Gallbladder seems fine but PCP recommends removal

[misha50]

Had a full GI work up: CT scan, Hida scab, ultrasound, endoscopy, blood and stool tests.  A few years ago I also had an endoscopy, colonoscopy, x-rays, and blood and stool tests.  Results of all the tests do not show any problems with my gallbladder, and also no gallstones.  There is some family history of gallbladder issues.

I have acid reflux for at least the past few years and, per my GI at the time, slow motility in my digestive tract.  Per my current GI I may have IBS also.  Most of my symptons were diarrhea, stomach aches/discomfort, and soft and black stools.  Prilosec has made these symptons bearable and has helped relieved them to some degree, however still have some of the above symptoms and gassiness.  In truth, I never really felt that I had classic traditional heartburn or had problems eating certain foods, such as I could eat spicy foods and not have much change in my symptoms.

However,  in the past year I have developed additional painful symptoms:
Alternating pain between my right chest muscle and right under my right rib, like a throbbing or someone grabbing me under the rib - this initially started off as pain in my right upper back, but now it's rare to have the pain in the back.  The pain definitely tends to happen after eating, but also when laying down to sleep and when waking up in the morning.  Pain killers, such as Advil and Vicodin do almost nothing to relieve the pain, however once I tried Vicoprofen and it helped a little, but this is a very potent drug and it felt very addictive as I enjoyed its effect on me, so this drug is out.  I also have nausea, a bitter bile taste in my mouth, a feeling of fullness due to the nausea, some heartburn.  Fatty/Oily foods tend to inflame the pain the worst, but eating in general tends to aggravate it.  The pain is debilitating as I can't concentrate, am ultra sensitive to any noise or stimuli, and in general am not able to function.

My PCP says I have classic gallbladder symptoms and wants to remove the gallbladder.  A GI and a surgeon that removes gallbladders will remove the gallbladder if I insist as I'm at my wit's end, but they think it could be musculo-skeletal, which my PCP says doesn't make sense as I get the pain after eating.  After discussing this with the GI and surgeon, they agree that musculo-skeletal doesn't appear to make sense either.

I will be seeing another GI for a second opinion, but at this point I'm ready/willing to have gallbladder removal surgery.  Thoughts or suggestions on this?  Thanks so much!

[misha50]

Jim, my last GI says that liver enzymes would be elevated if blocked bile ducts.  Will let you know what GI tomorrow says.  Misha

[JimK3145]

Misha,
Since your gallbladder is okay so far by the testing test on it and since your ejection fraction is very good (in the 60's), I'm wondering if that would qualify as biliary dyskinesia. I'm under the impression that if there was sludge in the common bile duct that it would be really hard to get a high ejection fraction like yours. I'll be interested in what this new GI chief has to say.
I had a capsule endoscopy done last week. (the one where you swallow the camera capsule). It takes 8 eight hours to complete. I got the results back today. My GI doc says that everything was okay, nothing out of the ordinary. So now, there's only 1 test remaining which will be a 1 year follow up endoscopy which I will have on Sep 2.  Even though my ejection fraction is 36%, my Doc says that my GB is okay. (I think it's borderline biliary dyskinesia) and I still don't have a good explanation for the bloating/slight nausea and intermittent RUQ that I still experience. Since my earlier post about the use of PPI's on ejection fraction and possible, RUQ pain, I convinced my GI doc to let me stop taking the Prevacid that I've be on for 11 months until the endoscopy. (that'll be about 4 weeks) to see if it makes any difference with the RUQ and possibly stomach pain. Hopefully between the 2 of us, we'll get some answers about the RUQ. Keep me posted.
P.S. Could you ask this new Chief GI the following question: Could biliary dyskinesia cause stomach bloating and or nausea/general queasiness and the RUQ and if one doesn't have dyskinesia, then what causes the bloating, RUQ, if all tests say the GB and other organs are all fine. Thanks. I'm looking forward to see what his answer will be.

[misha50]

Jim, won't know which antibiotic till the x-ray results are in, which will be next week.  However, I go on vacation for a week a couple days after my x-ray, which leaves only 1 business day to get the results to my doc and to see him.  So realistically I'll have to wait till after my vaca.  Thanks for the info on your experience, I'll look it up and take a read.

[JimK3145]

Misha,
What antibiotic are they going to give you for the bacterial overgrowth? I had this test done in June, was tested positive and was given Xifaxan, 200 mg tablets, 6x daily for 10 days. Xifaxan is a synthetic antibiotic which doesn't dissolve in the stomach but rather goes to the small intestine where it can do its thing. After the 10 days, I was still getting bloating and a queasy stomach so it really didn't work for me. I've attached a weblink to the use of Xifaxan for the treatment of IBS. The Doctor who is pioneering this drug also has a book out on IBS which I bought on Amazon. The book is pretty interesting. Here's the link about Xifaxan: http://www.cbsnews.com/stories/2006/10/16/health/webmd/main2096522.shtml
My current GI was familiar with this Doc's work. Hope this helps.

[misha50]

Just had a quick talk with my latest GI.  The results of the breath test for bacterial overgrowth were positive.  I believe he said that this was in the lower colon/bowels (not too sure as I didn't write it down).  I have a barium x-ray test next week, and with results from this he'll be able to advise how to treat me.  I also had a blood test done last week, I believe it was called the IBS Kit on the lab sheet.  Looks like there's some rays of hope here after all.  To me the bacteria overgrowth makes sense: about 10 years ago I had a couple of bouts with H.Pylori and successfully treated them.  Then I had symptoms making me believe that I had a similar infection, but the antibiotics I was given only worked a short time.  All my blood and stool tests since then have been negative, but if it walks like a duck and quacks like a duck, then I'm inclined to believe that this is a duck.  I've basically been on Prilosec since five years ago.

Otherwise, my PCP wants me to try to trigger the RUQ to prove or disprove that my pain is GB related.  Well today I had a strawberry ice cream to test this out, with a couple of lactaid pills as I'm lactose intolerant.  So far no problem with RUQ pain or right chest muscle pain ... there was a little discomfort under the surface, but very mild and had already been there throughout the day, so I should say that the ice cream resulted in no additional discomfort.  Perhaps later there'll be some diarhea, but we all have to live a little and suffer the results of eating ice cream.  My PCP recommends something greasy and fatty to eat in order to really test out the gb, which I can do, but as I have been diagnosed with colitis, IBS, I know that this will cause other problems, but I'm game for this.  My RUQ discomfort/pain has been more manageable the past couple of weeks, although this morning it was a little more uncomfortable, which I attribute to eating chicken last night ... may not make sense but this is a pattern that I've noticed.

Anyways, will report on what this GI says after my x-ray next week.

Otherwise, I have an appt. with another GI tomorrow who's the chief of GI at his hospital.  I figure one can never have enough second opinions.  At this point I'm not sure what to ask him, other than inquiring about what I've done so far and what his thoughts are on the next area of investigation, such as biliary dyskinesia.

[boron]

Misha, if you'll still see your new GI, ask him, if gastric biopsy excludes H. pylori infection, or breath test is more reliable (as I think). I think it's possible that H. pylori doesn't occupy the whole mucosa (gastric + duodenal), so it can be false negative.