recurrent vomiting and abdominal pain, status post 1 yr whipple procedure

  My dad was diagnosed with ampullary carcinoma august '97 he endured Whipple Procedure, chemo, and radiation therapy.  He did fairly well with the aforementioned, but has recently(about 2months) had a problem with vomiting.  He had an UGI in Jan '97, with negative results except for a small hiatal hernia.  He was placed on Prilosec at that time and was then diagnosed in Sept '98 with an anastomosis ulcer and gastric delayed emptying.  His doctor doubled the dose of Prilosec and my father was also placed on Propulsid, then later to Reglan, and now on a stronger medicine all of which have not improved the symptoms.  My question is where should we go from here?  Should he undergo another EGD, or is there other exam(s) that we should consider asking to have done?  Your time is this matter is much appreciated!!  Sincerely, Karen  
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Dear karen,
As you are aware Whipple procedures represent an extensive resection of the gastrointestinal tract to remove the tumor.  Because of the magnitude of the surgery, there may be disruption of some of the nerves innervating the gastrointestinal tract that are resposible for appropriate motility.  In addition, there can be ulcers or surgicl narrowings that impede motility.  
I think that there should be a repeat endoscopy to assess the possibilities of ulcers and strictures as the cause of vomiting.  A small intestine barium x-ray will be needed to rule out more distal obstructions.  Finally, a Ct scan of the abdomen is necessary to rule out recurrent tumor ( unlikely if the ampullary tumor was completely removed at surgery).  It is also necessary to exclude medical causes for impaired motility e.g. electrolyte imbalances, medications with anticholinergic side effects, intrabaominal infectio.
This informationis presented for educational purposes only.  Always ask specific questions to your personal physician.
HFHSM.D.-rf
*keyword: ampulaary cancer, vomiting
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