medicines and even the GI doctor told me my diagnosis was not reflux. How could the rib cage mal alignment be treated?
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replied February 4th, 2014
Thank you again !
With all the reports coming back normal and reflux medicines not responding and all the etiologies ruled out for gastric troubles like gastitis or H pylori all that is left is some skeletal muscle spasm because of rib cage mal alignment and i think you should seek a pain management specialist and let them help you with the pain with mean while all the precautionary measure for gastric troubles and diet lifestyle modification.
Topical NSAIDs and skeletal muscle relaxants and antispasmodics need to be discussed with your doctor too as treatment modality.Any how it needs a bit work up and regarding the rib cage if that has been all along life and no issues i think that as a reason for the pain is ruled out.
Upper endoscopy does not rule out GERD. For that 24 hours PH monitoring and Esophageal Manometry are the tests. Also mean while get tested for H Pylori and eosinophilic gastritis and follow the non pharmacologic plan. Lets see if it helps.
I am sorry for that rib cage malalignment. i got carried away with that. it has nothing to do with the pain. had it it would have been since birth.
Stay in touch with your gastro enterologist as complete work up and assessment is reuired which an online consultant from thousands of miles with just key board to tap fingers on, does not have.
Hope it helps
khan
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