Misdiagnosed esophageal spasms

[Alexcari]

Hi. My husband Alex has had painful epigastric bouts that were called esophageal spasms for years and was subsequently diagnosed with Barretts esophagus in 2001. Several years of Protonix therapy and a few EGDs later, the Barretts was said to be resolved however the esophageal spasms continued. Thier occurance was fairly infrequent but regular.Usually triggered by a rich or acidic meal or just large meal.  Symptoms were stabbing, burning  intractable substernal pain that came with nausea vomiting and diarrhea, lasting several hours to a few days; He was hospitalized a few times for observation bringing no new diagnosis. Then the episodes started coming more frequently, These episodes always started in the epigastric area but soon started to radiate to the ruq. No one ever even thought of his gallbladder. Then the episodes started happening alot more often much more pain in the ruq. What has brought all of this to a head is a major episode a few weeks ago that weakened him from the pain and diarrhea both and ended up in the ER yet again.This time the pain was well over a "10" and was shooting across to the left as well. They did a CT which showed a some density in the gallbladder and that was about it. His CBC was way off. H and H were high, white count was 14. Amylase and Lipase were ok so were ALT and AST. They hydrated him, gave him Toradol and sent us home. After several more hours of diarrhea he was back in the same state, The next day we saw a PA who redid the CBC and CMP. The CBC was better, white count almost normal, but this time his AST and ALT were both over 300. He is not on anything other than the Protinix, just FYI, not diabetic either. His MD redid the liver enzymes again the next day ALT was lower, the AST was another 100 points higher. He had an abdominal ultrasound showing a 2.5 cm stone and several small stones. He is going to have the gallbladder out next week, which I think is going to make a big difference him. But I am perplexed by a few things. He has had such consistent symptoms for so long I just don't get how the gallbladder disease was missed. Would you have thought of it? Another thing that is perplexing me is that when we asked about why the liver enzymes were so high and if there could be a relationship to the gallstones. We were told probably not. Okay, I started doing some reading and read some journals and could find the relationship quite readily. Quoting the University of Maryland Medical Center website:"Levels of liver enzymes known as aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are elevated when common bile duct stones are present. A threefold or more increase in ALT strongly suggests pancreatitis." He is still in quite a bit of pain and has explosive diarrhea after even the smallest, blandest meal. I realize I am on a ranting roll here, but I don't think his condition has been taken as seriously at it should be though I am relieved that he is getting the blasted thing out. I just can't help wonder if this has been the problem all along. What does it all seem like to you? Thanks for your time and your reply. Cari ( on behalf of Alex). ps forgot to mention that he has lost almost 20 lbs in 2 weeks.

[CalGal]

I believe a lot of people on gastro boards may have recognized the symptoms since there are high numbers of people on the boards who have gone through the same thing. However, many people go though years of suffering because gallbladder issues are not quite as obvious as most would think. In fact, go through GB tests and everything comes up normal but if surgery is done the doc will often come back to report a 'diseased' GB. It suggests we just don't have tests that are 'good enough' yet.

However, when enzyme levels go up, it's a clear indication that something further should be done. If your doctor didn't recognize that fact, you may want to consider finding another practitioner to work with in the future.

If the doc is going to remove the GB, please give your husband's system a boost by asking him to remain on a low fat diet for many months following the surgery. His system is not going to process fats the same way it did before the surgery. It can take awhile to adjust. Sticking to a low fat diet can help with that adjustment.