EPIGASTRIC AND CHEST PAIN ONE YEAR POST-CHOLECYSTECTOMY

THIRD TRIP TO THE FORUM. STILL HAVING AT TIMES SEVERE EPIGASTRIC/SUBSTERNAL/INTERMITTENT STABBING CHEST PAINS; USUALLY 2 HOURS AFTER EATING. HAVE PUT MYSELF ON A BLAND DIET FOR THE PAST 5 DAYS WITH MODERATE RELIEF. GALL BLADDER REMOVED NOV. 2001. HAVE HAD EGD 3 TIMES. COLONOSCOPY,CHEST X-RAY,ESOPHAGEAL MANOMETRY,MRCP. HAVE TRIED EVERY TYPE OF MEDICINE FOR GERD,ETC. DO HAVE MILD GASTRITIS AND SMALL HIATAL HERNIA. ALL TESTS AND BLOODWORK ARE NEGATIVE. CANNOT IMAGINE HIASTAL HERNIA COULD CAUSE THIS MUCH PAIN. MY GI DOC DOSEN'T THINK I HAVE SPHINCTER OF ODDI DYSFUNCTION. I'M NOT SURE. HAS ANYONE OUT THERE HAD THESE SYMPTOMS? I WOULD APPRECIATE ANY SUGGESTIONS. I ALSO HAVE HAD CT SCANS OF THE ABDOMEN AND CHEST. THANKS.

[nadia]

Yes I think it is possible to have that much pain with mild chronic gastritis, because that is what I have. I also have a small hiatus hernia.
Through my investigations of hiatus hernia, most do not even know they have it, but those who do, have mild to severe pain. The size of the hernia has no relation to the intensity of the pain.
I had my gallbladder taken out in June 2002, and have developed these problems since then.
The chest pain is quite bothersome and I am looking to find some relief through a naturopath that I am seeing.  The doctors have not given me any idea how these things should be treated other than PPI's.
The chronic gastritis, although thought to be mild, is constant pain.  I have no predisposing factors.(don't smoke, don't drink, no illicit drugs, not overweight) so they don't know how to recommend treatment.  The cause of the inflammation needs to be investigated.  If you have no factors contributing to this condition, you need to figure out why you have it.

[GI.PA]

There is a term used to sum up stomach pain when all other tests (including EGD's show very little).  It is termed Non-ulcerative dyspepsia (no ulcer on the test but your stomach feels like it is there).  This falls under the umbrella of irritable bowel syndrom (syndrome) or (the newest term) viseral hypersensitivity.  Many times PPI's are helpful, sometimes not.  If it hasnt been tried, many times a low dose tricyclic antidepresant (Elavil) can be extreamly helpful (in high doses used for Depression, in low doses for chronic pain, also has an anti-spasm effect).  It may be possible your gallbladder was never to blame for all this and just an innocent bystander (reguardless of what the pathology report says).

[ERRN]

THANKS TO NADIA AND G.I.PA FOR YOUR SPEEDY REPLY TO MY QUESTION TO THE FORUM. IF NOTHING ELSE IT'S SOMEWHAT COMFORTING TO KNOW THERE IS SOMEONE ELSE WHO HAS A SIMILAR PROBLEM. IT'S SOMEWHAT PERPLEXING THAT I WORK AS AN RN IN THE EMERGENCY ROOM AND SEE MANY PEOPLE COME IN WITH THE SAME AILMENT THAT I HAVE AND EVENTUALLY GET RELIEF, YET I STILL SUFFER. I GENERALLY AM IN EXCELLENT HEALTH; NEVER HAD A CIGARETTE,NON-DRINKER, NOT OVERWEIGHT, AVID JOGGER, YET WOUND UP HAVING A CARDIAC CATHERIZATION LAST APRIL DUE TO SUCH AN ACUTE ATTACK OF SEVERE SUBSTERNAL CHEST PAIN, ALTHOUGH NO INVASIVE INTERVENTION WAS DONE DUE TO HAVING LESS THAN 60% BUILD-UP OF PLAQUE ON MY LEFT ANTERIOR DESCENDING ARTERY. I HAVE NOT WORKED IN FOUR WEEKS; ACTUALLY BECAME MILDLY DEPRESSED DUE TO THE CHRONIC PAIN BUT PLAN TO RETURN TO WORK NEXT WEEK. I DID TRY ELAVIL FOR A SHORT PERIOD OF TIME BUT DIDN'T LIKE HOW IT MADE ME FEEL; FELT WEIRD. I STARTED ON PROZAC ABOUT TWO WEEKS AGO. HOPEFULLY THE BLAND DIET WILL GET ME OVER THE HUMP UNTIL I CAN FEEL BETTER. I MAY HAVE TO ACTUALLY LIVE WITH THE PAIN. PLEASE FEEL FREE TO RSPOND AGAIN NADIA AND TO G.I. PA I WOULD LIKE TO KNOW MORE ABOUT THIS VISCERAL THING. THANKS.

[nadia]

Funny you should mention non-ulcerative dypepsia.  That was my initial diagnosis and I fought like hell to try and get them to understand it was something more than that. That and IBS are used when doctors fail to find what is wrong. I tried to tell them for 1.5 years that my gallbladder was involved but was excused as an anxious patient. When I was put on elavil, I developed paroxysmal tachycardia and haven't been the same since. We need to investigate the side effects of these medications we are given.

[Lor]

I had my gallbladder removed in November 2000. I started having  RUQ pain right after surgery. Once I was sent home I started having severe pain. Pain so bad I would sweat like crazy and at times had to crawl into the bathroom to make myself throw up. It would relieve the pain for about 20 minutes or so then come right back. This would continue for several hours. After a week or so my husband figured out that the pain happened when my stomach was empty. It went away soon after eating. My Dr was out of town at that time. I saw the surgeon that did my surgery. He told me he doesn't doagnose - just takes the problem out. I spent the next year and half going from Dr to Dr looking for answers. Everywhere from University hospital to Mayo. All said it was IBS, 1 said it may be caused from a fibriod they found on a CT scan. Although I'm not sure why that would be in the URQ? One even said I should use birthcontrol pills and see if it might help. This is because my pain would intensify around my periods. I have been on so many medications elevil, prilosec, prevacid, pepcid, acifex, donnatal, reglan and on....The last Dr I saw. Looked at me when I walked in his office clearly in pain and said "has anyone talked with you about SOD?" I had asked a Dr a year earlier after reading about it on this forum if I could have it. He said no because it wasn't even a true illness. Long story short - I had the ERCP with/ menometry and he found the pressure in my bile duct was way up. Cut the sphincter and I had instant relief. I did develope pancreatitis from this, but feel it was well worth the risk. I still have pain from time to time, but it isn't 6 times a day - more like every month or so, and not nearly as extreme. Don't ever settle with IBS or similar. If there is pain there has to be a reason for it.

[schaeff]

I echo what Lor said. My pain began literally the day after gall bladder removal, yet two separate GI specialists, after all the non-invasive and blood tests, didn't even mention SOD. Both kept asking about stress. I kept saying why would it change so dramatically the day after surgery? Silence.  Although I have not and will not have the ERCP and SOM because of the potential complications, I am inexplicably lucky to get relief by drinking a large glass of water or eating another meal. I also use levsin .125 sublingual at first hint of pain (the first hint feels like hunger pangs 2-3 hours after a meal.)

Anyone who has this excruciating epigastric ==> RUQ pain following a gall bladder removal, and who has had all the standard CT, scope and blood tests to rule out organic GI disease, should absolutely ask their GI Dr. or seek referral to someone who knows about SOD.

[ERRN]

THANKS TO SCHAEFF FOR THE REPLY. I ALSO WAS RELUCTANT TO HAVE AN ERCP DUE TO THE HIGH RISK OF ACUTE PANCREATITIS SO I HAD A MRCP WHICH SHOWED A NORMAL COMMON BILE DUCT; WHICH ONLY ADDED TO MY FRUSTRATION. I HAVE TRIED PUTTING MYSELF ON A BLAND DIET WITH NO APPRECIABLE POSITIVE RESULTS. ONE THING I HAVE NOTICED IS THAT THE MORNING IS MY BEST TIME; VIRTUALLY NO PAIN...DOSEN'T START UNTIL THE AFTERNOON OR EARLY EVENING WHEN IT BECOMES EXCRUCIATING FOR ABOUT TWO HOURS. STILL OPEN FOR SUGGESTIONS. CAN'T GET SECOND OPINION WITH ANOTHER GI SPECIALIST AT A TEACHING HOSPITAL FOR TWO MONTHS SHORT OF GOING TO THE ER AGAIN; WHICH NEVER SEEMS TO HELP. THANKS FOR THE HELP.

[scotslass]

hi,
  Do any of you experience this same pain when you are sleeping, and it wakens you up?. I do and if i eat i feel much better, almost feels like a heartattack( not that i've had one) but very painful.??

[nadia]

I am awakened by this pain in the early morning hours. Usually around 5:00 am, and it goes on till I get up.  The chest pain can be quite intense and I attribute this to the hiatus hernia.  My next step will be to buy a book on it and try to live a lifestyle that is condusive to it's management.  I understand that this condition does not heal and if it is allowed to worsen, surgery is usually necessary.

[Lor]

I was up every night for a year and a half with pain during the night. It always happened between 2am and 6am. I spent most nights sleeping sitting up on the couch. Eating most always took my pain away. The problem with that is I had to eat every 3 to 4 hours to keep the pain down. I ended up gaining 30 lbs in a year and a half. Now after having a sphincterotomy done on my bile duct. I am finding it hard to get the weight off. It goes on so easy and seems like forever to get it off.

[scotslass]

Thanks for your comments.  Did you get the pain in your chest, and can feel it right through your back?? Like a tight feeling and when you eat it goes away??
I had my gallbladder out 1 1/2 years ago and i also had a Nissan Fundoplication done the same day. I have had this pain ever since and i never had it before the op.
What is the sphincterotomy??

[Lor]

My pain most of the time started just below the sturnum. I guess you could say it felt high enough to be in the chest area too. It always bore into my back. Which was just as painful. Sometimes the back pain would wake me up at night, and quickly change into the sturnum area. I have found putting a heating pad on my back really feels good. Helps take your mind off of the pain.
A shpincterotomy is when the shpincter to the bile duct is too tight. They make a cut in the sphincter to open it up more. Allowing the bile out easier and not causing the high pressure in the duct. By eating food you cause the bile duct to release bile. Which greating reduces the pressure. Although I will tell you there were times that eating only intensified the pain.

[krisg]

I too have been plagued by these debilitating painful attacks, since having my gallbladder out 5 years ago.  For the first 2 years it always woke me out of a dead sleep and was excruciating!
I would spend hours in such pain that I couldn't move and could barely breathe, pour with sweat and feel like the only relief would be to try to throw up.   Feels like a heart attack (although I haven't had one). Then one day I had my first "daytime attack", was hospitalized and put on demoral (the usual routine).  My liver enzymes were elevated. Since then (and for the last 3 years), I have gone from dr. to dr. trying to explain to them what was happening only to come out with a diagnoses of irritable bowel syndrome, and feeling very depressed.  Finally I went out of town (and state) and found a great specialist who recommended me to a top doc. at a top hospital to preform an ERCP with manometry and sphincterotomy.  I will have it done Feb. 18th.  I'm keeping my fingers crossed.  When you live with this kind of pain and can;t find a doctor who takes you seriously, it does get very depressing. Keep pushing on.  Keep searching for someone who can help you find some answers and take your pain seriously.  It may take time but is well worth it.  After being to the ER room twice last summer with these attacks of pain and elavated liver enzymes, I had to take matters into my own hands.  I gathered all my medical records and found a good GI who actually spent time with me (more than the usual 10 min.) I wish you luck !