Persistent Pain in Upper Right Abdomen
A 27-year-old male has been enduring ongoing discomfort in the upper right and middle right areas of his abdomen since early 2024. The pain consistently presents itself in the uppermost muscle of the right side. After a visit to his primary care physician, who proposed a diagnosis of costochondritis yet appeared dismissive of the patient's discomfort, it was noted that the right side of his abdomen protrudes slightly more than the left. Following this, he consulted with a gastroenterologist who also considered costochondritis as a possibility, given his active lifestyle with Olympic lifting and Crossfit, as well as his relatively young age. Initially, the pain was sharp and seemed to be exacerbated by movement or stretching; taking a deep breath would also induce discomfort. Fortunately, the intense pain subsided after approximately 30 seconds of controlled breathing. Over time, particularly through late 2024 and early 2025, this sharp sensation evolved into a dull, persistent aching discomfort. Identifying a precise cause has proven challenging, though there are indications that certain foods—especially dairy and acidic items—along with specific movements aggravate the area. To the best of his knowledge, he has never sustained an injury in that part of his body. He did contract COVID-19 for the first time in the fall of 2023 and experienced some lingering respiratory symptoms from long COVID that lasted until spring 2025. On his mother’s side, there is a noted history of gastrointestinal issues often triggered by stress and specific foods, with both his mother and grandfather having experienced ulcers, while both parents suffer from hemorrhoids, of which he also has chronic issues. After a thorough examination, the gastroenterologist ordered an extensive blood panel focusing on abdominal syndromes, all of which returned normal results. An endoscopy revealed mild chronic gastritis without any signs of blood in the stool. A CT scan without contrast also showed normal results, but the scan with contrast indicated a small, fat-containing umbilical hernia and polyarticular degenerative changes. A HIDA scan showed the gallbladder functioning normally, and a liver fibroscan also returned standard findings. In his attempts to find relief, the patient has tried various treatments including IbGard, MiraLax, fiber supplements, proton pump inhibitors (PPIs), and currently, antispasmodics. The only consistently effective—albeit temporary—relief comes from Gas-X and Tylenol. He used to take Ibuprofen for back issues but was advised to discontinue it due to its potential strain on the stomach; it has now been over a year and a half since he last used Ibuprofen. Is there anyone who has faced similar challenges or can offer recommendations for potential next steps? He is contemplating requesting a colonoscopy to eliminate any gastrointestinal concerns and might look into seeing a rheumatologist to determine if there are any underlying joint or muscle issues contributing to the pain.
Answers (1)
9/5/2025, 12:11:26 AM
OpenHealth AI
Persistent pain in the upper right abdomen can be quite distressing, especially when previous evaluations have not provided clear answers. Your experiences with varying pain types and the impacts of certain foods suggest a multi-faceted issue. You've rightly considered both gastrointestinal and musculoskeletal angles, given your active lifestyle and family history.
Understanding Your Situation
The pain pattern you've described—starting sharp and becoming a persistent dull ache—combined with your symptoms after certain foods, points to possible conditions like costochondritis or gastrointestinal sensitivities, particularly considering your family history of digestive issues. It's also important to indicate that the presence of a small umbilical hernia might not directly relate to your pain, but its potential to cause discomfort should not be overlooked.
Next Steps
Here are some prioritized actions you can take to help manage your discomfort while seeking clearer answers:
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Symptom Tracking: Start keeping a detailed symptom diary. Note the types of pain (sharp vs. dull), duration, triggers (food, activity), and any associated symptoms (like digestive issues). This information can be valuable for your healthcare providers.
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Dietary Adjustments: Since dairy and acidic foods seem to aggravate your symptoms, consider a trial elimination diet. Remove these items for a few weeks and gradually reintroduce them one at a time to see if you can pinpoint specific triggers. Keeping the symptom diary during this process will help corroborate any patterns.
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Gentle Exercise and Stretching: Engage in gentle stretching exercises or low-impact activities such as walking, which can help alleviate muscle tension. Avoid any exercises that exacerbate your pain, particularly those involving heavy lifting until a clearer diagnosis is established.
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Consult a Rheumatologist: Given the persistent pain and family history of joint issues, consulting a rheumatologist is wise. They can assess for conditions like fibromyalgia or other rheumatologic disorders that might produce muscle and joint pains.
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Consider Colonoscopy: Discuss the possibility of a colonoscopy with your physician to rule out any colorectal concerns, especially given your family history and chronic gastrointestinal complaints. This procedure can provide crucial insights into your gastrointestinal health.
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Pain Management Options: Since Gas-X and Tylenol provide temporary relief, you could also explore other over-the-counter pain management or speak with your physician about transitioning to other safe alternatives. It’s crucial to stay away from NSAIDs if you've previously experienced stomach issues.
Empathy and Support
It’s commendable that you are proactive about investigating this issue. Chronic pain can be frustrating, especially when the underlying cause isn’t clear. Keep advocating for yourself and seeking treatment options that you feel resonate with your condition. Stay connected with your healthcare providers, and if needed, consider seeking a second opinion if you feel your concerns are not fully addressed. You are not alone in this journey, and further exploration can lead to relief and better management of your symptoms.
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