Daily Abdominal Pains possibly caused by alcohol

32 yr Male, daily abdo pains/discomfort in naval area (above/below also) since Aug. which come and go  several hrs after eating and last several hrs. GP suspects IBS (initially gastritis)
Stools are regular & normal but in Aug I had red blood on side of stool on 2 occasions and constipation (now relieved by keeping up fibre) Ever since 18 (not every week but most weeks) I have drank around 6-8 pints of lager a night 2-3 nights a week. Then lived normal for rest of  week which started to cause pains. Meds tried; PPI’s Amoxicilin Clarithromycin Colifac Full Blood tests ok H. Pylori negative on stool and blood tests (whilst on PPI’s though) No Anemia Lymphocytes were 1.06 ALBUMIN was 51 but was dehydrated at the time FREE THYROXINE was 24.4 (thyroid stimulating hormone was 1.72)
white blood cells in urine; WBC’s 30 cells/uL. MCHC was 36.2 g/dL Kidney, liver, UTI and Sexual Health screen all ok. Amylase 83 IU/L didn’t have my other pancreatic enzymes tested though.
Abdominal ultrasound and CT Scan with contrast which said (liver, kidneys, pancreas, gallbladder, spleen, adrenal glands all ok and no hernia) a few scattered diverticular were seen in recto-sigmoid region but nothing to explain patients symptoms. IGA 1.87 g/L (no other allergy tests were done) Faecal Calprotectin 86.0 ug/g faecal elastase 1  > 500 ug/g Nothing seems to relieve these abdo pains I get other than peppermint oil a bit. Could I have an undetected pancreatitis which didn’t show up on any of these tests? As I had the worst pain in naval area (for a few hrs, just two hrs after drinking 3 glasses of wine on holiday 2 months back?) I have given up alcohol in general for 4 months. All tests done a few wks after this large bout of presumably alcohol related pain? Pains now come and go and are moderate again/discomfort around naval area few hrs after eating most foods. Can you recommend any treatment here (ideally don’t want an endoscopy unless have to)? Many thanks

[Enoch Choi, MD]

In the face of normal labs, ultrasound, CT scans it is reassuring that your abdominal pain is unlikely to represent something surgically reparable.  Undetected cirrhosis, pancreatitis, gallbladder stones, and complications from any of these are possible.  

Since you have considerable alcohol ingestion, to consider complications of cirrhosis, it is helpful to get endoscopy to look for varicies, gastritis, duodenitis and look at the gallbladder more carefully with ultrasound.

To consider complications of pancreatitis, the endoscopy can allow for ERCP (an ultrasound that looks more carefully there) although the CT looks at pancreatitis well

To consider complications of gallbladder stones, a HIDA scan or an endoscopy can allow for ERCP (an ultrasound that looks more carefully there) and if there needs to be a procedure, one could be done then (opening up the duct or stenting)

It's worthwhile to get a second opinion, which is who would evaulate for these options.

Enoch Choi, MD