[Red22]

I'm struggling to find an explanation for my Abdominal Pain. IBS is one option out of many, and I'm hoping some knowledgeable people here can tell me if it is a possibility?Two years ago, I started getting a vague pain a few inches below my front right rib. Often referred to as 'Right Upper Quadrant' pain, it seems to occur to anywhere in an arc below the lower right rib from say the front (i.e. stomach) round to almost my side. Generally, it's the One O'clock to Two O'clock position if my belly button is 12 O'clock position (hope this makes sense!). It comes & goes, with no clear pattern or timing. Sometimes it feels like a sense of fullness or bloatedness under that right rib, making sitting up/forward less comfortable than standing, as if bending forward at the waste was putting pressure on something slightly sensitive. Perhaps related to this, a full belly after eating can increase the feeling of pain or discomfort.I have tried drinking lots of water (Dr said it could be some kind of intestinal blockage). Blood tests for Liver function (amongst other things) were clear. An ultrasound scan of my abdomen found no problem in the various organs checked (inc. Gall Bladder, Liver etc), whilst a detailed CT scan of my Kidneys showed nothing either.Acting on the suggestion of one Dr that it could be a stomach/duodenal sensitivity, I initially tried taking Omeprazole, which reduces stomach acid production. I felt substantially better whilst taking it (I don't consider myself very 'suggestible', btw) and so was encouraged to think this might be some simple ulcer type problem. So I was checked by endoscope into stomach & duodenum, but no ulcers or anything else was seen. A sample of my stomach lining was at the same time taken for H.Pylori bug test (for possible ulcer cause) but came back negative too. But the taking of the sample (a small pinch of my stomach lining with the endoscope's 'grabber') made me almost jump off the table. This sensitivity was not normal, and surprised theatre staff greatly.An MRI scan of my lumbar & thoracic spine showed no evidence of any nerve entrapment etc which could cause such pain. Years of Osteopathy (for lower back problem) have also not really helped when the lower thoracic rib joint was targeted, this being a theoretical cause.I have a good diet, lots of fresh food (no junk) and have always gone easily and regularly to the toilet. I do not recognise descriptions of constipation, although the 'morning rush side of IBS does sound possible, but fresh fruit & veg can have this effect, I'd have thought? I've experimented with diet, but have yet to find a clear trigger. I've taken Fybogel Mebeverine for a week, which suppresses gut spasms, but don't think it has yielded a convincing improvement.I cannot relate my symptoms to Appendix problems (too high in abdomen for one thing) and so have started to wonder about digestive problems. I am starting to feel like a 'bad penny' at my Dr's surgery, and would like to return well informed for my next visit or else risk being brushed off with some pain killers etc.If anyone thinks I could have, or can't have IBS, or just has some other helpful suggestion, any advice would be appreciated.

 

[Kathleen M.]

If there is no change at all in bowel habit that rules out IBS (although the morning rush does sound like it could be a mild change which would fit with IBS).There is chronic functional abdominal pain which is all the pain of IBS without the stool issues, so totally normal stool doesn't rule out functional problems.If intestinal the problem can be associated with colon activity, but that isn't usually from any specific food so diet (other than keeping meals smaller and more frequent and limiting fat) often doesn't make any difference.If antispasmodics (either prescription or peppermint) seems to help that really does indicate something in the smooth muscles and usually that means the colon and it comes up the right side and has a bend right at the small intestine. That stomach remedies help and you have stomach sensitivity to pain may indicate you have some functional dyspepsia (and that is common to have both that and IBS).

 

[Red22]

Kathleen M.,Thanks for the quick reply. I've just quickly googled Chronic Functional Abdominal Pain, and I must say that as (like you) a person of scientific profession, I feel uncomfortable with conditions which lack physical evidence. That's not to say I disagree with you, just that I hate such ill defined things.Are you saying that if I take something like peppermint oil (any suggested type/dosage?) and it helps, then I may well have CFAP? Or would you say that the Mebeverine component of the Fybogel I'm trying right now is a sufficient antispasmodic to confirm test theory? I've felt a more 'stomach' pain since taking it, rather than the right flank pain, which has made it hard to declare this a definite success. A Dr some 5 years ago prescribed it after abdominal pain which he attributed to diverticulosis, a diagnosis I doubted due to my aforementioned lack of constipation, the presumed cause of this.And can you 'just get' CFAP in your middle years, for no apparent reason?

 

[Kathleen M.]

There are some biomarkers they now do have a blood test for so IBS/Functional GI issues aren't quite so much a mystery, but I don't know if they've looked at the other functional GI issues.Functional means doesn't show up on medical tests designed to find other conditions. Not no physical changes are found in any person at any time of any sort. They find lots of physical changes in the research and that is starting to show up in medical tests designed to find IBS (it is the most common they started with that).Functional GI issues do tend to "just start up one day". They are usually not birth to death disorders. You are fine most of your life and then they pop up. They also can go away over time so maybe you can hope to be one of the lucky ones.Usually something known to damage the nervous system is what starts IBS/functional GI problems (like a GI infection as the inflammation from that can disrupt the nerves in the gut wall and the gut doesn't just work fine by itself. It takes a vast neural net to sense and control it and anything that goes off with that large and complex system and you get one of the functional bowel or functional upper GI problems. Pain from nerves gone funky is often some of the worst pain any human ever experiences, as when it is screaming in pain just because it is screaming in pain there usually isn't any sort of off switch).Anyway. I take 2-3 peppermint Altoids and some people find a cup or two of peppermint tea is enough to ease the pain. Antispasmodics are about 50-50 and sometimes fiber increases pain all by itself.

 

[Red22]

Thanks for the further info. I am very curious about what you say, it would certainly be nice to think that what I have is a relatively minor digestive problem which might be relieved fairly easily.I'm not familiar with the peppermint Altoids you refer to, but there seems no shortage of peppermint oil tablets from various suppliers, often around 50mg content. Some state they are 'Entero coated', to avoid breakdown in the stomach acid and instead release further down the small intestine. Is this Entero coated form more (or less) applicable for testing the theory?I've tried plenty of ideas so far, and will certainly give peppermint a go.

 

[Kathleen M.]

I don't know that where the peppermint dissolves says much about what is causing the pain if any of them relieve it.I use the Altoids because around here they are both cheap and easy to get. I find them more convenient then tea, and no one pays any attention to someone popping a mint or two.

 

[screeb]

Delayed gastric empying may be the cause of the 2 0'clock URQ pain. I get it as well. The hypothetical cause of Gastroparesis is decreased Ghrelin ( a gastrointestinal neurotransmitter). Ghrelin is stored in the lymphatic system. You may be feeling the superficial lymph nodes draining into the right thoracic duct, thus releasing Ghrelin ( causing Gastric emptying).

 

[Red22]

screeb,Thanks for that idea, which is interesting. Following on from Kathleen M.'s posts, I've checked out the idea of Functional (non-ulcer) Dyspepsia, and am quite taken with the idea initially. The idea that you can have the symptoms of an ulcer, but no ulcer (or even H.Pylori) found via endoscopy would fit my experience. I've found a decent medical site which says that :

'About 6 in 10 people who have recurring bouts of dyspepsia have non-ulcer dyspepsia'

This makes the idea of a stomach related problem, but no ulcer/H.Pylori, far from fanciful. The same article later talks about acid suppressing drugs like Omeprazole giving relief for some people, as it did for me. Apparently only 1 in 3 Functional Dyspepsia sufferers have IBS, which would fit with my general lack of bowel problems. I think I read somewhere that delayed gastric emptying may be related to or the same thing as Functional Dyspepsia , would you know for sure?The peppermint suggestion hasn't worked so far, and I'm thinking of returning to Omeprazole, possibly long-term, which I believe is fairly safe. How are you controlling your problem, and are there any direct tests to confirm it? Or just a long series of eliminations, like I've had.