What else could be going on?

[tammy60]

I am a 44 year old w/f.  I am 30 pounds overweight.  3 months ago I visited my PCP because of severe RUQ pain and mid back pain. I also was having some reflux.   CT showed possible inflammation of small bowel and I subsequently had UGI endoscopy and colonoscopy. I also had UGI endo around 2 yrs ago for similar symptoms and was shown to have mild gastritis.  This most recent ugi endo showed early Barrett's, hiatal hernia, strictures, ( was dilated) and bleeding gastritis and esophageal erosions at the point where the esophagus meets the stomach.   I do not drink ETOH, nor do I smoke.  I have taken short courses of prednisone and NSAID's for lumbar disc disease but not since May of last year.   Last week I felt like I had something caught in my throat after eating and contacted my GI doc and had another UGI scope and had another stricture up higher and was dilated.  I have been taking Nexium 40 mg daily for the last 3 months, was just increased to twice per day.  I continue to have discomfort in my RUQ, and pain in my mid back.  I had a lab choly in 1996, so my gallbadder is gone.  I have had no weight loss.  However, I feel very full and uncomfortable after eating.  My GI has suggested I consider having an ERCP to determine if I could have a blocked bile duct.  My lipase and amylase are both normal.  I am a RN, with years of ER experience so I am knowledgable and of course getting a little concerned.  My father died of colon CA at age 53. R We missing something?

[Kevin Pho, MD]

I would agree with the ERCP.  One consideration would be Sphincter of Oddi dysfunction - which can cause gallbladder-like pain.  The term has been used to describe a clinical syndrome of biliary or pancreatic obstruction related to mechanical or functional abnormalities of the sphincter of Oddi.  This can be magnified especially after a cholecystectomy.  

If there is hesitation about the ERCP, one can obtain a fatty meal ultrasound study.  If it is positive or inconclusive, an ERCP can be done with Sphincter of Oddi manometry.  

If there is a problem with the Sphincter of Oddi, there are various options.  Medications used to treat this would include calcium channel blockers and nitrates.  Electrocautery and botulinum toxin injection can also be tried.  If these methods fail, then surgery is always an option to correct this condition.

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.

Thanks,
Kevin, M.D.