Biliary Colic?

[Ellby]

I am a 37-year-old Canadian female of healthy weight. I eat a healthy diet except for a lot of potato chips (my one weakness!). I was diagnosed with irritable bowel syndrome in 1993 based on clinical symptoms, but for the past several years it has been quite manageable. I sometimes have increased urgency and frequency of bowel movements/diarrhea, especially when stressed, and sometimes stomach pain in the late afternoon/evening. Sometimes I have constipation. I can live with all that.

But over the past year I have had six or seven very unusual middle-of-the-night episodes in which I am awakened by intense and extremely uncomfortable tightening of the upper central abdomen, which the first couple of times led to vomiting. After an hour or two, give or take, the pain gradually subsides and I go back to sleep. The next day my abdomen is tender but otherwise OK. I started tracking what I ate on those occasions and noticed it tends to happen after a large, fatty meal, often with a glass or two of wine.

After three episodes I went to my doctor, who prescribed a pelvic and abdominal ultrasound, both of which were normal. She also prescribed an upper GI barium X-ray with small bowel follow-through. The results showed “flocculation and segmentation of the small bowel, suggestive of malabsorption.” My doctor sent me to a gastroenterologist, who performed an upper endoscopy to look for evidence of celiac disase. Everything looked normal. They also ordered a stool O&P test and some blood tests: alk. Phosphatase, hemoglobin, WBC count, Ca, Albumin, CRP, TSH, CBC. All normal. The specialist’s conclusion was that my complaints are caused by irritable bowel syndrome. He prescribed Dicetel, which unfortunately produced a great deal of gas and caused around-the-clock stomach pain, so after three days I stopped taking it.

Last week I noticed my stool suddenly had a yellow tinge to it and a day or so later I had another of those painful nighttime episodes. This time, I found information about biliary colic on the Internet. The description of biliary colic sounds so exactly like what I have been experiencing. Yet the abdominal ultrasound didn’t show anything abnormal. My question: Can this be a gallbladder problem, instead of (or in addition to) IBS? If so, what about the fact that all my tests so far (except for the upper GI X-ray) have been normal? Should I be pursuing this with the specialist, who obviously thinks I have nothing to worry about?

Other minor problems, probably non-related: I have a constant problem with sinus congestion; I had shingles 2 years ago; I had midcycle bleeding a few months ago for the first time; and my brother was recently diagnosed with Crohn’s disease.

Thank you for your help.

[Kevin Pho, MD]

Gallbladder certainly  should be considered.  Liver function tests would be helpful, along with an abdominal ultrasound.  If negative, a HIDA scan can be considered to look at the gallbladder function.  

If the tests continue be negative, you can consider looking at the pancreas, starting with the pancreatic enzymes and CT scan.  

These options can be discussed with your personal physician, or in conjunction with a second GI opinion.

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.
kevinmd_