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  I have written in before and have appreciated your excellent knowledge.  I have been complaining a lot lately about strong spasm pain just below the sternum.  This was especially prevelant early in the morning upon wakening.  I just had a detailed meeting with my G. I. Doc with the following results.  He reviewed with me the results of a upper GI CT scan a year ago which indicated a slightly irregular and thickened area of bowel adjacent to the ampulla.  Also the following was the results of a Cholangiogram that was done at the time of my LAP chole 3 months ago that revealed chronic inflammation without stones.  " There is a somewhat unusual collection of contrast at the ampulla with a somewhat rounded configuration.  Although this might represent an unusual recess of the duodenum, a choledochocele, which is a type of choledochal cyst, cannot be excluded, and clinical correlation is recommended.  In addition, there is contrast filling of an apparent bowel loop in the expected location of the proximal duodenum which has an unusual appearance in that its communication with the transverse duodenum distal to the ampulla is norrowed and irregular on both of these images; although this might represent a duodenum deformed by peristalis, a large diverticulum cannot be excluded.  Possible limited sclerosing cholangitis involving the ampulla also cannot be excluded in the region of the irregularity and possible choledochal syst."  As a note of reference, I have had some sort of spasm type of pain in the midepigastric area since I was in my late teens.  ( I am now 45 ) This spasm discomfort has waxed and waned for years but in the last 3-4 years has become more frequent.  And it has become more acute since the removal of the gallbladder, even though the right epigastric pain has disappeared.  My G.I. Doc wants to schedule an ERCP within the next few weeks.  He thinks it is a duct problem, not a pancreas problem. ( I don't drink, CT scan normal a year ago ).  He says he will be looking for any possible stones or cysts in the area as well as any abnormal type of congenital duct formation.  My question is why do we need to do this when we did the Choleangiogram which would show abnormalities in the duct?  Also, I have heard that the odds are good that ERCP can lead to an Acute Pancreatic attack or even death??  Your adivice on this is appreciated.  I find myself very apprehensive about where this is going.  ( As a side note, he wants to do a PH monitoring to see what is going on with my mild grastritis which is controlled by Prevacid and depending upon those results may recommend a LAP Nisan.) Many thanks!!    
Dear James,
You appear to have a complex clinical problem. I am going to try to provide you with some insight into what may be causing your symptoms. You have described a number of abnormalities in the tests. It is important to understand that a test result ultimately needs to interpreted based on the patient
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