Exocrine Pancreatic Insufficiency & Chronic Pancreatitis

[LF83]

Hello,

I am having 6 months of heartburn, I have done some tests incl. ultrasound, bloodwork, and urinalysis and allergy testing, all of which came back neg. for anything. I am on a strict diet and using PPi's for multiple months, but the symptoms haven't gone away. symptoms: stomach problems (stomach burning), mild diarrhoea (which i've had for some years already on and off. Its specifically notable that i still have it now because I take lots of fibre on my diet). Fibre seems to be helping but stool is still 'softish' a few days per week, stool colour normal, brownish. Bowel movement once a day or once every 2 days.

I did a digestive stool analyses at a clinic, it came back with elevated fecal fat levels and and low 'good' bacteria, with softish stools were to the clinician a potential sign of low pancreatic elastase enzymes, which has not been specifically checked for yet, unless symptoms dont go away with a healthy diet + recommended probiotics. Now, i'm on a specific diet, high fibre, no sugar, plus probiotics etc. but I developed generalized stomach pain, sometimes it radiates to the back but its just mild, when I sleep i don't have all this, its usually throughout the day that it progresses. I must also add that since the heartburn started I got a weird type of abdominal pain which is a pain upon pressing deep just below the navel, it pulsates there, its not otherwise really noticeable and I have mild nausea sometimes.

I'm really worried because I did some research and I read the most common causes for exocrine pancreatic insufficiency are cystic fibrosis (which i dont have) and chronic pancreatitis, and, if you have CP that its not curable and there is a severe lower life expectancy associated with it. Is this all true and does it sound as if I have this? If it does, I read CP most common cause is alcoholism and cystic fibrosis, since i'm 25 and drink very little, the ultrasound and blood/urine checks, it seems unlikely again I have that. Thanks!

[LF83]

Hi Doc,

But seen as I did have an ultrasound, don't drink, am only 25, and don't have bad abdominal pain 'attacks' etc.. doesn't it seem very unlikely for it to be pancreatitis?
Or even cancer for that matter? What about a differential? Because those things really worry me, and I won't be able to get a checkup within the next weeks, I would really appreciate any advice on that!!

Thanks.

[Kevin Pho, MD]

I agree with further evaluating the pancreas.  I would opt for a CT scan or MRI, which can give more information than an ultrasound.  This can evaluate for chronic pancreatitis, as well as possible masses or cancer of the organ.

If inconclusive, a blood test for celiac disease can be performed, as well as an endoscopic ultrasound or ERCP.  

If cystic fibrosis is suspected, it likely would have presented earlier on in life.  I would consider gene testing if that is a consideration.

These options can be discussed with your personal physician.

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.

Kevin Pho, M.D.
www.kevinmd.com
www.twitter.com/kevinmd

[LF83]

Sorry, I also forgot to add the relevant info that I've done an endoscopy for heartburn 5 months ago, which came back normal.

[LF83]

I forgot to add I also have undigested food in my stool often.