Ruling out a pancreatic problem

[Chase1313]

Over the past 30 days, I've had bloating, loss of appetite, weight loss (12-14 pounds), loose bowel movements that float and occasionally have chunks of food in them- today and once before the stool was almost yellow (also have intermittent "normal" movements too), stomach aches, reflux/indigestion (some burning, mostly feels like bits of food in my stomach, esophagus and throat- I'm taking Prilosec twice per day) sometimes worse after eating, when I do have an appetite I'm full quickly and stay full for hours.  Sometimes I get chills/shivering very early in the morning.  I also have a pain in my back on the left side, right in the middle, although that almost seems muscular.

I've gone through every test I certainly could have thought of including an abdominal ultrasound, EGD, CT, colonoscopy, small bowel follow-through, stool cultures, and blood tests.  Everything has come back normal with exception to a minor case of diverticulosis.

My question is this...since I've had the CT and blood tests that measured my pancreatic enzymes (blood test was about 21 days ago, CT 16 days) and both came back normal, can I safely rule out a pancreatic problem, or could something still have been missed?  If something was missed on the scan, would the labs have caught it?

I'm only 30, so I'm afraid my age and the relatively low occurrence of pc in younger people may have caused something to be missed.  There just doesn't seem to be an explanation for my symptoms.  I was told the diverticulosis wouldn't cause these symptoms, and IBS/GERD (unless I'm getting attacked by both, but I'm treating the GERD) symptoms don't seem to line-up.  Biopsies of the small bowel have ruled out Crohn's and celiac.

Can IBS cause a lack of appetite and weight loss?  I'm really scared about a pancreatic issue-- if you think I can rule it out based on the test results, I can probably lean toward a double whammy of GERD and IBS.  Please help!  I have a GI appointment in a few weeks, but I'm terrified!

[Kevin Pho, MD]

I would say that pancreatic disease is less likely given the negative imaging scans and normal pancreatic enzyme levels.  If the pancreas continues to be suspected, an MRI or endoscopic ultrasound can be discussed..

I also agree that you have had a pretty comprehensive evaluation, ruling out most of the common causes.  

I would ensure that the stool tests were evaluated for various forms of malabsorption.  Also, a gastric emptying scan can be done, although your presentation would be atypical for gastroparesis.

Another consideration would be a 24-hr pH study or esophageal motility study conclusively looking for GERD, or an esophageal motility disorder, respectively.

These options can be discussed with your personal physician.

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 Pho, M.D.
www.kevinmd.com
www.twitter.com/kevinmd

[Chase1313]

I forgot to mention that I also get belching after eating, in the morning, and sometimes have a bitter taste in my mouth.  Sorry for the omission, thanks.