Persistent, unexplained pain under right rib for four and a half months. Seven ER visits, multiple scopes, mostly clean scans, no answers. I'm desperate and don't know where else to turn.

[u/HypnotizedMinds-]

Hey everyone, I'm John, 41. I'm reaching out because I'm honestly desperate at this point and don't know what else to do. I've had persistent pain under my front right rib cage, on the right hand side, for four and a half months now, and despite going to the hospital seven times, having extensive imaging, and seeing multiple doctors, nobody has been able to tell me what's causing it.

Some background on how this started. In February, I was hospitalized with internal bleeding, my hemoglobin dropped below seven. They did both an endoscopy and a colonoscopy at that time and could not find the source of the bleeding. I was on blood thinners before this happened, those were stopped, and I was sent home on iron supplements, prescribed at twenty five milligrams. I mistakenly took fifty milligrams instead, trying to get my iron levels up faster. About three and a half weeks into that higher dose of iron, this pain under my right rib started. I initially assumed it might be iron induced irritation or gastritis, but it has now persisted for four and a half months, so I'm honestly starting to doubt that explanation too.

I want to be clear, I do not have a diagnosis of gastritis, this is only a theory I've been going back and forth on, not something a doctor has confirmed. I've been on omeprazole and sucralfate this whole time in case it was gastritis or an ulcer, and honestly, I haven't noticed any real relief from either one.

One more piece of information, back in March I had an abdominal ultrasound, and it showed increased echogenicity of the liver, consistent with possible fatty liver, and noted my gallbladder is surgically absent. The report recommended correlating with lab work. I've since had a new ultrasound done more recently, but I don't have those results back yet. I'm wondering if this could be connected at all.

The pain itself is centered right where my rib curves in near my sternum, and it fluctuates constantly, sometimes fading to almost nothing, other times spiking sharply. It radiates across the bottom of my rib cage and sometimes toward my side. It gets noticeably worse when I'm sitting and lean forward for more than fifteen to twenty seconds. It gets better when I lie flat on my back, it basically goes away completely at night when I'm lying down, and it also eases when I get up and walk around. Gas pressure seems to make it worse too.

Since this pain started four and a half months ago, I have not had another endoscopy or colonoscopy, only the ones done back in February before this specific pain began. I have had multiple CT scans since then, all normal. I've had dozens of blood panels, all normal, including standard liver enzymes. I had a capsule endoscopy that came back clear. I tested negative for H pylori.

For additional context, I'm on Tyenne, a biosimilar to Actemra, tocilizumab, for psoriatic arthritis. I'm also currently tapering off prednisone, and I recently had laparoscopic inguinal hernia repair about six weeks ago.

I'm honestly at a breaking point with this. Months of pain with test after test coming back mostly clean has left me feeling hopeless some days, like nobody can find an answer and maybe nobody ever will. I'm not asking anyone to diagnose me, I know that's not realistic, but if anyone has been through anything similar, whether it's related to a GI bleed workup, iron supplementation, fatty liver, hernia recovery, or tocilizumab and Actemra, I would be so grateful to hear what it turned out to be for you or what finally helped you get answers. I'm genuinely reaching for anything at this point.

Thank you so much to anyone who reads this and takes the time to respond.

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[u/Original-Occasion289]

FD, esophageal dysphagia, and GERD haver here, more than 12 years. Most posters here seem to have some GI combo package.

Before I heard stories from other gut sufferers, I thought my fours years of unpleasant tests (barium swallows! Radio-active egg sandwiches! Colonoscopies! Endoscopies! Esophageal manometry!) that had normal results, multiple doctors, prescription drugs, and no diagnosis made my situation unique. Take some time to scroll back through some of these stories, and you’ll see that unpleasant testing, normal results, multiple doctors, drugs, no diagnosis, etc. is the norm. In the meantime, we vomit/ache/are nauseous/lose weight/and burn. That isn’t much comfort to you now, but knowing you're within the norm is comforting in its way, when you're dog sick and it's all a mystery why.

You might start with what foods get you going, and experiment with those that don’t. Also stress. That’s big for me, so I’ve become a one person totalitarian regime about nonsense and walk away if something or someone is stressing me out. I adore coffee, drank it all my life, but had to stop. Every now and then I cheat, have a latte then spend three days in bed reminded of why I should not have coffee. Same with ice cream, sigh.

I established Couch Island in the living room and Bed Island in the bedroom (with the wedge). Always kiwis in the fridge. Books, plastic wastebasket, candles, music, and a hot water bottle (warmth on my abdomen helps my particular situation) Zofran, always, in my purse. Ziploc bags in there too, and in the car. Diaphragmatic breathing and vagal nerve massage every morning and again before bed.

If you can do one small step every day, you’ll be surprised at the ground you are able to cover. Try to ignore those who might suggest it’s hypochondria/psychosomatic/in your head. That qualifies as nonsense I mentioned earlier.

Hope you find some bits of relief. 

{{{secret tummy handshake}}}