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Gastroenterology  (Expert Forum)
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Fatty Liver and Stomach Discomfort
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D. Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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MedHelp Member's Question

Fatty Liver and Stomach Discomfort

by outshined1, Jul 05, 2003 12:00AM
In March, I went to the doctor with discomfort in my abdomen and nausea. I have been on Prevacid for 4 years to deal with GERD, but these seemed like different symptoms because prior to this illness, the GERD was well under control for a year. Four years ago I had a barium swallow upper GI to diagnose the reflux disease.  Back to March, I had an ultrasound and it was discovered that my liver was slightly fatty (enlarged 1mm). I had numerous blood tests for hep, liver, and pancreas functions, and a cholesterol check and everything came out good, minus the liver enzymes being slightly elevated. I am 5'10" 170 so I am not overweight and I exercise fairly regularly. I cannot seem to eat many foods anymore without feeling sick to my stomach, and there is really no pattern in the types of food I eat as to what makes me sick. Could there be something more complex wrong than just a slightly fatty liver (enzymes very slightly elevated) that could be the cause and be treated? Would getting my stomach scoped be a good idea? I have felt fairly bad since late February and it is now early July. I could use another opinion. Thanks!
Doctor's Answer

by Kevin Pho, MD, Jul 07, 2003 12:00AM
Hello - thanks for asking your question.



As you have commented below - NASH is certainly a possibility, especially if you don't drink.  Most patients with NASH ar asymtpommatic, but nausea, fatigue and right upper quadrant pain is possible.  



With elevated liver enzymes, I would ensure that there are no other causes, including hepatitis, alcohol, medications, Wilson's disease or hemochromatosis before settling on the diagnosis of NASH.  If not done already, I would test for the diseases above (i.e. iron studies for hemochromatosis, ceruloplasmin for Wilson's disease etc).



A liver biopsy is the only sure way to diagnose or exclude NASH - this should be considered if the diagnosis is still in question.



If that is negative, other tests to consider would be a gastric emptying scan to evaluate for gastroparesis or an upper endoscopy to evaluate for any upper GI pathology that can cause nausea (i.e. a mass or pyloric stenosis).  



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Thanks,

Kevin, M.D.

Member Comments (7)

by roxnsox, Jul 06, 2003 12:00AM
There are several different types of "fatty liver".  Since you have said that you have elevated liver enzymes, I would think this would means that you have Steatohepatitis.  "Steato" means "fatty" and "hepatitis" means "inflamed".  You could call your doctors office and ask the nurse if this is what your doctor has written down as a diagnosis.  The only known treatment for this at the present time is to go on a low fat diet.  Other treatments are being studied at the National Institutes of Health in Bethesda, MD.  You can search on the Clinical Trials website to see the studies that are being conducted presently.  

   I was diagnosed with Nonalcoholic Steatohepatitis (NASH).  Personally, I have found that I feel much better if I avoid all trans fats (hydrogenated fats and oils).  This is hard to do but I was willing to do it in order to have a healthier life.  I also avoid all artificial sweeteners.  I was having a lot of stomach discomfort when I was drinking diet Snapples, etc.  When I stopped drinking them, my stomach pain went away.  

   I hope this information helps you.  



by yoshi, Jul 06, 2003 12:00AM
from what i have been told by pharmacists and doctors of prevacid,nexxium and prilosec -it is only good for 24 hours and we have to keep taking it.

but i have found that if i keep taking it every day,day after day i may not have enough acid in my stomach to do the job and you all know what job it has to do-digest FOOD,all kinds of food!!

thats why some folks drink a soda with their meals,some take cranberry juice to help them raise the stomach acid level in their stomach.

also another piece of bad news on too little stomach acid is this-most of us do have a slight level of h pylori bacteria and with low stomach acid,this bacteria has a chance to grow.

these days while i take my prevacid before i go to bed,during the day while i eat,i have a glass of cranberry juice or pineapple jucie or sometimes just a soda .

try to see if this help with your problem.

(i know a woman who tended her disabled husband for 17 years,he has stomach ulcer and doc told him he needs to take prilosev every day! well,after he past away,they found pieces of undigested oreo cookies in his stomach!)

by tessa0825, Jul 06, 2003 12:00AM
To: yoshi
I think that if some of us were to try and worry about TO LITTLE ACID at the same time we are supposed to be worrying about TO MUCH ACID we would create a medical mess in our system...It would be great if everyone had a scientic background and understood everything about PH balance....I do have a little understanding of obtaining proper ph  but if I were to try and apply it with my own medical conditions I would probably create some internal disaster..So I have to do what the SCIETIFIC EXPERTS (my docs.) advise me to do and know that they certainly have more knowledge than I do......If you are being treated for reflux why in the world would you be drinking a soda with meals?..It is on the DO NOT consume list of every GERD diet....Taking PPIs and drinking a carbonated soda seems like a lost cause to me...Im not saying your wrong, Im just saying if you have acid reflux then you have to stop the reflux...It gets real confusing when you consider that with fundoplication surgery nothing happens to stop the production of acid, yet most people never need PPIs afterwards and can eat most anything, so...bottom line, is it an acid problem or a LES muscle problem?......Kind of like the chicken or the egg theory....Either way, Im not sure its safe to try and figure it all out, thats why we have GI Specialist!!...Good luck and take care....Tessa

by yoshi, Jul 06, 2003 12:00AM
thats a good point,i will take it up with my GI spcialist.

by outshined1, Jul 07, 2003 12:00AM
To: roxnsox
Thanks for your comment.  The diagnosis for me was NASH as well, and I tend to watch what I eat, and I do believe it is fatty foods that contribute the most to my discomfort.  I also stay away from soda and caffeinated beverages to control the GERD.  I do notice that it seems my digestion is slower, do you have any input on if NASH is the cause of this?  I was getting mixed responses on whether or not reducing the fat in my diet will help reverse the problem in the long run, do you know anything about that?  On my next appointment I'm sure I'll ask thse questions, but as it is not for a few months, any input would be appreciated.  Thanks

by roxnsox, Jul 07, 2003 12:00AM
Your Q--I do notice that it seems my digestion is slower, do you have any input on if NASH is the cause of this?

My A-- When I was diagnosed with NASH and changed to a healthier diet which included more fiber, I noticed that I became more constipated. I found this to be very odd because it seems that the opposite would be true.  I have increased my water intake and this helps.  The diet recommendations from the dieticians was general.  They wanted me to eat foods from the food pyramid and reduce my food portions.  They like to emphasize food portions.  

  Something else I want to mention is that fatty foods do not cause NASH.   I think they call NASH a metabolic disease.  Your body does not process the fat properly and it gets stored in the wrong places (in the liver).  I even have some fat in my kidneys.

by roxnsox, Jul 07, 2003 12:00AM
Does Prevacid have the warning not to use it if you have liver problems?
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