Dull pain in the middle of my front where the ribs come together

by M C
(Utah, USA)

Don't know what to do.

I have have been experiencing this since May of 2012. I have had a dull pain that is right in the middle of my front, right below where the ribs come together.

I have had CTs and an EGD. I have also had a scope down my throat. The CT did not see any stones in my gallbladder. The EGD did drain within normal range though it was lower. The one thing that caught the doctor's attention is that I complained of pain while it was filling. He thought this may be gallbladder disease.

Since May of 2012 the pain has come and gone but has never fully gone away. I have had GERD before and have been of Omeprozole for esophageal erosions.

For the last couple of weeks the pain has been much worse. Not only is the pain where it normally is but I feel like I have a constant stomach ache, worse pain and nausea after eating and the pain is going through to my back. There is also some burning in my esophagus even though I am on the Omeprozole. The pain also goes up the side of my neck, up the sides of my head and is giving me headaches.

I suspect that is just secondary and muscular.

No one can give me a diagnosis for sure.

I am about 6'5" and 475 pounds. I am very over weight as you can tell.

Some have talked about Pancreatitis and having a "swollen" belly. I don't feel any swelling but I have a large stomach so I may just not be able to.

I would also think that if this were Pancreatic, Liver or Stomach cancer I would have been dead by now. All three of those kill pretty quickly under the best of circumstances and 2.5 years of ZERO treatment would likely mean I would be gone already.

But I won't lie and say this does not scare the hell out of me. I am also tired of living in pain. My doctor thought it was Fatty Liver Disease.

But I keep reading that NAFLD does not usually present with pain. Also, a biopsy was never done to confirm that diagnosis.



Dear Mr M C,

Thank you for contacting us regarding your condition.

I can see that you are very concerned about this pain in your upper abdomen. Despite all the different tests that have been done, there is still no definitive and clear diagnosis.

I completely agree with you that it is very very unlikely that the pain is due to Pancreatic, Liver or Stomach cancer. No. Nothing in your history would suggest that.

What I can understand is that:

  • This pain has been going on for about 2.5 years
  • It is mainly in the upper middle point of your chest/abdomen, right below where the ribs come together, where we also call the epigastrium
  • Gallbladder disease and ulcers has been excluded.
  • You are somewhat on the bigger side in terms of your weight
  • You were on Omperazole for GERD
  • You thought the pain might also be causing you headaches and that it spreads to your neck and side of your head sometimes.


Well, I seems to me that you might be suffering with one of:

  1. Non Ulcer Dyspepsia (NUD) with associated stress induced symptoms like the headache.

    Or

  2. Intermittent Esophageal Spasms.


It is very very possible that your symptoms could also be due to NAFLD. One of the symptoms of Non Alcoholic Fatty Liver Disease (NAFLD), without any iota of doubt, is a dull pain in the right upper mid upper abdomen. It is a very common cause of right upper abdominal pain. Up to 30% of people with abnormal BMI (BMI greater than 27 and more) suffer with this condition.

I note that you mentioned that you have not been tested for this. I will strongly recommend that you go to your doctor to organize for tests for this.

Tests you should be doing include:
  • Gamma-GT liver test and all the other Liver Function Tests
  • Your platelet count along with complete blood count
  • Fasting lipids and blood sugar test
  • Liver ultrasound scan and if that is back as normal, you may want to go ahead and have a liver MRI or MRCP done


Because you mentioned that you have had this pain spread to your neck and side of your head, it would be very very important that you go to the Emergency Room, should that happens again, to have cardiac work up to exclude pain arising from your heart. Please this is very important and if this is the only takeaway from this online interaction, we would have achieved something great.

If all the above tests and assessments come back normal, then you can be rest assured that it is not likely to be anything serious.

Meanwhile, what about trying some antioxidant vitamin E supplements and a definite weight losing plan? I am sure both measures in combination would give you some relief and make you feel much better.

Please I would love to hear back from you on how things went.

Many many thanks again for using abdopain.com.

Good Health To You.



Dr O Edema MD MRCGP CCFP MSc DRCOG
Family Physician and WebMD
Abdopain.com

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Oct 15, 2014
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Update #1
by: Michael Cuthbert

Doctor, thank you very much for your information and caring. I thought I would update you with some new information. The pain has continued to get worse and I went in to see my Internist on Saturday. I had blood work done and my Kidneys, Liver and Pancreas all came came as functioning normally. I guess that rules out Liver and Pancreatic Cancer. That is good! But I don't think I mentioned something the first time. I did have a HADI Scan and my Gallbladder did empty within normal range. But, I did complain of pain while they were filling it. For some reason this seemed to key two different doctors into believing it was likely my Gallbladder. My Internist did also say I have NAFLD. She has not done a biopsy though which is what I have read is needed to confirm this diagnosis. But with my weight I would not be surprised. The only thing is that I have read that NAFLD does not produce pain. I am getting bloating and an upset stomach a lot now too. I didn't really get those symptoms until the last few weeks. The pain is right where the rib cage comes together and about 2ish inches below the ribs. Wouldn't this be too high for the Gallbladder? Also, this is pain that NEVER goes away. If I press on that spot it is always tender. Another couple of things that may be related. One, I am VERY OCD and a massive stress case. I am in a constant state of tension that really never goes away. There are times when I realize how tense I am and I "let go" of it for a second. My whole body hurts when I do. The muscles in my stomach are just short of burning due to tension right now. In truth it is hard to differentiate between the muscles burning and what I have felt for the last couple of years, at this moment. The second thing is that I have had something else weird with my gut. For a long while about every month I would get sick with flu like symptoms. I would get diarrhea and vomiting. But it would always start with beginning to burp up a "rotten egg" smell. The only way it would stop is if I would vomit all the food in my stomach. It was as if my system shut down, the food in my stomach began to rot and my body would expel it. This would usually last a day or less but it would really make me feel awful. I am not sure what else to say at this point. I am at the point where I want to chuck it all and have them start removing body parts until the pain and misery goes away. The other frustration is getting my doctor's office to get moving on a referral for another EGD. The last one was clean but I would like another to ease my mind.

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