Differential diagnosis - GI or OB/GYN

Hello, I am in  need of some advice relating to a problem that started in October 2010, remitted for about five months, and now has come back.  I am trying to figure out if my problem is truly a gastro problem or if it could be ovarian cancer with GI symptoms.
I had an endoscopy last January that showed 'inflamed gastic cardiac mucosa consistent with reflux esophagitis". They found two benign fundic polyps without a whole lot to say about those.   I have had HORRIBLE burning stomach pains across the bottom of my rib cage for months.   It started last Jan./February and went away after a few months on Omnaeprazole.    I had FIVE OR SIX months of relief after stopping the medication, then it started up again in December.    I started the meds again and am NOT getting any relief.  

I have been worked up by the OB/GYN with a CT scan, transvaginal ultrasound, and pelvic exam which were ALL normal.  HOWEVER, my CA-125 has been moderately elevated, which makes me not want to abandon the possibility of ovarian cancer.  I have actually had these tests repeated TWICE, all normal except the slightly elevated CA-125 (which was 32, and then 46). I am a pre-menopausal female, so this figure did not alarm her, even though it was higher than the upper limit of 35.  I don't seem to have any of the other symptoms of OC, though for a while I was having pelvic pain that has since resolved.

1.  Does the endoscopy results from above saying "inflamed gastric cardiac mucosa consistent with reflux esophagitis" mean that my problem IS gastroenterological and NOT OB/GYN?  I don't understand whether or not I can rule out my stomach problems being connected to an ob/gyn issue (specifically ovarian cancer).

2.  Should I ask for another endoscopy since the last one was done a year ago and my problems are continuing?

[Poorna Chandra, SMD, DM]

Dear mochamommy0816,

Thanks for posting your query.

1.     It is unlikely that the pain in your stomach area is linked to your ovarian problems. Usually, pain just below the ribs is due to problems in lower esophagus and chest, stomach, duodenum, gall bladder, liver, spleen and rarely pancreas. The organ from which the pain is originating can be identified by a good history and physical examination. Reflux can cause upper abdominal discomfort and pain. On endoscopy, you usually find either a reddish esophageal mucosa with erosions or nodularity. Reflux may have an associated hiatus hernia or a lax lower esophageal sphincter, in which case retching during the endoscopy will cause an inflamed appearance of the cardiac mucosa. Ovarian problems frequently cause pain in the periumbilical area (area around the umblicus) and rarely in the flanks. CA- 125 can be elevated in a number of causes including gastrointestinal causes as it is of epithelial in origin.

2.     Reflux usually has a remitting relapsing course (which means that there will be unpredictable relapses and the disease would be quiet in between these relapses) and I would suggest that you take a two week course of proton pump inhibitors like omeprazole, taken twice a day and prokinetics like domperidone before considering endoscopy. Since these are prescription drugs, I would suggest that you consult your primary care physician for them.

3.     As I mentioned that reflux disease has a relapsing remitting course, you should not be unduly worried about the long duration of symptoms.

4.     I would suggest that you take a proton pump inhibitor twice daily and a prokinetic agent like domperidone for two weeks under the supervision of your physician. Non-response to medication can only be commented upon only after you have taken optimal doses for an appropriate duration of time.

Hope that this information helps and hope that you will get better soon.

Thank you for using MedHelp's "Ask an Expert" Service, where we feature some of world's renowned medical experts in their fields. Millions have benefitted from our service to get personalized advice for them and for their loved ones.

Best Regards,
Dr. Poorna Chandra K.S

[mochamommy0816]

(Continued)
3.  Should I be worried that this is something more serious since the symptoms have went on for THIS LONG and the fact that meds aren't working?  

4.  Should I ask for another type of medication on the chance that maybe there is another one that will work and that this one just isn't the one?

  I do have an appointment with a new doctor next week, but would like to get some other thoughts before then.  I am not seeking an internet diagnosis, just thoughts :)

[mochamommy0816]

Wow, thank you for your insightful and very thorough comments, Dr. Chandra.  You have explained all of my questions very thoroughly and this helps me tremendously.   I will discuss further with my new doctor next week. I at least feel that I am going in the right direction with a gastroenterogolist, and not needing to pursue additional medical attention with a GYN or other specialist.  Thank you for confirming that I am seeking the right kind of medical attention and for responding so well to my questions!