Aa
Gallbladder seems fine but PCP recommends removal
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!
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!
Here's an article that Calgal had sent me some months ago concerning Proton Pump Inhibitors. I had mentioned that I've recently gotten my HIDA scan results (EF was 36%) and I've been on PPI's for about 11 months. My RUQ pain started about 2 months after starting the PPI's. I have sent a letter to my Gastro doc asking to whether I could stop the PPI's for about a month to see if that makes any difference, before I sit down with him to discuss the HIDA results. Thought you might find this interesting. I am also experiencing a lot of bloating also so I'm not sure if gas is not the cause of the RUQ pain.
"Proton Pump Inhibitor May Reduce Gallbladder Function
April 21, 2005 — A short course of proton pump inhibitor (PPI) therapy may result in a significant reduction in gallbladder motility and new-onset biliary symptoms, according to the results of a preliminary prospective study presented at the 2005 annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons in Fort Lauderdale, Florida.
A previous study has shown that discontinuation of PPI therapy after fundoplication for reflux disease results in normalization of preoperative biliary dyskinesia in a significant number of patients, coauthor Mitchell A. Cahan, MD, told Medscape. "Our study looked at the converse of that — what the effects of PPI therapy would be on gallbladder function in healthy volunteers." Dr. Cahan is a clinical instructor of surgery at the University of North Carolina School of Medicine in Chapel Hill.
In the study, gallbladder ejection fraction (GBEF) was assessed by cholecystokinin (CCK)-stimulated hepatobiliary (HIDA) scan at baseline and after one month of omeprazole therapy (40 mg/day) in 19 volunteers with no history of gastroesophageal reflux disease, biliary disease, or chronic abdominal pain.
Results at 30 days showed that omeprazole therapy was associated with a decrease in gallbladder motility in 79% of patients; overall, mean GBEF decreased by 13.6% compared with baseline (42.8% ± 32.3% vs 56.4% ± 30.0%; P < .01).
"Even more telling is the fact that before they started on omeprazole, five individuals had ejection fractions of less than 35% (biliary dyskinesia) — and at the end of the month, that number had doubled to 10," Dr. Cahan pointed out. "Moreover, of 15 patients who completed a symptom survey at the end of 30 days, four had symptoms that were compatible with biliary pathology such as nausea and vomiting, increased flatus, and right upper quadrant pain."
Although these findings are preliminary and larger studies are needed to determine clinical implications, Dr. Cahan recommends that healthcare providers seek objective evidence of reflux prior to initiation of PPI therapy and that they remain aware of evolving data regarding the effects of such therapy on biliary function.
"Given the fact that PPIs constitute the eighth most prescribed class of drugs, providers need to be cognizant of these potentially adverse findings leading to abnormal gallbladder function that could promote cholelithiasis or biliary dyskinesia," Dr. Cahan said. "Patients receiving escalated or long-term PPI therapy are potentially subject to these adverse effects."
The investigators report no pertinent financial conflicts of interest.
SAGES 2005 Annual Meeting: Abstract S120. Presented April 15, 2005.
Reviewed by Gary D. Vogin, MD"
"Proton Pump Inhibitor May Reduce Gallbladder Function
April 21, 2005 — A short course of proton pump inhibitor (PPI) therapy may result in a significant reduction in gallbladder motility and new-onset biliary symptoms, according to the results of a preliminary prospective study presented at the 2005 annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons in Fort Lauderdale, Florida.
A previous study has shown that discontinuation of PPI therapy after fundoplication for reflux disease results in normalization of preoperative biliary dyskinesia in a significant number of patients, coauthor Mitchell A. Cahan, MD, told Medscape. "Our study looked at the converse of that — what the effects of PPI therapy would be on gallbladder function in healthy volunteers." Dr. Cahan is a clinical instructor of surgery at the University of North Carolina School of Medicine in Chapel Hill.
In the study, gallbladder ejection fraction (GBEF) was assessed by cholecystokinin (CCK)-stimulated hepatobiliary (HIDA) scan at baseline and after one month of omeprazole therapy (40 mg/day) in 19 volunteers with no history of gastroesophageal reflux disease, biliary disease, or chronic abdominal pain.
Results at 30 days showed that omeprazole therapy was associated with a decrease in gallbladder motility in 79% of patients; overall, mean GBEF decreased by 13.6% compared with baseline (42.8% ± 32.3% vs 56.4% ± 30.0%; P < .01).
"Even more telling is the fact that before they started on omeprazole, five individuals had ejection fractions of less than 35% (biliary dyskinesia) — and at the end of the month, that number had doubled to 10," Dr. Cahan pointed out. "Moreover, of 15 patients who completed a symptom survey at the end of 30 days, four had symptoms that were compatible with biliary pathology such as nausea and vomiting, increased flatus, and right upper quadrant pain."
Although these findings are preliminary and larger studies are needed to determine clinical implications, Dr. Cahan recommends that healthcare providers seek objective evidence of reflux prior to initiation of PPI therapy and that they remain aware of evolving data regarding the effects of such therapy on biliary function.
"Given the fact that PPIs constitute the eighth most prescribed class of drugs, providers need to be cognizant of these potentially adverse findings leading to abnormal gallbladder function that could promote cholelithiasis or biliary dyskinesia," Dr. Cahan said. "Patients receiving escalated or long-term PPI therapy are potentially subject to these adverse effects."
The investigators report no pertinent financial conflicts of interest.
SAGES 2005 Annual Meeting: Abstract S120. Presented April 15, 2005.
Reviewed by Gary D. Vogin, MD"
I had posted earlier to Misha50 and had mentioned the possibility gas in the colon causing pain. Below is an excerpt from the brochure "Gas, Bloating and Belching".
"Gas and Abdominal Pain:
Abnormalities of motility are thought to be associated with abnormal
sensitivity. This increased sensitivity to normal volumes of gas may
result in pain. For some who suffer with (pain that has no known cause), it is believed that abnormal motility and sensitivity may be the source of pain.
Splenic Flexure syndrome is a chronic abdominal pain disorder triggered by trapped gas at the left flexure (bend) of the large colon. This flexure is located where the large colon runs horizontally then bends downwards towards the rectum. This bend occurs near the spleen--hence the name ‘splenic flexure.’ Trapped gas in this location can cause pain to be felt in the chest region. Called ‘referred pain,’ since the pain is felt in a region distant from the source, it can mimic heart disease. Gas trapped in the right flexure can mimic pain of gallbladder disease or appendicitis".
This was from the website: www.digestivedistress.com
"Gas and Abdominal Pain:
Abnormalities of motility are thought to be associated with abnormal
sensitivity. This increased sensitivity to normal volumes of gas may
result in pain. For some who suffer with (pain that has no known cause), it is believed that abnormal motility and sensitivity may be the source of pain.
Splenic Flexure syndrome is a chronic abdominal pain disorder triggered by trapped gas at the left flexure (bend) of the large colon. This flexure is located where the large colon runs horizontally then bends downwards towards the rectum. This bend occurs near the spleen--hence the name ‘splenic flexure.’ Trapped gas in this location can cause pain to be felt in the chest region. Called ‘referred pain,’ since the pain is felt in a region distant from the source, it can mimic heart disease. Gas trapped in the right flexure can mimic pain of gallbladder disease or appendicitis".
This was from the website: www.digestivedistress.com
Do not have your GB removed. Try visceral manipulation to have it drained. If it is functioning okay-you probably have SOD. The only way to find out if you have SOD is with ERCP w/manometry. Do not believe any GI/or other doctor that tells you differently. I had my GB removed last year for the same exact sxs as you describe. What I ended up with is severe gastroparesis (I did not have this before) living on TPN for the past year. I belive I had SOD-no I know I had SOD to begin with and when the GB was removed the SOD became worse. AS for the gastroparesis-I'm not sure if the surgeon cut my vagus nerve but that is my suspicion. Had I had an ERCP in the first place I would not now be waiting to die on tpn complications. Most doctors don't have a clue about SOD and many don't even think it's a real condition. If your GB is functioning on a HIDA then there is nothing wrong with your GB. Go to a biliary expert and have an ERCP.
Actually you opened an interesting question: can gas in the colon press on the gallbladder and cause typical gallbladder pain? Hm, hm.
A litle more precise answer:
Pressing with fingers on a gallbladder with stones, can (not necessary) cause pain.
Enlarged liver could cause pain in gallbladder with stones, bot not likely in healthy gallbladder.
Enlarged liver is often painfull by itself, or by pressing on it...
Pressing with fingers on a gallbladder with stones, can (not necessary) cause pain.
Enlarged liver could cause pain in gallbladder with stones, bot not likely in healthy gallbladder.
Enlarged liver is often painfull by itself, or by pressing on it...
Yes, it's good to have some research to be prepared for discussion with GI...
Questions for GI:
- are liver (GGT) OR pancreatic (amylase, lipase) enzymes increased in ALL cases of biliary dyskinesia, or only in some people, or only during pain attack?
- the same for increased pressures detected during manometry: are high pressures always detected or only during pain attack?
With other words: what is possibility of false negative results of manometry?
Questions for GI:
- are liver (GGT) OR pancreatic (amylase, lipase) enzymes increased in ALL cases of biliary dyskinesia, or only in some people, or only during pain attack?
- the same for increased pressures detected during manometry: are high pressures always detected or only during pain attack?
With other words: what is possibility of false negative results of manometry?
Have an Answer?
You are reading content posted in the Gastroenterology Community
Learn which OTC medications can help relieve your digestive troubles.
Is a gluten-free diet right for you?
Discover common causes of and remedies for heartburn.
This common yet mysterious bowel condition plagues millions of Americans
Don't get burned again. Banish nighttime heartburn with these quick tips
Get answers to your top questions about this pervasive digestive problem
