Persistent Right Upper Abdomen Pain After Meals: What to Do? - Gastroenterology and Hepatology

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Persistent right upper abdomen pain after meals can be quite distressing, especially when previous examinations such as colonoscopy, gastroscopy, and abdominal ultrasound have not revealed any underlying issues. Given your symptoms and the lack of findings from these tests, it is important to consider a few potential causes and the appropriate steps to take.

Firstly, it is essential to understand that pain in the right upper abdomen can be associated with several organs, including the liver, gallbladder, pancreas, and even the right kidney. Since your ultrasound did not show any issues with the liver or gallbladder, it may be worthwhile to explore other potential causes.

1. Biliary Colic: Even if your ultrasound did not show gallstones, sometimes small stones can be missed, or there could be a condition known as biliary dyskinesia, where the gallbladder does not function properly. This can lead to pain after eating, especially after a fatty meal. A HIDA scan (hepatobiliary iminodiacetic acid scan) can assess gallbladder function and help diagnose this condition.

2. Gastritis or Peptic Ulcer Disease: While you mentioned having undergone gastroscopy, it is possible that gastritis or a peptic ulcer could still be present but not easily identifiable. Symptoms can sometimes be intermittent. A trial of proton pump inhibitors (PPIs) or H2 blockers may help alleviate symptoms, and if they do, it could indicate that acid-related issues are at play.

3. Functional Dyspepsia: This is a common condition characterized by chronic pain or discomfort in the upper abdomen without any identifiable cause. It can be triggered by certain foods or stress. Dietary modifications, such as avoiding spicy, fatty, or acidic foods, and eating smaller, more frequent meals may help.

4. Pancreatitis: Although less common, inflammation of the pancreas can cause upper abdominal pain, particularly after meals. If you experience any additional symptoms such as nausea, vomiting, or changes in stool, further evaluation may be warranted.

5. Musculoskeletal Pain: Sometimes, pain in the upper abdomen can be referred pain from musculoskeletal issues, such as rib dysfunction or muscle strain. A physical examination by a physician or a visit to a physical therapist may help identify if this is the case.

6. Psychological Factors: Stress and anxiety can manifest as physical symptoms, including abdominal pain. If you suspect that stress may be contributing to your symptoms, consider discussing this with a healthcare provider who can guide you toward appropriate stress management techniques or therapies.

Given the complexity of your symptoms and the negative results from previous tests, I recommend consulting with a gastroenterologist if you haven't already. They can provide a comprehensive evaluation and may suggest further testing, such as a HIDA scan, MRI, or even a referral to a pain specialist if necessary.

In the meantime, keeping a food diary can be beneficial. Document what you eat and when the pain occurs to identify any potential triggers. Additionally, consider lifestyle modifications such as reducing stress, avoiding known trigger foods, and maintaining a healthy diet rich in fiber, which can help with overall digestive health.

In conclusion, persistent right upper abdominal pain after meals can stem from various causes, and a thorough evaluation by a specialist is essential to determine the underlying issue. By taking a proactive approach and exploring different avenues for diagnosis and treatment, you can work towards finding relief from your symptoms.