stomach pain, all tests negative

[joannela]

Hello.  I've previously written to you about my father (late July, subject was "pancreatic cancer, gallstones?), he's 62, white, about 5'9, 168 lbs, non-smoker, (for about 15 or 20 years), has type II diabetes which was until recently controlled by oral medication. He's lost some weight recently due to his recurrent stomach pains and since then his sugar has not been high so his doctor told him he didn't need the medication as long as his sugar remained stable.  

His symptoms are bad stomach pains, either soon after he eats or late at night. The pain wakes him up and keeps him up. He also has pain in his upper back, between his shoulder blades. It doesn't happen every day, but usually a couple days a week. He has no nausea, diarrhea or constipation, and his appetite is normal; he eats less however b/c of anticipation of the pain a large meal will cause him.  He's been through a battery of tests recently: endoscopy, colonoscopy, transabdomenal ultrasound of the liver, gallbladder and pancreas, CT scan of his abdomen and blood work including CBC and liver panel.  All were normal - no gallstones or masses were seen on the ultrasound or CT.  He has a "simple cyst" on his right kidney but his Dr. told him it was nothing to be concerned with and was not causing his symptoms. The CT results stated that the pancreas was a little bit "fatty," but the radiologist (or whoever interpreted the CT), his regular doctor and the GI's nurse (who reviewed the CT scan but he hasn't seen the GI dr. yet) saw nothing unusual or alarming with the pancreas.

He will be following up soon with his GI, but can you think of anything that could be causing this?  How likely is it that all these tests could have missed something serious?  An in-law suggested a HIDA test to test gallbladder function, which she says can cause such symptoms even in the absence of gallstones. Your thoughts?   Any other tests we should consider?

Any advice you can give would help. We are extremely relieved that the testing so far has not revealed cancer or anything else immediately life-threatening, but it's difficult for us to see my father in such pain, and he's incredibly frustrated.

Thanks

[Kevin Pho, MD]

There has clearly been a comprehensive set of tests.  It is unlikely that something major would be missed by the tests already completed.

At this time, you can consider more specialized GI testing.  A HIDA scan with CCK stimulation can evaluate the gallbladder ejection fraction.  You can also consider a 24-hr pH study (looking for GERD) and esophageal manometry (looking for esophageal motility disorders).  

These can be discussed with your personal physician.

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.
http://www.straightfromthedoc.com

[joannela]

Something I forgot. Throughout all this testing he had his yearly stress test which revealed some abnormalities. Two weeks ago he had a cardiac cath and had two stents inserted. His pain has continued since the cath, however, and his cadiologist does not believe the pain in his stomach and back is related to his cardiac condition.

Thanks