Persistent Right Upper Quadrant Pain with Refractory Heartburn in Young Adult Female

Case at a Glance

A 32-year-old female presents with progressive right upper quadrant abdominal pain over several months, recently complicated by severe heartburn unresponsive to proton pump inhibitor therapy.

Patient's Story

The patient reports onset of intermittent right upper quadrant pain at the beginning of the year, initially occurring every 1-2 weeks but progressively worsening to daily symptoms. She describes recent onset of severe, persistent heartburn that began acutely and has not responded to her current acid suppression regimen or over-the-counter antacids. The patient also experienced an unusual 3-week period of constipation, which has since begun to resolve. She denies significant past medical history of gastroesophageal reflux disease.

Initial Assessment

Physical examination revealed right upper quadrant tenderness. Initial laboratory workup included stool studies showing absence of Helicobacter pylori but elevated fecal calprotectin levels suggesting intestinal inflammation. Abdominal ultrasound was performed and showed no gallbladder abnormalities or biliary pathology.

The Diagnostic Journey

Given the persistent right-sided abdominal pain with normal gallbladder ultrasound, the primary care physician initiated empirical acid suppression therapy with omeprazole 20mg twice daily and famotidine twice daily, reasoning that the right-sided location made peptic ulcer disease less likely. However, the recent onset of severe, medication-refractory heartburn prompted urgent gastroenterology referral for further evaluation.

Final Diagnosis

Pending gastroenterology evaluation. Differential diagnosis includes functional gallbladder disorder (requiring HIDA scan for evaluation), gastroesophageal reflux disease with possible complications, or inflammatory bowel disease given elevated calprotectin.

Treatment Plan

Current medical management includes dual acid suppression with PPI and H2 blocker therapy. Gastroenterology consultation scheduled for comprehensive evaluation including possible HIDA scan to assess gallbladder function, upper endoscopy to evaluate for reflux complications, and consideration of inflammatory bowel disease workup given elevated fecal calprotectin.

Outcome and Follow-up

Patient awaiting gastroenterology consultation. Symptoms of heartburn remain refractory to current medical therapy, requiring urgent specialist evaluation and potential diagnostic procedures.