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What is the cause and treatment for epigastric pain?

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Gastroenterologist
Practicing since : 1996
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History: 43 year old male in good health - daily swimmer. Acyclonic cholecystectomy in Feb. 2011 (only surgery ever). Acute pancreatitis 10 months after treated with 24 hr NPO. Colonoscopy and Endoscopy showed Some acid flow back symptoms into terminal iliac triad in 2011-2012, but treated extremely successfully with Entocort. Current: Nine days ago, dull pain started in epigastrium (close to wall, dull, centered, just below rib cage). The pain isn't progressing, but isn't going away and is wearing me down. I can't get myself to swim and have to force myself to eat, and even then in small portions. I can work, but it's getting harder. No position changes help it or make it worse. Heat sometimes helps. Tried Entocort again, Zofran...no effect. Pressing the area does not increase pain nor does releasing it. Excessive positional strain (picture opening a stuck window at an odd angle) flares it up. I am out of ideas and so is my primary doc. Any suggestions? (FYI - I don't drink, smoke, etc. Only Rx is 2mg Lorazepam as needed to assist sleep...I'm a cryptologist...hard to shut the brain off some nights). Thank you.
Posted Tue, 25 Mar 2014 in Liver and Gall Bladder
 
 
Answered by Dr. Ratnakar Kini 5 hours later
Brief Answer: Answer given below Detailed Answer: Hi, Thanks for posting your query. I am Dr.Ratnakar Kini and I am pleased to assist you. I went though your post about abdominal pain. The common causes of epigastric pain are peptic ulcer disease and pancreatitis. If it is peptic ulcer disease you will get good relief with medications like prilosec and antacids. An upper GI endoscopy may be done to look for it. If it is due to pancreatitis you may get good relief with medications like ultracet. An USG /CT scan may be done to look for pancreatitis. You have mentioned that you have had pancreatitis 10 months ago. Alcohol intake is the most common cause of pancreatitis. Since you do not drink, there should be some other cause for panceatitis you had 10 months ago. So you may require more tests to be done to find the cause. You can discuss with your doctor about all these. I hope that answers your question. Let me know if I can assist you further. Regards, Dr.Ratnakar Kini
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Follow-up: What is the cause and treatment for epigastric pain? 7 hours later
The pain doesn't feel anything like the acute pancreatitis...that was burning and a 10/10 pain...this is more dull and 6/10, but it just won't go away. I've tried antacids, cholestyramine powder, etc. with no relief. It has no burning sensation, and like I mentioned, heat is the only thing that brings ANY relief. Does that help bring up a guess of any possible treatment? Thx
 
 
Answered by Dr. Ratnakar Kini 1 hour later
Brief Answer: Answer given below Detailed Answer: Hi, Since excessive positional strain worsens it and that heat brings relief, then the possibility of muscular pain should be though of. Ultracet again would provide good relief in this case. I hope that answers your question. Let me know if I can assist you further. Regards, Dr.Ratnakar Kini
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