Ongoing Severe Epigastric Pain and Nausea

[JayeGirl]

I'm a 36 year old female, 5'1", about 105 lbs.  I have been dealing with severe epigastric pain and nausea on and off now for about the last two years.  In May of 2008 I had a cholecystectomy after a HIDA scan showed that my gall bladder was flushing well below the normal rate.  I continued to have severe pain after this surgery, and was passed around from doctor to doctor for a while.  During this time I had an EGD which showed a healed ulcer, but nothing else.  Meanwhile, as I had been overweight when this had all started (around 155 lbs), my weight was beginning to drop dramatically because I was in so much pain after I would eat, and also because of frequent nausea and vomiting.  I had an elevated liver count on one blood test, but nothing else to indicate any other abnormalities, and as I visited the ER several times during this period for acute pain and vomiting, I had occasion to have my blood tested often.  Finally I found a family doctor who realized that prior to my cholecystectomy, my common bile duct had been dilated, and that it was continuing to dilate, according to a CT scan that I'd had done in the ER (this was around December of 2008).  By this time, my weight was down to around 100 lbs and still falling, so there was some cause for urgency.  She sent me to a gastroenterologist who looked into Sphincter of Oddi dysfunction and subsequently did a sphincterotomy via ERCP on me, which revealed that there was quite a bit of sludge building up in my common bile duct.  I felt much better after this and even started to gain a little weight back, when the pain began to return around May of 2009.  My gastroenterologist sent me to a large research hospital for help (U of Michigan), where I was put on Cholestyramine to help my body metabolize fat, and also to help process bile - which my previous gastroenterologist had found an excess amount of in my stomach when he'd done the sphincterotomy.  My pain continued to worsen, and U of M did another ERCP, during which manometries were done on both my pancreatic duct and my common bile duct.  The pressure level was extremely high in both ducts, and the gastroenterologist repeated the sphincterotomy on my Sphincter of Oddi, which had stenosed shut, and also did a sphincterotomy on my pancreatic duct and put a temporary stent in that opening.  I went back after two weeks to have the stent removed, and during that procedure, two large ulcers were found - one in my duodenum and another in the gastric body of my stomach.  After this procedure, I developed an acute case of pancreatitis and was hospitalized for a week.  My weight dropped down to 90 lbs.  This was in July of 2009.  After the pancreatitis cleared up and the ulcers were treated, though, things seemed to get better.  I was able to go off all pain meds entirely, and was able to eat almost whatever I liked, though I still remained cautious.  In August, I moved from Michigan to the Chicago area to pursue my graduate degree, and in September the pain began to return - just a little at first, but it is now so severe that I am unable to eat solid foods without having an acute attack of pain.  The pain is in my upper middle abdomen, just below my sternum and a little under my ribcage, sometimes a little more to the left-hand side.  Usually it comes in waves.  It is generally accompanied by nausea, and sometimes by vomiting.  I take Zofran for the nausea, but sometimes this is not enough.  I have a new gastroenterologist here who has been very kind, but I fear maybe not aggressive enough.  Any advice or ideas anyone might have about what might be wrong with me or what I should do would be appreciated.  I am a little scared and frustrated.