Left Upper Abdominal Pain: Causes and Next Steps - Gastroenterology and Hepatology

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Understanding left upper abdominal pain can be quite complex, especially when multiple diagnostic tests have been performed without a clear resolution. Based on your description, it seems you have undergone a thorough evaluation, including abdominal ultrasound, X-rays, gastroscopy, colonoscopy, and blood tests, which have revealed several findings: fatty liver, multiple gallbladder polyps, mild gastric ulcer, and duodenal ulcer. Despite being on medication for over three months, your symptoms have not improved and may have worsened.


Possible Causes of Your Symptoms
1. Gastric and Duodenal Ulcers: While you have been diagnosed with mild ulcers, it's important to note that even mild ulcers can cause significant discomfort, especially if they are aggravated by certain foods, stress, or medications. If the ulcers are not healing, it may be due to continued irritation from NSAIDs, alcohol, or even stress.

2. Gallbladder Issues: The presence of gallbladder polyps, although usually benign, can sometimes lead to discomfort, especially if they are causing obstruction or inflammation. Gallbladder disease can manifest as pain in the upper abdomen, particularly after eating fatty meals.

3. Fatty Liver Disease: This condition can lead to inflammation of the liver (steatohepatitis), which may cause discomfort in the upper abdomen. If the liver is inflamed, it can lead to pain and discomfort.

4. Referred Pain: Sometimes, pain in the upper abdomen can be referred from other areas, such as the pancreas or even the heart. Conditions like pancreatitis or cardiac issues can present as upper abdominal pain.

5. Functional Gastrointestinal Disorders: Conditions like functional dyspepsia or irritable bowel syndrome (IBS) can cause chronic abdominal pain without any identifiable structural abnormalities. Stress and anxiety can exacerbate these conditions.


Next Steps for Evaluation
Given that your symptoms have persisted despite treatment, it may be time to consider further evaluation:
1. Follow-Up with a Gastroenterologist: Since you have already seen a gastroenterologist, it may be beneficial to return for a follow-up. Discuss your ongoing symptoms and the lack of improvement with the current treatment plan. They may consider adjusting your medications or conducting further tests.

2. Consider Imaging Studies: If not already done, advanced imaging such as an MRI or CT scan of the abdomen may provide additional insights into any underlying issues that were not visible on previous tests.

3. Endoscopy Re-evaluation: If symptoms persist, a repeat endoscopy may be warranted to assess the healing of the ulcers and to check for any other potential issues that might have developed since your last procedure.

4. Dietary and Lifestyle Modifications: Sometimes, dietary changes can significantly impact symptoms. Keeping a food diary to identify potential triggers, reducing alcohol intake, and managing stress through relaxation techniques or therapy may help alleviate symptoms.

5. Pain Management: If the pain is severe and persistent, discussing pain management options with your healthcare provider may be necessary. This could include medications or alternative therapies.

6. Psychological Evaluation: If stress or anxiety is suspected to be contributing to your symptoms, a referral to a mental health professional may be beneficial. Conditions like anxiety can manifest physically and exacerbate gastrointestinal symptoms.


Conclusion
In summary, while your diagnostic tests have ruled out several serious conditions, the persistence of your symptoms suggests that further evaluation is necessary. It is crucial to maintain open communication with your healthcare provider and advocate for your health. If you feel your concerns are not being addressed, seeking a second opinion from another gastroenterologist or a specialist may provide new insights and treatment options. Remember, managing abdominal pain often requires a multifaceted approach, including medical treatment, lifestyle changes, and sometimes psychological support.