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Gastroenterology  (Expert Forum)
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Cancer
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

Cancer

by tuff case, Apr 05, 2004 12:00AM
I had my Gall bladder out in 3/99, right after that the symptoms of IBS began which I was disgnosed with in 2/00. I was also disgnosed with Diabetes in 1997 (A1C 6.0-6.3 2003). In 10/02 I asked to be put on an anti-drepressent(effexor)(not for IBS).  12/02 I started getting nauseated every day with upper abdominal pain, this has now gone on for over a year.  While I was on the effexor I did not have any of the IBS symptoms, I went off the effexor in 11/03. 1/03 Pelvic ultrasound normal. 2/03 Metabolic panel with neg for HP IgG, ABS. My Primary Care Physian (PCP) and I tried switching me on to a different anti depressent to see if that may have been the problem after a month of no relief I went back on the effexor (better results) and he also then referred me to a Gastroenterologist (GE). 3/03 EGD results GERD grade II, Hiatal hernia, and Chronic Gastritis, Colonoscopy done at the sme time showed Few small scatted Diverticula, in sigmoid colon and small non-bleeding hemorrhoids. 4/03 Gastric Emptying scan within normal limits. US of Liver and Pancreas showed Liver Coarse schotexture w/ increased echogencicity seen throughout & hepatic duct 7.3 mm same as US preformed when gallstones found. Liver Panel normal and regular CT (not spiral) of abdomen normal.  (I also during 4/03 went to see a dematologist about white spots I get on my hands after showering which he explained was "hives to warm water" I was given clarinex however this no longer helps and I quit taking it and I nw get red hives on my face that itch in addition.) 6/03 had ERCP where GE found "There was no evidence of filling defect, but there was some sludge-like maerial pouring through the papilla with the injection of the dye. Sphincterotomy was performed for therapy of SOD (type II) or post cholecystectomy syndrome." I did develop pancreitis, in hospital for 3 days. I started having facial flushing (before the hives) that continued throughout the day and feeling as though somthing was building up in my abdomen and then releasing (about once every 3 weeks). 10/03 CA 19-9 normal EUS normal. 11/03 ERCP GE passed a Wilson-Cook 8.5 mm sweeping balloon through the sphincter of Oddi. 2/04 ERCP measured the pressure of the valves and found that they had to cut the SOD again and the Pancreatic valve, however since that time pressure building and release I felt once every 3 weeks is now at least 6 times a day and much more painful. I still have the nausea and abdominal pain. GE feels that it is IBS at this point and actually as ask me to try an anti-depressent paxil which he said he has had better results, but if I did not have the symptoms while on effexor I have a hard time believing this will help, considering I have eliminated stress in my life except this.  I am scheduled for another ERCP but I do not think he feels he will find anything. Could the problem be beyond the bilinary valves, is it truly IBS?  Should I request any tests be redone? Any advice Thank
Doctor's Answer

by Kevin Pho, MD, Apr 07, 2004 12:00AM
You have had a comprehensive GI evaluation, including the ultrasound, CT, ERCP, upper and lower endoscopies.  Other tests to consider would be a 24-hr pH study to evaluate for GERD or esophageal motility.



If the ERCP continues to be non-revealing, then IBS may be a consideration.  IBS is normally accompanied by a change in bowel habits (either constipation or diarrhea).



Increasing fiber would be the first treatment.  Antidepressants and antispasmodic therapy can be considered - there are small trials suggesting some benefit.  



Diarrhea-predominant IBS can be treated with Lotronex and constipation-predominant IBS can be treated with Zelnorm.  These medications can be discussed with your gastroenterologist.



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 (12)

by krisg, Apr 06, 2004 12:00AM
To: tuff case
You are the only other person that I have come across that feels that "boom" feeling throughout the day.  I feel it right where the ribs split.  I first started to feel it after my first biliary sphincterotomy.  It would be sporadic.  Now that I just had a sphincterotomy on the pancreatic duct and again on the bile duct, I feel the "boom" throughtout the day.  You're right, the "boom" feeling is much more uncomfortable and makes me stop dead in my tracks to catch my breath.  It is like a big shock goes through the body or something.  It is hard to describe but you sound like you are experience ing the same thing.  I wonder if it is from the sphincterotomies??  Please let me know if you find out what it's cause is.  Thanks

Kris

by tuff case, Apr 06, 2004 12:00AM
I am glad to hear that I am not crazy about the "boom" feeling.  I was not even sure how to explain it to the Dr.  An you so right about it stopping you dead in your tracks.  How long have you had it? What my Dr had said is when he goes in to do this next ERCP he may cut the other pancreatic valve that leads to the duedonum (spelling?)  I am almost afraid to have him do any more cutting.

by tuff case, Apr 06, 2004 12:00AM
I did want to add the IBS symptoms I have are teh cramping and ugency to go the the restromm but not the costipation.

by tuff case, Apr 06, 2004 12:00AM
To: Kristin
Thanks! I will let know what I find out.  I know with the next ERCP the GE is talking about Cutting the pancreatic valve that empties intot he dueodonm (spelling?) Not sure I want to be cut any more because like you said everytime they only seem to make it worse.  How long have you had the "boom", (I like your term!)?

by krisg, Apr 07, 2004 12:00AM
To: tuff case
I have had the "boom" feeling since feb. 03 (my first sphincterotomy).  I had 5 months pain free from the procedure.  Then last July I started to have attacks of pain again.  I just had the pancreatic sphincter cut on March 24th.  I had an ERCP and the dr. measured the pressure in the pancreatic sphincter and the pressure was high.  He cut that sphincter and then recut the previous biliary sphincterotomy that I had last year (feb. 03).  I did get pancreatitis from the procedure and was miserable for a couple of days.  Since the procedure in march, I was feeling pretty good until yesterday.  I had alot of pain and it took lots of pain meds before it calmed down.  The dr. is thinking that the stent he put in my pancreatic duct is maybe clogged or causing pain.  I had an xray today to see if the stent has moved out of the duct but the radiologist wasn't very clear on his report.  I go friday for another xray to see if the stent is actually moving along or if it is still in the duct.  If it is still in the duct then I have to go have another ERCP and have it removed.  If it has moved on it's own then I just continue to recover and hope that the attacks don't happen anymore.  It is a wait-and-see process. And sometimes a painful one.  But I do feel that it will all be worth it in the long run.  Good luck with your procedure.  Do you mind me asking where you are going for the ERCP??

Kris