Upper Abdominal Pain: When to Seek Medical Help - Gastroenterology and Hepatology

Pain in the upper abdomen and left chest?

In recent years, I have been experiencing stomach pain intermittently.
When it becomes severe, I visit a doctor and take gastric medication.
During a health check-up in February and March, I received a report indicating two abnormal tumor markers related to the digestive system (slightly above the standard) and an abnormal result for Helicobacter pylori.
Subsequently, I underwent examinations at a teaching hospital, including gastroscopy, colonoscopy, and abdominal ultrasound, which revealed no significant issues, and I was only advised to undergo eradication therapy.
However, the stomach pain persists, particularly after 2 or 3 PM, and while medication provides some relief, forgetting to take it leads to increased pain.
A subsequent CT scan also showed no significant problems.
The pain is located in the upper abdomen, slightly to the left, about the size of a palm, and sometimes feels like a needle stabbing, especially near the lower edge of the left breast.
Pressing on the area provides some comfort, but releasing the pressure increases the pain.
I also tend to experience chest tightness, palpitations, and a slightly elevated heart rate, with my heart rate exceeding 100 bpm with minimal exertion.
I wear an Apple Watch, which occasionally shows my heart rate dropping to between 40-50 bpm.
During those times, I often feel particularly fatigued, and I wonder if there is a connection between the two issues.
When the pain occurs, lying flat and resting on my left side is more comfortable.
I would like to know which specialty I should consult to improve my condition.
I have already seen a cardiologist and a gastroenterologist.

Y Hui, 40~49 year old female. Ask Date: 2023/10/11

Dr. Hu Guozheng reply Gastroenterology and Hepatology

It is recommended to have regular follow-up visits to monitor your current discomfort.
Please seek medical evaluation based on your symptoms.
Thank you.

Reply Date: 2023/10/11

More Info

When dealing with upper abdominal pain, especially in the context of your medical history, it is crucial to approach the situation with a comprehensive understanding of potential underlying causes and appropriate medical specialties to consult. Given your symptoms and previous evaluations, here are some insights and recommendations.

Understanding Your Symptoms
1. Location and Nature of Pain: You describe the pain as being located in the upper abdomen, specifically on the left side, and sometimes radiating towards the left breast. This could suggest several possibilities, including gastrointestinal issues, musculoskeletal problems, or even cardiac concerns. The fact that pressure alleviates the pain somewhat may indicate a musculoskeletal origin, but it’s essential to consider other factors.

2. Associated Symptoms: You mentioned experiencing chest tightness, palpitations, and a history of abnormal heart rates. These symptoms can be interconnected, as stress and anxiety can exacerbate both gastrointestinal and cardiac symptoms. The heart and digestive system are closely linked, and issues in one can often affect the other.

3. Previous Investigations: Your previous tests, including endoscopy, colonoscopy, and imaging, have ruled out serious gastrointestinal conditions. However, the presence of abnormal tumor markers and Helicobacter pylori suggests that there may still be underlying issues that need to be addressed, particularly regarding your digestive health.

When to Seek Medical Help
Given your ongoing symptoms and the complexity of your case, it is advisable to seek further medical evaluation. Here are some steps you can take:
1. Gastroenterology Follow-Up: Since you have already seen a gastroenterologist, consider scheduling a follow-up appointment to discuss your persistent symptoms. It may be beneficial to explore further diagnostic options, such as a gastric emptying study or additional imaging studies, to rule out conditions like gastroparesis or other functional gastrointestinal disorders.

2. Cardiology Consultation: Given your symptoms of palpitations and variations in heart rate, a cardiology consultation is warranted. An electrophysiological study or a Holter monitor might be useful to assess your heart rhythm over a more extended period, especially since you’ve experienced episodes of bradycardia (low heart rate).

3. Psychological Evaluation: Since you mentioned feelings of anxiety and stress, it may be helpful to consult with a mental health professional. Anxiety can manifest physically, leading to gastrointestinal symptoms and exacerbating existing conditions. Cognitive-behavioral therapy (CBT) or other therapeutic approaches may provide relief.

4. Pain Management: If your pain persists, consider consulting a pain management specialist. They can offer various treatment options, including medication adjustments, physical therapy, or alternative therapies like acupuncture, which may help alleviate your discomfort.

Conclusion
In summary, your upper abdominal pain, coupled with your cardiac symptoms, suggests a multifaceted issue that may require a multidisciplinary approach. It is essential to continue working closely with your healthcare providers to explore all potential avenues for diagnosis and treatment. Keep a detailed symptom diary to help your doctors understand the patterns and triggers of your pain, which can be invaluable in guiding your treatment plan. Remember, effective communication with your healthcare team is key to finding a resolution to your ongoing discomfort.

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