What else should we consider pursuing?

  My 17 year old daughter developed unusual symptoms about 4 months ago. In sum, she loast her appetite and virtually quit eating. She experienced upper abdominal pain as well with periodic bouts of nausea. We went to an Internal Medicine Specialist who ran tests. The gall bladder showed stones and "opaque masses" that the Radiologist called sludge balls. The doctor recommended gall bladder removal. We saught the opinion of a local Gastroenterologist. He ordered blood work that indicated normal absorption of food. He then examined her esophogus and stomach with a scope. The area where the esophogus enters the stomach and the area at the outlet were severely irritated. The areas easily bled when probed. He prescribed a regimen of Prilosec (20 mg) twice a day. After about two weeks, she was able to eat more (she gained two pounds), but with no appetite. Within the last few days, her food intake has decreased again and the stomach pains have returned (she is still on Prilosec). Should we have the gall bladder further evaluated? Should we be looking at the lower digestive tract? Or should we be looking elsewhere? Let me assure you that my daughter loves to eat.

[HFHSM.D.-rf]

Dear Ed,
Thank you for your interesting questions.  Your daughter is young to have gallstones, assuming that she does not have other illnesses. Despite the X-ray findings, I would be reluctant to remove the gall bladder without a strong history of biliary colic pain.  Biliary colic pain is an aching discomfort that starts approximately 30 minutes after eating and increases in a step-wise fashion for 45-90 minutes before subsiding.  The pain is usually located in the right abdomen under the ribs.  It has been observed that abdominal pain recurs  in many patients when the gall bladder is removed for pains not suggestive of biliary colic.  Even when gall stones are present, the gall bladder is not always the cause of pain.
I would followup with the gastroenterologist to verify that the esophageal inflammation has resolved with medical treatment.  Additionally, I would obtain a gastric emptying test because delayed gastric emptying can cause a loss of appetite and abdominal pains.  A gastric emptying test is easy for patients.  Your daughter would eat a meal that contains radioactivity.  She would then lie on a table while a special camera and computer program determined how fast the radioactivity left the stomach.  Finally, I would also do a small intestine barium series to exclude intestinal causes for her pain.  If all these tests fail to find an explanation for the pain and your daughter is still symptomatic, I would then reconsider the surgery option, recognizing that the pain may recur post operatively.
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.
If you want, we would be happy to see your daughter in the Division of Gastroenterology at Henry Ford Hospital. You can arrange an appointment with Dr. Fogel, one of our experts in the diagnosis and treatment of abdominal pains, by calling the Henry Ford Physician Referral Line at [phone].
HFHSM.D.-rf
*keywords: abdominal pain, gallstones, biliary colic, gall bladder surgery
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