Chronic Left Abdominal Pain: Seeking Answers and Diagnostic Options - Gastroenterology and Hepatology

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Chronic left abdominal pain can be a complex issue, especially when it has persisted for 2 to 3 years without a clear diagnosis. Your description of the pain being located under the left rib cage, continuous, and not significantly affected by eating or movement suggests that it could involve various organs, including the stomach, intestines, or even musculoskeletal structures. Given that you've already undergone a gastroscopy and ultrasound without significant findings, it’s understandable that you feel frustrated and confused about the next steps.

First, it’s important to consider the potential causes of your symptoms. Chronic abdominal pain can arise from gastrointestinal issues such as gastritis, peptic ulcers, or functional gastrointestinal disorders like irritable bowel syndrome (IBS). However, since you mentioned that the gastroscopy revealed only mild inflammation, it may be less likely that your symptoms are solely due to gastric issues.
Other possible causes could include:
1. Pancreatic Issues: Conditions like chronic pancreatitis can cause persistent pain in the upper abdomen that may radiate to the back. Although you have not reported any specific symptoms related to the pancreas, it may be worth discussing with your physician.

2. Biliary Tract Disorders: Gallstones or inflammation of the gallbladder (cholecystitis) can also lead to pain in the upper abdomen, particularly after eating fatty meals.

3. Musculoskeletal Pain: Given the location of your pain, it could also be related to muscle strain or rib dysfunction. Sometimes, pain that seems to originate from internal organs can actually be due to musculoskeletal issues.

4. Visceral Pain: Conditions such as endometriosis or other gynecological issues can also manifest as abdominal pain, especially in women.

5. Functional Disorders: Conditions like IBS or functional dyspepsia can cause chronic abdominal pain without any identifiable structural abnormalities.

Considering your situation, here are some diagnostic options you might discuss with your healthcare provider:
1. CT Scan of the Abdomen: A comprehensive abdominal CT scan can provide detailed images of the organs and help identify any abnormalities that may not have been visible on ultrasound or during gastroscopy.

2. MRI: An MRI can be particularly useful for soft tissue evaluation and can help rule out issues related to the pancreas or other abdominal organs.

3. Colonoscopy: Given your symptoms, a colonoscopy may be warranted to evaluate the colon for any potential issues, especially if there are concerns about inflammatory bowel disease or other colonic disorders.

4. Blood Tests: Comprehensive blood tests, including liver function tests, pancreatic enzymes, and inflammatory markers, can provide additional information about your overall health and help identify any underlying conditions.

5. Stool Tests: Testing for infections, inflammation, or malabsorption issues can also be helpful.

6. Functional Testing: If gastrointestinal motility issues are suspected, tests such as gastric emptying studies may be useful.

7. Referral to a Specialist: If you haven’t already, consider seeing a gastroenterologist who specializes in functional gastrointestinal disorders. They may have additional insights or testing options.

In conclusion, while it can be overwhelming to navigate chronic pain without a clear diagnosis, there are several avenues to explore. It’s essential to maintain open communication with your healthcare provider about your symptoms and concerns. A targeted approach to further testing, based on your history and current symptoms, can help identify the underlying cause of your pain and guide appropriate treatment. Remember, it’s important to advocate for your health and seek the necessary evaluations to find relief.