Severe Epigastric Pain

[freewaysbandit]

What other tests are available when you've had EGD, CT Scan, MRI/CP AND ERCP? The radiologist indicated a possible stricture in one of the bile ducts. So ERCP was completed this week. Ducts were all clear so no tissue samples were taken. There was no indication of cancer in the liver or pancreas. The gastroenterologist who did the ERCP is sending me back to my original gastroenterologist. I am not on any medication for the gastric distress they have described as epigastric pain. The last attact was sudden onset and quite severe. Not having a diagnosis at this point, I have concerns the pain will return. I've had mild abdominal pain for several months. I've lost more than 10 pounds since the symptoms worsened as my appetite decreased. Any suggestions for how to pursue a diagnosis at this point. Blood work was done a few days prior to the ERCP and all results were "normal".

[freewaysbandit]

Thanks. I found that website last night and bookmarked it. Will spend some more time reading through it and did find good info.

[CalGal]

For IBS diet suggestions, try helpforibs.com.

[freewaysbandit]

I did see the regular gastro doc on August 15th. Despite going prepared with questions, I never got the opportunity to ask. It seems evident we are all lucky if we have 7 minutes in the office with the physician! Due to all the other tests coming back negative, he has decided to go with IBS. He put me on Amitiza, 24 mg twice daily for eight days, then 8 mg twice daily. I was not pleased to discover the limited literature available on this medication. So far, side effects seem minimal. I think it will take some time to see if it is really working as I was on vacation and out of my daily routine starting the Amitiza. This morning, my stomach isn't doing well and I'm having pain again. I'm not really sure where or what to do next. I started doing a web search for IBS food plans as the doc offered nothing in terms of diet and foods to avoid. The pattern with food upsetting my stomach and colon is so inconsistent I can't come up with a good plan on my own. I'll just keep looking for additional information to increase my level of comfort. I'm trying not to get discouraged, I know there are a lot of women suffering with this disorder. It is not life threatening but can certainly feel disabling at times.
Thanks for your help. Open to any suggestions.

[freewaysbandit]

Thanks for the article link. I will bring this up with the doctor on Friday. No mention has been made about a problem with SOD. I'll keep you posted.

[CalGal]

Freeway, read through this: http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease1&organ=3&disease=12&lang_id=1

It may not be the condition you have, but the info might just come in handy.

Strictures may in fact by spasms, and if that's the case, they may not be seen. If the spasms were seen in the bile duct proper, they could also occur in the sphincter. Ask as MANY questions as you can and get copies of all the records and read through them.

And if they didn't do manometry, ask them why they didin't. You can't tell whether the pressure in the ducts is elevated without it.

[freewaysbandit]

Thanks for your feedback. I don't know if manometry was done with the ERCP. I have a follow-up the end of the week with my original gastroenterologist. I may be able to get additional information if he has the report from the ERCP specialist. Both imaging techniques pointed to a "stricture or closure" in the bile duct. The specialist told my family afterward that he did not find any closure in any duct! As slow as this process has moved, I wonder if I could get the labs ordered and completed during an "attack"!

[CalGal]

Freeway, was manometry done when the ERCP was done? There doesn't have to be a stricture, but I'm wondering if what the radiologist saw could have been a spasm. And spasms don't always show up during an ERCP. Did the radiologist 'film' a 'closure' within the common bile duct? If so, that might account for the pain. And if manometry was done, higher pressures may be have recorded during the ERCP that would give you an indication that the pain you're seeing could be related to SOD - sphincter of Oddi dysfunction.

Unless blood work is done during and 'attack', liver and pancreatic enzyme levels will be found to be normal.