What Causes Intermittent Pain Under Ribs?

Posted on Tue, 18 Aug 2015

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Tue, 18 Aug 2015 Answered on

Wed, 9 Sep 2015 Last reviewed on

Question : Hello, I am a female of 33 y.o. for a month and a half now I have pain under my ribs. It started under right side, but now I feel intermitant pain on the right and left side. It is usually a dull pain, that gets worse after eating, or when I bend forward. Since it started, I went to my GP that did a serie of blood test, and found nothing except a low ferretin. I also had an ultrasound that showed nothing. I have lost 2.5 kg since begining of XXXXXXX and feel tiredish.
The last time I had these kind of pains, I had also episodes of pale stools, and I did a lot of test and an MRI that showed nothing, so the doctor could not figure out what's wrong. I have IBS and mild gastritis, but these pains do not seem to come from the bowela. I am worried that I might havea problem with my pancreas, or gallbladder, even though the results are normal. Any advice or toughts would be appreciated. Thank you! XXXX

Answered by Dr. Dr. Klerida Shehu (2 hours later)

Brief Answer:
Colonoscopy is advised...

Detailed Answer:
Hi XXXXX

I read carefully all your concerns and I can say as follows:

1. You have been diagnosed with IBS and gastritis. IBS alone can explain your symptoms. The pain is localized on right and left side where are located two angular regions of large bowel. Both of them are regions were the spasms due to IBS are more painful. The fact that the pain starts after meal can be explained by Gastritis and bowel spasms that often starts after meal.

2. You have done abdominal MRI and ultrasound and the results come back normal.

MRI is the gold standard exam to diagnose gallbladder and pancreatic issues. So to my opinion there is no reason to suspect for gallbladder or pancreatic issues.

On the other hand if I were your treating doctor I would recommend performing colonoscopy to rule out /confirm organic bowel issues.

With regards to low ferreting (it would be better if I have the result) it may be related with:

- menstrual periods

- gastritis

- organic bowel issues

Meantime I would recommend to :

- start PPI treatment

- use anti spastic like butischopolamine

- use plenty of water

- increase physical activity

- avoid unnecessary stress

wish you all the best

Dr. Klera

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Klerida Shehu (28 minutes later)

Hi, thank you for answering. The MRI was done 2 years ago, so is it possible that anything happened since? Also, what made me think it isn"t bowels is that the pain is a little higher up and often closer to the middle: I would say left and right from the stomach. The pain is also at times burning, and not like colonic spasms I felt before. When it comes to the ferritin level it was 11ng/L and I wasn't menstruating. I forgot to mention that the doctor also performed an occult bleeding test, which was negative. The last gastroscopy was done in November last year, and the colonoscopy 2 years ago.

Answered by Dr. Dr. Klerida Shehu (27 minutes later)

Brief Answer:
Please follow...

Detailed Answer:
Hi back XXXX

Since you have done MRI two years ago than should repeat MRI or Ct scan to better evaluate gallbladder and pancreatic issues.

You are reporting that you have done Colonoscopy 2 years ago, so you don't need to repeat it.

Ferritin 11ng/L is slightly decreased level. Nothing to be worried. It may be related with gastritis. You need to start iron supplements.

Your pain may be related with Gastritis too. This the reason Why I recommend to start PPI treatment.
Wish you all the best.
Dr.Klerida

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Klerida Shehu (24 hours later)

Is MRI or CT better for evaluating gallbladder and pancreatic issues? I am a little bit worried about the radiation, since my husband and I are trying to conceive, and I already have a diminished ovarian reserve.
Also, is it possible to have a serious pancreatic issue, without it being visible on the ultrasound?

Answered by Dr. Dr. Klerida Shehu (18 hours later)

Brief Answer:
Please follow....

Detailed Answer:
Hi back
Let me explain again:
1. Abdominal ultrasound has 87 % sensitivity. So in rare cases it may miss gallbladder or pancreatic issues.
2. You are still on pain, weight loss ; those are the reasons why I recommend doing
MRI or Ct/scan despite the side effects like radiation.
You can discuss with your doctor to repeat MRI so you can avoid X ray radiation of Ct scan.
wish you all the best and good luck.
dr.klerida

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar