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Back pain, dizziness, bloating, and fatigue
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Back pain, dizziness, bloating, and fatigue

It's been about 5 year I've had upper back pain near shoulders. Just to sit for about 5 min. without lean on something makes my back hurts. I also have belching,bloating,and dizziness too. Also i feel my stamina is decreasing too as when jogging or running, I can only do it much less(getting fatigue faster) than before.
I've visited several doctor and had MRI for my head and back, but the result says nothing wrong. I also had endoscopy and the result says I have GERD.
A USG shows that there's sludge in the gallbladder.
Is it possible that my back pain& other symptoms caused by the acid reflux, or probably from the gallbladder ?

Thanks
2827584_tn?1340583296
Absolutely. It would probably be wise to obtain a contrasted CT to rule out other sources such as a pancreatic abnormality first. If this didn't show any other reason for the pain removal of the gallbladder would be indicated.
11 Comments
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Avatar_m_tn
Thank you for your response Dr.
however, the doctors that I visited here in Bandung, Indonesia says that the gallbladder can not causing such problems, and this makes me really hopeless. Could you suggest something to tell to my doctor regarding this?

Thank you
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2827584_tn?1340583296
If they are of the mind that the GERD is what is causing your symptoms then they would have to admit that the therapy isn't working. The first thing to realize is that endoscopy doesn't diagnose reflux. It can show inflammation of the esophagus which is usually caused by reflux but esophageal motility disorders or other problems could also result in the esophagitis. An empiric course of therapy is reasonable for prsumed GERD but if this fails the physician is obligated to more thoroughly evauate the problem. The test that actually diagnoses GERD is a 24 hour pH study that measures the number of episodes and total time the esophagus is exposed to acidic refux. The motility of the esophagus is also measured during the study to rule out motility disorders such as diffuse esophageal spasm which could explain back pain. If these studies don't give the diagnosis of GERD and your symptoms correlate with reflux episodes your physician needs to look for other causes. It is not normal to have sludge in the gallbladder although it is a nonspecific finding. It can result from other issues that temporarily affect gallbladder function or true gallbladder disease. Your pain pattern could be coming from the irritated esophagus, pancreas, or biliary sources to name a few. All of these need to be considered if the therapy for a presumed diagnosis isn't working. If the GERD is formally diagnosed and the therapy ineffective then anti-reflux surgery would be indicated with a 95% rate of success.
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Avatar_m_tn
On friday I went to see the doctor again. I also showed this conversation excluding your last comment, but he was still not really sure that the gallbladder is the problem. But then he asked me to get a CT-Scan for the abdomen, and before that to take a blood test. After taking the blood test, the results came, and says that my amilase is high (126, where normal is 25-100), and Erythrocyte Sedimentation Rate (ESR) is high(36 mm/hour). The CT-Scan is scheduled for tomorrow, and I'll inform you on the results.
Thank you

  
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Avatar_m_tn
*not excluding, I meant I only showed your first comment, because I visited the doctor before you last comment came, btw thanks..
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Avatar_m_tn
So the CT-Scan result says that all are normal, the liver, gallbladder, pancreas, and kidneys. Could you explain me if the gallbladder is still possible to be the cause of the disease, and so a surgery is needed?
thanks
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2827584_tn?1340583296
There are several possibilities. It would probably be worth getting a HIDA scan with CCK stimulation. The mild bump in your amylase may be due to sphincter of Oddi dysfunction, pancreas divisum (a congenital abnormality of the pancreas) or may be unrelated as some people have a slightly different form of amylase that isn't cleared as rapidly and run slight elevations even when nothing is wrong. However, the fact that you had sludge documented in the gallbladder and an elevated amylase would generally make gallbladder removal the recommendation unless there was another obvious diagnosis.
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Avatar_m_tn
I'll have a HIDA scan tomorrow, but the CCK is not available and they'll use milk instead. Will there be any difference in the result? And what to expect?
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2827584_tn?1340583296
That is an old fashion way of doing it. There is a little compromise on the quality of the data obtained but should give an answer.
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Avatar_m_tn
Actually the HIDA scan is very rarely done here, and the doctors here don't see the ejection fraction as something important, all that's important is there's no bile leakage and the bile is flowing. That's why they're amazed when asked to get the EF number.
Milk with 8mg of fat used as stimulator.Here's the EF after stimulation:
EF minute 20: 27%
EF minute 40: 51%
EF minute 60: 60%
and no bile leakage.

My last USG shows that there's no sludge anymore. The USG that shows sludge is conducted on Dec 2011. So after all these tests they conclude that the source of my problem is from the reflux and also from the stress from thinking and worrying too much about the disease.
Any advice doc?

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2827584_tn?1340583296
This would indicate relatively normal gallbladder function. In the US, we would obtain a 24 hour pH study for a solid diagnosis of gastroesophageal reflux and to correlate the symptoms with episodes of reflux. If the symptoms correlate and are refractory to medical therapy then surgery would be recommended- usually a laparoscopic Nissen fundoplication. This gives very good eresults in approximately 95% of patients.
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