continued stomach and digestive issues post gallbladder surgery

[KayB]

Late fall 2006 I had my gallbladder removed due to "multiple" stones which caused lots of problems--things are better.

I have been on Prevacid 30 mg for reflux as well but was hoping to discontinue using it.

Earlier this year (2007) they ordered an upper GI x-ray and small bowel study as I was supposed to have had one earlier in the fall of 2006 and for some reason it was never ordered. That test came back free and clear with no issues at all. I should add that I have had upper and lower abdominal ultra-sounds, two trans-vaginal ultrasounds, an abdominal x-ray, HIDA scan which revealed no issues (other than the gallstones, all between late summer 2006 and last month). I have also had a free and clear colonoscopy two years ago, even with a family history of diverticulitis (one parent) and two pre-cancerous polyps (the other parent). I was told to come back in five years due to family history.

A couple weeks ago one of the physicians at the clinic thought I should have a blood test for h pylori antibodies due to the GI issues I'd been having. At that point things were OK gastric-wise for the most part though I still had the occasional "blips" in that area. The test did come back positive so I was started on a course of antibiotic therapy--flagyl and tetracycline. I have to take tetracycline due to a possible penicillin allergy.

I began the antibiotic therapy  not quite two weeks ago.  Four days after I began, despite being on Prevacid, I had the absolute worst case of reflux I've ever had--even before I began taking Prevacid!  I felt like my esophagus was in spasms and I could feel the acid coming up my throat. That seemed to alleviate somewhat the next day though my throat felt a bit on the raw side.  I began to take probiotics and digest enzymes and that's helped somewhat but I still get burping, gas pain mid-section on occasion, a feeling of fullness after I eat on occasion, and just feeling uncomfortable GI-wise.  I am still taking the Prevacid as directed.  Two days ago I laid down on my back to rest and had two episodes of stuff coming back up my throat, howbeit without the pain I experienced previous.

This morning I had to take quite a long time to eat breakfast as I just did not feel like eating. In the middle of the night last night I woke up with that burning gas feeling mid-section which lasted until I got up this morning.

Additionally, while not having diarrhea, bowel movements have been very "fast" and very soft, more narrower than usual and with a horrible odor I'm not used to.

My question(s) are--could this all be related to the antibiotic therapy? I understand tetracycline is quite strong. None of this really started until after I'd begun taking the dual course of antibiotics, though in looking back about 1 week or so prior I'd had some gas pain/pressure in my mid section, right below where the bra band ends. That was somewhat surprising as I'd not had it before.

Since I had a clear upper GI x-ray/small bowel study, and clear colonoscopy, as well as two clear trans-vaginal ultra sounds and clear lower and upper abdominal ultra-sounds (all  of them within the last 6 months)you'd think I wouldn't have major issues. Is it possible for something major to crop up in a short amount of time.

ALL my labs (blood CBC, urinalysis, liver/pancreatic enzymes, kidney functions, etc), cholesterol, HDL/LDL have been good with the exception of the h pylori (these labs have all been since January).

It's been not quite 6 months since I had my gallbladder surgery and I recovered fairly well from that I thought with minimal side effects. I am wondering if this could be related to no longer having a gallbladder...guess I'm just grasping at straws.  Also, my last day of using the antibiotics is tomorrow after a 2 week course.

Is there anything else I can do or speak to my health care provider about?

Thanks for any help. I'm the type who tends to over-stress about these things and always imagine the worst..

[Kevin Pho, MD]

You have had a comprehensive evaluation for your symptoms.

Looking further at the upper digestive tract can be considered if the symptoms continue.  This can be done with an upper endoscopy.  Re-testing for H Pylori also can be done (via breath or stool tests).  The eradication rate is not 100% for this bacteria, and other treatment options may need to be considered.

More specialized testing like a gastric emptying scan, 24-hr pH study, or Sphincter of Oddi manometry can all be considered if the symptoms continue.

These options can be discussed with your personal physician, or in conjunction with a gastroenterologist.

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_

[KayB]

PS I still feel a bit of twingey-ness in the area right below the right rib cage on occasion--about where the gallbladder used to be.

I am also wondering about celiac disease as a possibility--but wouldn't that have shown up on a colonoscopy or the upper GI x-ray??

[aeonx]

Try keeping a food diary.  Sometimes with post cholecystectomy patients, certain foods cause them to have distress in the general area where the gallbladder used to be.