Where do I go from here?

For the last nine weeks I have had symptoms including loose bowel movements that sometimes float, sporadic diarrhea, weight loss of 20 pounds, indigestion, belching, abdominal discomfort (sometimes a stomach ache, sometimes pressure directly below my sternum), back pain (which I can`t determine if it`s muscular or related to the other symptoms), early feeling of fullness, and at the beginning- loss of appetite...my appetite has slightly returned, but I still get full quickly.  Though some days I still don't care to eat.

I`ve had every test under the sun including an abdominal ultrasound, EGD, colonoscopy, CT scan, small bowel follow-through, stool cultures, 72-hour fecal fat test, and multiple blood tests. All have come back normal.  I have been on Flagyl to test for Giardiasis and Xifaxan for bacterial overgrowth.  No change.

I lost around 14 pounds in the first three weeks, stopped losing weight for the next three weeks, then started again a few days before the end of the Fagyl treatment.

I was on 80mg per day of omeperazole, but was told to stop it to see if the side effects of the med were causing some of my symptoms.  I have been off for 96 hours with no change.

Where do I go from here???  My GP and GI are at a loss.  I know it's very difficult to say over e-mail without an exam, but I'm at a complete loss.  

My biggest fear is that pancreatic cancer was missed on the original CT scan, which was 8 weeks ago.  I had a blood test today, which was normal, including pancreatic enzymes.  I`m 31 years old, so I know PC is rare at my age, but still possible.

Is it possible for the CT radiologist to miss PC? What are the chances of that happening? Can the scan itself fail to pick-up a mass or lesion?

Any advice or ideas you could provide would be very appreciated.  I don't care to, or need to, lose any more weight.  This has been going on for so long with no resolution that I've been started on Citalopram for depression and panic attacks.

Thanks.

[Kevin Pho, MD]

You have indeed been through a comprehensive workup for your symptoms.

If pancreatic cancer is a concern, yes, a CT scan can miss it.  Further testing can include an MRI of the abdomen and/or an endoscopic ultrasound.

I would also consider more specialized tests, like blood tests to evaluate for celiac disease, or breath tests to evaluate for lactose deficiency.

Otherwise, I can't think of any other tests to consider.  Many of the major GI disorders would have been ruled out with the tests you have had already.

Another opinion can be sought with a GI physician, preferably at a major academic medical center.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.

KevinMD.com
Twitter.com/kevinmd