Have you been taking a medicine for the reflux seen on the gasstroscopy?
If so, what are you taking?
Have you had a follow-up gastroscopy to see if the reflux has improved?
Have you had a CT scan of the abdomen?
Thank you for the additional information.
I would note that there is much overlap when considering the cause of pain felt in the upper abdomen and lower chest. Conditions in the abdomen can cause chest pain and conditions in the chest can cause abdominal pain. However, you have had a very thorough evaluation for chest conditions, so while I am going to talk about further evaluation of the abdomen, this is because you have already had a more extensive evaluation for chest conditions that can cause pain.
Reflux, or more properly, gastroesophageal reflux disease (GERD), is a common cause of abdominal or chest pain, which can radiate to the side or back. The esomeprazole is a great medicine for GERD, but there is no medicine that works 100% of the time in controlling GERD. If someone has persistent symptoms despite taking esomeprazole, then either it has helped the reflux or this may be one of the small minority of people in which the medicine will not work. If the former, then we should be looking for other causes of the pain, which I will discuss further below. But if the latter, we would need to consider more aggressive care for the reflux, such as augmenting the esomeprazole with a medicine that works by a different mechanism or consideration of surgery for the GERD. A repeat gastroscopy would be the usual method for identifying the persons with persistent reflux despite esomeprazole.
As for evaluation to look for other possible causes, the usual next test that I would consider would be a CT scan of the abdomen. An MRI of the abdomen can be better for certain organs, such as the liver or spleen. But for overall assessment of the abdomen looking for conditions that can cause pain, a CT scan would usually be the preferred test. If there are findings on exam or other tests that raise concern about the liver or spleen, then a corresponding MRI would be appropriate, but you do not mention any such findings thus far.
If you have not had a colonoscopy, this also can be considered. From your description of symptoms, a colon problem would be less likely. But the colon does wrap around the abdomen and if there is no other cause of pain that can be found, it would be appropriate to consider a colonoscopy.
If I can provide any additional information, please let me know.
Yes, a repeat gastroscopy would be appropriate. if the reflux is persistent, I usually add an H2 antagonist, such as ranitidine, to the esomeprazole, although there are other similar medicines.
I would still usually check a CT scan since the fatty liver and the spleen seemed to be getting better. Since you ask about any prior cases, there actually was a specific case of a patient in which the CT scan found the cause of chronic recurrent abdominal pain. I live in a part of the US in which there is a large population of retirees, and several years ago I had an initial visit with a newly retired women that had been having chronic recurrent abdominal pain. She had just retired from a hospital associated with one of the top medical schools in the US and had undergone a very extensive evaluation without having found any cause. I reviewed the tests that had been done and the only test that had not been done was an imaging test of the abdomen and I ordered a CT scan. The CT scan showed a soft tissue tumor behind her intestines. She ultimately wanted to return to the hospital from which she had just retired for her surgery, as she had a good relationship with a surgeon there, and when she returned she like to tell how the surgeon like to joke with the medical team that she had to retire for a community doctor to find the problem that had not been detected by his colleagues. It is not that a CT scan will commonly find the cause of pain, as a soft tissue tumor is not common, but it is appropriate to consider a CT scan when the usual tests fail to detect the cause of pain.
It would be unusual for a small lump to cause the extent of pain that you describe. There certainly are medical schools in England, as there are centers for training new doctors and for doing research, although I am not familiar with specific facilities. When I search on the internet, there is a School of Medical Education at Newcastle University (see http://www.ncl.ac.uk/mbbs/ which is oriented towards student, rather than patients). There are apparently several hospitals associated with the Medical School, so it is not clear which would be the best to be at for a patient with persistent abdominal pain, but it looks like the primary hospital is the Royal Victoria infirmary. You can contact them directly to determine how you can get an appointment.
A Radiologist will read the images, but your GP or Gastroenterologist will correlate the CT scan findings with the other clinical findings. The Gastroenterologist would be the appropriate specialist for this type of pain. If a higher level of specialist is required, that would usually mean a referral center Gastroenterologist rather than a community Gastroenterologist.
You are very welcome. I hope that everything goes well and you get to the bottom of this soon.