Abdominal trouble after gallbladder removal

[Cindy C]

I had my gallbladder removed (lap) 5 months ago.  I had epigastric and upper right quadrant pain and a HIDA scan showed a 4% ejection fraction.  I was doing fine until about a month ago when I started getting the same pains - not to the same degree, but as time goes on it seems to be getting worse.  Last Friday I had an endoscopy and it showed I had a small stomach polyp, a hiatal hernia and acid reflux.  I was diagnosed with GERD before the gallbladder.  I just started taking prescription zantac 2 weeks ago after trying many others which did not agree with me.  I guess I am trying to figure this out.  First of all, is a stomach polyp anything to worry about (I have not seen the doctor, this was on my discharge sheet)?  It said it was a small polyp.  Secondly, could the hiatal hernia/GERD be causing the same type of pain?  It starts soon after I eat and I can feel it going down and it is concentrated where (I assume) my gallbladder used to be. Should I have any other testing done?

[Kevin Pho, MD]

It is doubtful that the stomach polyp is causing your symptoms.  As for anything to worry about - this can be done if they biopsied the lesion during the endoscopy.

GERD, an ulcer, or inflammation of the upper digestive tract can all lead to the symptoms you have described.  A 24-hr pH study can be considered to conclusively give a diagnosis of GERD.

You can also consider Sphincter of Oddi dysfunction, which can cause RUQ pain.  This condition can be more common in those without a gallbladder.  If your GI doc suspects this, an ERCP with Sphincter of Oddi manometry can be considered for further evaluation.

You can discuss these options with your personal physician.

Followup with your personal physician is essential.

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, M.D.
Medical Weblog:
kevinmd_b

[surgeon]

If they saw a stomach polyp, they would have biopsied it unless it clearly was totally innocent-appearing. In any case, it would not be causing symptoms. GERD certainly can cause the symptoms you describe. Diagnosing pain from the gallbladder is difficult when there aren't stones. If the HIDA shows both low ejection fraction, AND the injected drug given during the test EXACTLY reproduces the pain in question, there's a good chance removing the gallbladder will help. It remains a difficult area. In your case, it may mean the gallbladder was not the problem. There's also the syndrome called SOD (sphincter of oddi dysfunction) which, if you look at other messages here, you'll see is also a possible explanation for people with gallbladder-type pain after gallbladder removal -- and difficult to diagnose with certainty. You could ask your gastroenterologist about the possibility.

[Cindy C]

He did send the polyp to be biopsied.  I am asking if they are usually non cancerous.  The injection during the HIDA scan did reproduce my symptoms. Also, since I started taking zantac, I seem to have more pain.  Is this a coincidence?