Subject: Re: HAVE HAD SO MANY TEST ALREADY
Forum: The Gastroenterology and Liver Diseases Forum
Topic Area: Digestive
Posted by HFHSM.D.-rf on February 08, 1999 at 21:35:13:
In Reply to: HAVE HAD SO MANY TEST ALREADY posted by DEB on January 31, 1999 at 21:26:28:

For the last couple of years I've had constant abdominal pain. I first had an endoscopy to see if my history of reflux was causing my asthma to flair up where they discovered I, in addition to gastritis, esophagitis and errosion, had h.Pylori. I went through two courses of quadruple treatment for the h.Pylori first because the biopsies confirmed the bacteria and the second round because I still had the abdominal pain and they felt I may still have the bug. My pain didn't subside and I have been on Prilosec for all of this time. I had a follow-up endoscopy that showed all the -itis's muched improved and no evidence (via biopsies) of h.Pylori. My doctor has suspected gallbladder problems but an ultrasound, Hida Scan, BE and stool studies have all been, thankfully, normal. I was finally referred to a gastroenterologist who says the next step is an ERCP. He agrees with my primary care doctor that he feels it's biliary and probably the gallbladder even though all the tests have been normal. I have a lot of tenderness when the doctors have palpitated my abdomen. My symptoms do not seem to be connected with a particualr type of food I eat, just sometimes eating itself and sometimes because I haven't eaten. My current medications include: Prilosec 20mg twice a day, Estrace 1mg once a day, Percocet and Phenogren as needed and Imitrex nasal spray as needed. Also the usual inhalers for asthma as needed. Now for my questions:

1) I am very concerned about having an ERCP after reading about so many people in your forum having problems, ie: pancreatitis.
What is your feeling about this?

2) Is there some other tests you could recommend that I discuss with the doctor here, maybe less invasive and safer?

3) If my gallbladder is still in suspect, why haven't any of the tests so far showed a problem?

I apologize for the length of this missive, I'm trying to give you any relavent information you may need.

Thank you for any guidence you can give me.

DEB
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Dear Deb,
Thank you for your letter. I will attempt to answer the questions that you have posed.
1) ERCP is the test most frequently done to identift pancreatitis. There isd a risk thjat the nERCP itself may precipitate an attack of pancreatitis. The pancreas can also be evaluated by endoscopic ultrasound. This test will demonstrate pancreatic inflammationm adn depending on your anatomy will also demonstrate gallstones. Unfortunately, if you have stones (which I think is unlikely based on the tests already done)they can not be removed during endoscopic ultrasound and you will need to be scheduled for ERCP. The advantage of endoscopic ultrasound, however, is that it is a safe study without risk of pancreatitis.

2) Sometimes, symptoms like those that you describe are due to delayed gastric emptying. Have you had a rasdioisotope gastric emptying study?

This information is presented for educatioanl purposes only. Ask specific questions to your personal physician.

If you wish a second opinion from the Henry Ford health system in Detroit, you should meet Dr. Ben Menahem of our group who performs both ERCP and endoscopic ultrasound. YOu can mak an appointment by calling our Physician Referral Line aty (800)653-6568

HFHSM.D.-rf
*keywords: pancreatitis
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