Went To ER Saturday With Severe Pain In Right Upper

Brief Answer:
Gold standard test endoscopy should be done.

Detailed Answer:
Hello,
Thanks for choosing "Ask a Doctor" service on HealthcareMagic for your query.
Have gone through your details and i appreciate your concerns.
Initially i would like to say that it's gastritis.
A patient with right upper quadrant pain-
Differencial is either gall bladder pathology(removed in your case) or Acid peptic disorder(which you are a known case of).Every other diagnosis mentioned on net is very rare.
Now please go through every line and try to understand that basic cause of your problem is reflux of acid from stomach to esophagus as well as excessive surge of acid in stomach by oxyntic cells.
Stomach is lined by a natural layer of mucosa membrane which is resistant to acid however mucosa in esophagus and duodenum is easily destroyed by acid which regurgitates and flows into duodenum from stomach.This cause severe irritation of esophagus/Duodenum leading to inflammation causing symptoms like heart burn chest pain right upper quadrant or epigastric pain(vary from individual to individual).

Have a more detailed look,
The esophagus is a muscular tube that is located in the chest and serves to transfer food from the mouth to the stomach which is also lined by later of membrane which is to an extent resistant to acid unlike esophagus. The lower esophageal sphincter (LES) is a valve that is located at the junction of the stomach with the esophagus. Its function is to prevent acid and other contents of the stomach from coming back into the esophagus. GERD is a condition in which excessive acid-containing fluid refluxes (flows) back into the esophagus, in part because the lower esophageal sphincter is weak.
In some patients with GERD, the esophagus reacts to the repeated injury from the acidic fluid by changing the type of cell increasing chances of adenocarcinoma (5% cases).


Now Proper management consists of two step-
1)Control acid production-Just taking pepcid in optimal doses wont help.There are much better PPI's available in market these days which are formulated specially for severe gastritis cases/ recurrent gastritis.for e.g Nexium,Rabeprazole.

2)Prevent reflux of acid formed back to esophagus-This part is completely overlooked by your doctor.

Please discuss this answer with your primary or Gastroenterologist and request him to first do your endoscopy.
Giving sucralfate to a patient just suspecting that there could be ulcers is not a good decision Initially an endoscopy should be done.Some times gastritis is caused by a bacteria called H.pylori which needs completely different treatment regimen.Unnecessarily loading a patient with medicines without doing proper investigation makes no sense.Every drug has its side effects.Once endoscopy is done request him( or he will by himself) put you on PPI-antacids like Rabeprazole or Esomeprazole.
Esomeprazole can be used in the dosage as high as 80 mg twice daily.Trials have shown that esomeprazole is superior to other PPI's in controlling reflux symptoms. Also, request him/her to add Domperidone 30mg or Levosulpiride(both are prokinetic)slow release once daily. This will slow down the reflux of acid back.Prokineic should be added in your regimen.

An antacid containing local anesthetic (Mucaine gel ) should be taken 2tsf thrice daily.

Acotiamide is another wonderful new drug and is very effective in controlling symptoms of GERD and esophagitis. In trials- Acotiamide, a gastrointestinal motility modulator, at a standard dose of 100mg thrice daily has significantly affected esophageal motor functions or gastroesophageal reflux in healthy adults.

All these drugs should be given by your gastroenterologist to provide you with relief in your problem.Once symptoms starts to settle down these drugs would be tapered and you would be kept on minimal possible medicine with proper food modification.

Don't be in hurry to stop medicines . As your symptoms will improve drugs would be tappered off gradually by your doctor.

Now let's come to life style change(In long term it's the game changer)
Avoid-
Dairy products, which contain sugar lactose that causes gas.
Vegetables, including onions, radishes, cabbage, celery, carrots, brussel sprouts, broccoli, cauliflower and legumes.
Fruit sugar, which is especially high in prunes, raisins, bananas, apples, apricots and fruit juices from prunes, grapes and apples
Fiber.
Fatty foods and carbonated drinks.

Try Eating more fermented foods. These are rich in both good bacteria and enzymes you can try raw natto kefir or cultured veggies. This is probably one of the most important first steps.
Take a high-quality probiotic.
Take external enzyme supplements.
Exercising, to help keep food moving through your system.
Using spices that may help to prevent flatulence. These include turmeric, coriander, peppermint, fennel, sage, chamomile and ginger.
With above mentioned medication and restrictions you cn take meat and corn.

Discuss the complete explaination with your doctor and reply me with what he says.

Hope i answered your query in details and hope you understood my explaination.
In case you have more doubts feel free to ask.

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