What could cause intermittent, dull and chronic abdominal pain?

Q. I have intermittent, dull, chronic left abdominal pain below ribcage. Can Pradaxa intake cause this?

Answered by
Dr. Mian Shah Yousaf
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Apr 08, 2020

Hello doctor,

I have been experiencing upper left abdominal pain just beneath lower ribcage and on the opposite side in the back. I have intermittent, dull, and deep chronic pain.

I am 43 years old, nonsmoker but consumes alcohol (not for the last four months). My blood pressure is 120/80 mm Hg. I am currently on Omeprazole 20 mg daily (one month).

I am diagnosed with pneumonia and pulmonary embolism. It is confirmed by chest CT. I was prescribed Pradaxa for three months (stopped taking medication on Mark 26). I have a history of acid reflux, sleeps on a 6-inch wedge pillow to manage the symptoms.

Tests I underwent are:

Abdominal CT with contrast: unremarkable, mild diverticulosis, not considered relevant to pain.

Chest CT with contrast: unremarkable, PE and pneumonia cleared.

Blood tests all normal, no sign of pancreas or kidney trouble.

My primary care physician suggests pain is associated with PE. My pulmonologist says it is very unlikely to be associated with PE and recommends to confer with a gastroenterologist. Could this be an ulcer or some other issue within the stomach or GI tract? Perhaps caused by the Pradaxa medication? Would the abdominal CT have uncovered peptic cancer or other serious GI issues? What further testing would you recommend? Should I wait to see if things get better or act soon? If it is safe to wait, how long should I give it?



Welcome to icliniq.com.

I must appreciate the detail history you provided which is very helpful in diagnosing your condition. After reviewing your history, in my opinion, this pain is not related to pulmonary embolism. It looks like to be associated with some gastritis and stomach issue.

Now coming to your queries, the CT (computed tomography) Abdomen has ruled out serious abdominal issues such as malignancy but it could not rule out peptic ulcer disease. You can just wait for it and take the medications which I am prescribing. I do not think that waiting is going to cause any further issues as it does not look like to be something serious.

Take the following treatment for two weeks and if no improvement then we can consider EGD (esophagogastroduodenoscopy).

Investigations to be done:

None at the moment.

Differential diagnosis:

Gastritis. Peptic ulcer disease. Esophagitis.

Probable diagnosis:


Treatment plan:

Continue Omeprazole but increase it to twice daily before meals. Syrup Gaviscon (Alginate)

10 ml three times daily after meals. Both these for two weeks.

Regarding follow up:

If no improvement will consider EGD.

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