gallbladder pain

I have been diagnosed with an ejection fraction of 25% from a Hida Scan also a ct scan showed distention of the

Gallbladder. My Gastro Doc does not want to have my gallbladder removed, I have daily pain on rt. side through to back and chest pain also,pain is also on left side under ribs at times. On Protonix and Bentyl for 2 months with no inprovement,I forgot to mention I do not have any stones, just pain.Why would a Doctor put off GB removal?  Thanks for any help!

[CalGal]

The doc is putting off the surgery because the rate of problems after GB surgery for a lowered ejection fraction with NO stones is causing a lot of difficulty in the GI community. Post surgical problems seem to be showing up more and more, and a condition called SOD (sphincter of Oddi dysfunction) seems to be 'uncovered' in a lot of cases after the GB is gone. It's very possible that SOD may be the thing that was causing the pain the the first place.

Big problem? There's really not a good treatment for SOD at this time. I know that's not much comfort, but I think your doc is only going to suggest surgery if you're desperate or unless you find another doc who hasn't been reading a lot of the reports on the statistics.

If you haven't been following a low fat diet, you may want to consider it. Also, if you're female and taking any form of BC pills or hormones, try to consider something else. Hormones can rally impact the GB.

PPIs can also result in changes in GB functioning.

[tsco]

I disagree,  MY Ejection Rate was 22 (no stones) and my Doc who is wonderful is leaving it up to me.  I don't have pain like you but other wierd symptoms.   Removing the Gall Bladder doesn't cause sphincter problems you either have the oddi thing or you don't and removing may not help if you do.  My doc said that is a rare problem. Ask the Doc why not now.  If I'm having pain the thing is coming out.  A fellow at work just had his removed as an emergency surgery.  He had subtle pain for two months then ...boom a big attack.  The thing is if you have baby symptoms, like my doc said, you can nurse the gall bladder for years and avoid surgery.  

[sugarcatmom]

As someone who just had her gallbladder removed 3 months ago due to pain, digestive issues and an ejection fraction of 20%, and also someone who respects your opinion and knowledge, would you be able to point us in the direction of these statistics?? I think it would do a service to those of us faced with this decision to see them in black and white, as reading these posts before my gallbladder surgery had me frozen in fear for a month not knowing which way to turn.

Thank you.

[Cheri70]

I don't think removing the GB is an easy decision if one does not have stones.  I wish I had researched more before I had mine removed (0% EF, no stones).  I am not better 9 months after removal, and I'd say worse.  So obviously in my case, the GB was not the problem.  I don't think there are any real good answers, but if you do not have stones I think it wise to work around it as best you can.  Obviously if there is no relief or no diagnosis after further testing it might be the only way to go.

[sugarcatmom]

I'm definitely better off now than before the surgery,  but I do have some residual pain that is positional and movement related from the surgery itself.  It's annoying, but it seems to be going away s-l-o-w-l-y.  For me, as I was slowly starving, the surgery was necessary (although it took me a long time to actually come to that realization).  Ask your doc why he's hesitant. I'd be interested to hear his answer. And good luck. I wouldn't wish this on my worst enemy. I know how frustrating (and painful) this can be.

[CalGal]

For one opinion from John Hopkins, see: http://hopkins-gi.nts.jhu.edu/pages/latin/templates/index.cfm?pg=disease1&disease=12&organ=3&lang_id=1

I believe you'll see a 10-20% rate quoted there.

I'll try to find some other that are are in general domain rather than on medical data bases that can't be accessed without without an access code.

[CalGal]

Try this one (although you may have to sign in) - it's on PCS, which groups in SOD - look under frequency. In the beginning the authors state that 10-14% is reasonable, but if you look at the varous individual studies you'll find that the statistics quoted vary from study to study: http://www.emedicine.com/med/TOPIC2740.HTM If you can't pull it up, after signing in, search for postcholecystectomy syndrome.

There are studies showing up to a 40% rate, which is a tough statistic to swallow.

[sugarcatmom]

Thank you for those sites.

40% is a tough statistic to swallow.  I believe my second opinion gastroenterologist told me about 85-90% without stones are helped by the surgery, whereas symptoms are alleviated or totally resolved.

I guess that's why my surgeon said there are no guarantees with this procedure.  At this point, I'm counting myself lucky.

Thanks again.

[JimK3145]

If you don't mind my asking, what other digestive symptoms did you have before your GB was removed besides right upper quadrant pain? Did you have stones? Was the pain just after eating or was it intermittent during the day? Were you getting bloating? Slight nausea? I have an EF of 35% which is right on the borderline of good GB vs bad GB, but I'm still getting slight bloating after eating no matter what I eat. I'm eating low fat also. My tests say that I have no stones and that all organs look good, good blood levels as well as good enzyme levels also. I'm stumped as to the cause of the bloating! Any help would be greatly appreciated. Thanks!

[JimK3145]

I forgot to mention that I have intermittent Right upper quadrant pain, but it doesn't seem to be related to what I eat.

[sugarcatmom]

It started with pretty bad right upper quadrant pain going through from the back to the front or the opposite, front to back. It felt sometimes like my liver was actually pulsating with pain, mostly after fatty meals, at first. When I cut down on my fat, the pain got better but didn't go away. I had it every day, not necessarily related to food. However, when I did happen to eat a fatty meal, I was in agony with burning and pinching under the rib cage.  I also had yellow diarrhea and when they weren't yellow, stools were very funky looking.  No bloating, and no nausea, until the week before I had mine removed.  That's when I had my first bout of nausea.

I had no stones, a 20% EF,  and the pathology report read that the gallbladder had multiple adhesions and was chronically inflamed. In retrospect, I had had that pain and problems with digestion of fatty foods (diarrhea) for years, but I chalked the pain up to hemangiomas on my liver and the diarrhea to IBS, which I've never been formerly diagnosed with.  I did have an endoscopy 5 days before surgery to rule out any ulcers. I was diagnosed with mild gastritis. Nothing more on that end.

Recovery from surgery was tough, I am not going to lie. And it was done as a lap. There were days the burning was so bad in the gallbladder area that I couldn't get out of bed. I don't think that's the typical experience, however.

My gastroenterologist said the billiary pain could continue for 3-6 months after surgery, and for the first 6-8 weeks, that's what I experienced. Presently, the pain I am feeling (and although on a daily basis, it is mild) is based on movement and position. My Primary doc feels this should go away eventually. I do occasionally feel pinching where the gallbladder used to be and some pressure behind my right breast area, but it's improving.  I have no more digestive issues and while I haven't tried any high fat foods (I don't miss them, believe me), I have no problem eating these days. Stools are normal in color and frequency.

Good luck!

[CalGal]

I'm going to make a very wierd suggestion, but there is a basis for it. There are some people who have symptoms of what appears to be GB issues when they may, in fact, having issues dealing with food intolerance problems. Would you consider trying a couple of complete eliminations - at separate times - for a few weeks and see what happens?

One would be diary - not so much for the 'lactose' portion of it, but due to the major protein in dairy - casein. You'd also need to avoid products with added 'whey.'

The other would be gluten elimination. That's all wheat, rye, barley (and possibly oats). The problem with this portion of a trial is that gluten is hidden in everything, so you'd have to read labels, etc.

I know it sounds like a miserable idea, but with all your tests turning up basically negative and your on-going bloating, it might be worth a try. I know most people only try this when they hit absolute rock bottom, but I though I suggest it anyway.

[sugarcatmom]

I'd also throw in an Upper Endoscopy if you haven't already had one.  

[JimK3145]

Thanks for the reply. We've corresponded back in March. At that time, you sent me a link about use of PPI's vs. GB Ejection fractions. I'll get to that in a bit. I'm on my 2nd Gastro doc. Here's the testing results to date:
Colonoscopy, Mar 05: everything looks good, No polyps, come back in 10 years
Aug 07: slight bloating, stomach pain
Endoscopy, Sep 07: mild gastritis, slight hiatal hernia, Barrett's esophagus. No H. Pylori Pathology said nothing was pre-cancerous. Put on PPI's at that time.
Right upper quadrant pain started in Nov 07.
Nov 07: Abdominal sonigram: no GB stones. Everything looks normal. No wall thickening of ducts.
Barium swallow test, Dec 07: positive but new Gastro doc said that this test is very unreliable and that with all the PPI's that I've been on, I shouldn't have any reflux.
Mar 08: CT scan; All organs look good.
Mar 08: Blood test: all levels good. Nothing out of whack.
Jun 08:Test for Celiac disease: negative
Jun 08: MRI with contrast: GB looks good as do other organs.
Jun 08: Breath test for bacteria overgrowth: slightly positive, given Xifaxan, 1200 mg daily for 10 days. Didn't help. Xifaxan is used to treat IBS. Here's a link: http://www.cbsnews.com/stories/2006/10/16/health/webmd/main2096522.shtml
Jul 08: HIDA with stimulation: 36% EF. Teaching Hospital where the new Gastro doc is located says that they consider anything above 33% to be normal.
Jul 08: Capsule endoscopy: everything looked good.

No diarrhea, no constipation, am very regular.

Back to PPI's. I have an upcoming follow up endoscopy for Sep 2, 08. Based on the paper that you sent me, I've gotten permission from my Gastro doc to stop PPI's that I've been on since Sep 07 for 1 month to see if that makes any difference. Just stopped them this past Monday. In addition, also this past Monday, I've stopped all dairy (I was using lactose free skim milk even though I'm not lactose intolerant).
New gastro doc thinks that what I have is non-ulcer dyspepsia (sounds like too much of a catch all diagnosis to me). I also have an appointment to see a dietician/nutritionist in mid-August. Maybe I've picked up some food allergy or something. Sounds as though gas is being generated but where and by what?

With everything that I read on these posts, could I still be having a problem with my common bile duct or with biliary dyskinesia even though the gastro guy says my GB is  fine. I've read that anything below 40% EF is considered suspect. Can problems with the duct and or GB cause slight nausea/bloating?

The kicker in all of this is that up to June 07, I had never had any gastro problems whatsoever. All this started after June, 07. If you have any other thoughts, please let me know. Once again, thanks for all your previous help.

[JimK3145]

Thanks for the reply. I didn't have the reactions to fatty foods as you did (pain, yellow diarrhea) so it looks as though my problems are somewhat different. After reading these forums, I'd be scared to death to having my Gallbladder be removed if it comes to that. Although, I know of at least 5 people who have had GB's removed recently and didn't have any problems afterwards. I guess the people with no problems wouldn't be on these forums.
P.S. Please see my earlier post to Calgal concerning what testing I've had. I think that I'm running out of things to test for.

[sugarcatmom]

I was absolutely paralyzed with fear for a good month before the pain got so bad and I'd lost so much weight (I wasn't eating at all) that I had to do it. And that happened after I came here!  I'm not pleased that I'm still in some pain, believe me, but I didn't have a choice. And comparatively speaking, I am better off today than I was on May 11.

Like I said, I wouldn't wish this on my worst enemy.  I hope they find what your problem is and there's a resolution to it.

[Linda1949]

A positive note about Gb surgery. I had mine out on June 7 th 2008. I was very miserable for about 1 month before Dr. got me in for Hida scan. My function was 10 % and no stones. After waiting another 3 weeks for my surgery I was ready. I had been to this web sight and had read about the problems people had after their surgeries. Of coarse I was very nervous about getting  it removed but I was also sick of being sick. My gallbladder surgery was my 4th surgery in 3 years. 2 arthoscopic shoulder surgeries and a thyroid removal. I didn't feel like my shoulder had improved much and I had gone through all of my physical therepy visits. I didn't know that your gallbladder can cause back and shoulder pain also. of coarse after reading all the horor stories of problems after surgery I headed back to my surgeon after 3 days complaining of my same symptoms. Dr. said I would be fine, these things take time and gave me some med for the nausea. He was right.I thought I had pancreaitis. You know I had all the symptoms!!Not to make light of the few individuals who do have problems. I had some rough days but am now doing good. I don't stuff my self like I use to do and eat low fat. Lost some needed weght and feel better. I'm 59 and heard from alot of people who had their gallbladders out(amazing the #) that they were up and fine after operation. Some quicker than others. I've had several on going conditions that make diagnois difficult . I imagine alot of people have similar health stories. I still have my arthritis to deal with but at least now my gallbladder is not side lining me like it did before surgery. Good luck to you and know there are good results from surgery.
Linda