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

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Understanding left upper abdominal pain can be complex, especially when the symptoms are vague and intermittent. Based on your description, it seems that you have been experiencing a sensation of bloating and discomfort in the area just below the sternum, near the lower rib cage. You have already consulted a gastroenterologist, who performed an endoscopy and diagnosed you with mild inflammation of the stomach and upper esophagus, as well as mild gastroesophageal reflux disease (GERD). However, despite medication, you have not seen significant improvement.

There are several potential causes for your symptoms that may warrant further investigation:
1. Gastritis and GERD: As you mentioned, the inflammation of the stomach lining (gastritis) and GERD can cause discomfort and bloating. These conditions can lead to symptoms such as a feeling of fullness, nausea, and pain, especially after eating. If the prescribed medications (like proton pump inhibitors or antacids) have not alleviated your symptoms, it may be worth discussing with your doctor about adjusting the treatment plan or considering additional therapies.

2. Peptic Ulcers: If the inflammation persists, it could potentially lead to the development of peptic ulcers, which can cause similar symptoms. An ulcer can cause pain that may be felt in the upper abdomen and can be exacerbated by certain foods or medications.

3. Functional Dyspepsia: This is a common condition characterized by chronic or recurrent pain in the upper abdomen without any identifiable cause. It can manifest as bloating, discomfort, and a feeling of fullness. Treatment often involves dietary changes, stress management, and medications to reduce stomach acid.

4. Gallbladder Issues: Although your pain is located in the upper left abdomen, gallbladder problems can sometimes present with pain in the upper abdomen, particularly if there are gallstones or inflammation (cholecystitis). Symptoms may include pain after eating fatty meals, nausea, or bloating.

5. Pancreatitis: Inflammation of the pancreas can also cause upper abdominal pain, typically more severe and often associated with nausea and vomiting. It is less likely given your symptoms, but it is something to consider if your pain worsens.

6. Cardiac Issues: While less common, it is important to rule out any cardiac-related issues, especially if you experience additional symptoms such as shortness of breath, sweating, or radiating pain.

Given that your symptoms have not improved with initial treatment, it would be advisable to follow up with your gastroenterologist for further evaluation. They may recommend additional tests such as an abdominal ultrasound to check for gallbladder issues or a CT scan to assess for other potential causes of your discomfort.
If your gastroenterologist does not find any further gastrointestinal issues, it may be beneficial to consult with a pain specialist or a functional medicine practitioner who can explore other underlying causes, including dietary intolerances or stress-related factors that could be contributing to your symptoms.

In summary, while your symptoms may be related to gastritis or GERD, there are several other potential causes that should be explored. Continuing to work closely with your healthcare provider and possibly seeking a second opinion or additional specialties may help you find the relief you are seeking.