Digestive Disorders / Gastroenterology Expert Forum
In search of answers
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This is a place to ask questions about digestive problems and receive a personal answer from a highly qualified doctor. You will also find support from other members who share your interest in digestive disorders. Digestive Disorders include: Anal and Rectal problems, Barrett’s Esophagus, Bleeding in the Stomach and Digestive Tract, Constipation, Crohn’s Disease, Gastritis, GERD, Heartburn, Proctitis, Short Bowel Syndrome, Ulcers, Whipple’s Disease, Zollinger-Ellison Syndrome (and many more).

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In search of answers

I'm a 33 year old white non-smoking male. I've been having upper mid abdominal pain that goes to the right side of my back and to the upper right side of my abdomen- above the rib cage. I was in the ER with what I thought was another bout of pericarditis. But EKG was normal as we're the cardiac enzymes. The ER doc asked if I had ever had my gallbladder out which I haven't. I followed up with the Nurse Practitioner and she thought it may be gastritis and gave me Nexium. I had real bad pain over the weekend and my doctor was thinking gallstones so he ordered an Abdominal Ultrasound. Only think it showed was mild fatty liver disease. I've taken steps the last year to clean up my diet. My liver functions were normal as was my CBC, Triglycerides, and SED rate. My cholesterol was 167 but my LDL was 108 and my HDL was 36- which I take 1000mg of Niacin for. I saw the nurse practitioner again today and she ordered blood work for pancreatic enzymes and H-Pylori and referred me to a surgeon. I've lost about 6 pound since I'm not eating. Food sounds good it's just a little painful to eat. But if it wasn't painful, I have no doubt my appetite would be normal. I'm not throwing up- so the food I'm eating is staying down. Bowel movement are not as constant since I'm not eating as much but they appear to be of normal color- occasionally I get some that float. No jaundice or fever. Of course I researched my symptoms and pancreatic cancer comes up which freaked me out. But there is no family history and I've heard it is extremely uncommon in people under 40. Normal CT scan 4 years ago along with normal colonoscopy. I've heard a study shows it takes years for pancreatic cancer to develop. I'm wondering if this could still be my gallbladder or an ulcer. Any insight or peace of mind would be greatly appreciated!
351246_tn?1379685732
Hi!
First of all let me assure you that chances of pancreatic cancer are less. I am glad that your nurse practitioner has requested for pancreatic enzymes and tests for H pylori infection (endoscopy or carbon urea breath test?).

The pain which you experience in upper middle abdomen, and the pain which comes with eating, is usually due to gastric ulcers and less frequently due to duodenal ulcer. Patients lose weight as they are afraid to eat and hence eat less often than required. The only confirmatory diagnosis is endoscopy (hence in my opinion you should go for this). H pylori infection is known to aggravate the ulcer and associated gastritis. If this is found, then you will need to take a course of antibiotics for it. Also Niacin can cause gastritis and gastric ulcer. So, ask your doctor if stopping this will help. HDL levels can be increased and LDL levels brought down with exercise and diet control.

Take antacid gel and ranitidine along with Nexium until you can consult a gastroenterologist (as not a surgeon but a GI doctor). Take bland diet (avoid too salty or too spicy food) and avoid alcohol, fuzzy drinks, tea and coffee (or take decaffeinated versions). Eat small frequent meals (maybe 5-6 per day).

The other possibility is pancreatitis. If this is the case, serum amylase and lipase will be raised. If it is chronic pancreatitis, then the enzymes may be normal. Common tests used for diagnosis are fecal elastase in stool, serum trypsinogen, CT scan and ultrasounds (which often come back normal), MRI, ERCP and MRCP (all of these imaging studies are more conclusive). Treatment is by analgesics and antioxidants. You will need to avoid alcohol until the inflammation settles down.
If the above two conditions are ruled out, then possibility of inflammation of gall bladder, Crohn’s disease and IBS should be looked into. Also keep a food diary. See if you can find a correlation between food and pain.

Please consult a gastroenterologist as soon as you can. Meanwhile follow the above mentioned advice. I sincerely hope you will find this information useful in your journey towards better health.

Hope you get well soon! Good Luck and take care!


4 Comments
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My sincerest thanks for the reply. In the back of my head I know the odds of pancreatic cancer at my age is slim to none. They actually did a blood test for the H Pylori. She said they were going to refer me to a surgeon because they feel a GI doctor would pass me off to a surgeon. I'm not sure if the surgeon is related to the mild fatty liver they found on the ultra sound. I've been keeping a bland diet since this started last week- lean turkey, crackers, fruit. I've cut soda out of my diet. I don't drink alcohol or coffee. I do like tea though. But what was strange was even water caused stomach and back pain. The pain when eating isn't as bad but with drinking, after taking a sip, about 3-5 seconds later, I have that upper back pain. Other than that, I have some twinges of pain but I'd say 80-85 percent of the time it was while trying to eat or drink. I will have to ask about seeing a GI because our insurance won't cover a specialist without a referral from a primary physician. Once again, thank you for the response and at least giving me a little peace of mind about most likely not having to worry about pancreatic cancer. I will keep you updated as I get answers. Thanks again!

Jarrod
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Avatar_n_tn
My H-Pylori blood test was negative and my pancreatic enzymes were normal. Next step is the upper GI series. Like I said, the ultra sound revealed a mild fatty liver which neither the nurse practitioner or surgeon seemed worried about. My liver enzymes were normal except for bilirubin which was 3.2 which they diagnosed years ago as Gilbert's Syndrome. I know rapid weight loss can cause that and I did loose about 7-10 lbs in a week because of the pain eating. I know it's reversible and I know diet is a part of it which I'm cleaning up. Is it okay to cheat every now and then with a treat?
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1440398_tn?1371757990
i have just the same symptoms at my right abdomen, i was placed on Nugel, omaprizone, chlaritomycin and amoxacylin.. it was only the chlaritomycin that i realised had some effect.. after my medications got finished the discomfort began again.. it's intense now.. the discomfort is pepperish.. i am so worried since it's expensive to even meet a specialist in Ghana
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