Re: Prevacid

Posted By rd on June 03, 1998 at 20:09:53:

In Reply to: Re: Prevacid posted by HFHSM.D.-rf on May 26, 1998 at 23:43:41:





How does a diagnosis of Zollinger Ellison Syndrome get confirmed or ruled out?  Before having the secretin stimulation test, I had three fasting gastrins done at different times which bordered on abnormal, but the doctors felt that the level may have been high due to the Prevacid.   I was under the impression that the secretin stimulation test would do this and I would know one way or the other.   Would staying on Prevacid during the test make a difference in the results?  I had the test done while on the Prevacid because the doctor said that the percentage of increase in the gastrin level was the key, not the base level.  Apparently, my gastrin level went up from the secretin but not enough to confirm a diagnosis of ZE.  Is this a test I should have repeated at some point if my symptoms continue?   What is "sporadic" ZE?  By the way, I am 35 with no other major health problems.

I have been taking 90mg of Prevacid for 6 months now for what was thought to be reflux.  Before that, I took 60 mg of Prevacid for 4 months.  I was initially put on it for asthma like symptoms, and malaise after eating.   An acid ph study done while I was taking 60 mg was abnormal.  My gastroenterologist (my third one) referred me for surgery because he felt I would never be able to come off of the 90 mg dose, so the ph study was repeated.  This time I went off of the Prevacid for 5 days and the study came back normal so the surgeon was skeptical that I have reflux.  Although my EGD does show recent evidence of reflux, I do not have classic symptoms.  My other symptoms initially were burning in my back, URQ pain (intermittent), belching, and malaise after eating.  When I started taking Prevacid, the malaise slowly went away and I felt normal.  After several months, the RUQ pain also stopped.  On the suggestion of the surgeon, I tried going off of the Prevacid slowly, but after I was completely off for 8 days, the malaise after eating and the RUQ pain (which had been gone for 4 months!) came back.  I started taking the Prevacid again and am slowly returning to normal.  This happened to me a couple other times early on when I went off of the Prevacid for some tests; that was how I knew the Prevacid was helping intially.  I have had numerous ultrasounds, ct scans, enteroclysis, blood work-ups, secretin stimulation test, etc.  I guess I can stay on the Prevacid for the rest of my life but I really would like to know why I have severe malaise after eating and RUQ pain if I don't take it.  If my stomach makes too much acid, could that cause these symptoms?
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: Dear rd,
The dose of Prevacid that you are taking is substantially greater than that used by most gastroenterologists.  The inconsistency between the two pH studies is disconcerting and further confuses the clinical picture.  I assume from your tests that the physicians looked for Zollinger ellison syndrome and were unable to confirm that diagnosis.
You do not provide information regarding your age and concurrent medical problems.  I would wonder about other diagnoses including delayed gastric emptying and mesenteric ischemia.
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.
HFHSM.D.-rf
*keywords: abdominal pain, esophageal reflux
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