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HIDA scan 94%-hyperkinetic GB vs SOD??

My 21 year old daughter had a Nissen in Nov 2011. Solved the GERD. Then developed gastroparesis, had pyloroplasty 6/2012. In retrospect the surgeon thinks she has pyloric stenosis since birth. She was OK for 2 weeks or so, then developed nausea,severe pain after eating, esp. rt side,wraps to back, then all over abd.. GI Dr. thinks she is stresses out- she has IBS also, but this kid doesn't complain unless something is wrong, and it IS. She continues to have pain, not eating, lost 15 lbs, not able to work,etc.Went back to surgeon who ordered US of RUQ abd and HIDA scan. US ok, HIDA scan read as "normal, EF 94%". GI Dr says fine, need ,need motility expert consult. Surgeon,btw, from your Alma Matter, said, OMG, you have hyperactive GB disease and need chole. ALL her sx seem like GB related. Do you agree? Could this be SOD? She had exact type pain during the HIDA scan when they injecked the CCK.Labs all WNL. Your advice on her dilemma would certainly be appreciated.(we LOVE our surgeon and believe him however all other Dr's say no way have Chole). Thank you so much for your help in advance!! Worried Mama
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Avatar universal
Thank you so much for your reply, it certainly makes me feel better going ahead with the lap chole after seeing your advice. Your diligence in these uncharted waters is amazing and it helps patients like my daughter understand and be able to make informed decisions. We are new to this site and will continue to post her progress as we feel it helps others as well. Thank you so very much again for your help!!
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2827584 tn?1340579696
MEDICAL PROFESSIONAL
I have been seeing patients with biliary type symptoms and extraordinarily high ejection fractions for fifteen years. Out of approximately 3500 cholecystectomies that I have done, three dozen have been in this situation. For the first dozen years there was no support in the literature but 90% of my patients saw symptom resolution. I am not convinced that the gallbladder is, in fact, diseased but clearly the symptoms are reproduced with CCK administration. I have often wondered if these patients may actually have lower than normal CCK levels and increase the receptors in the gallbladder and Sphincter of Oddi making them hyper reactive when a standard dose of CCK is administered. I also feel that most of these patients have a more generalized dysmotility disorder of the entire foregut as your daughter would certainly support. The other clinical disorder that I have been convinced co-exists with these problems is bile reflux gastritis. Your daughter is a good example of this also. When the pyloroplasty was done any resistance to duodenogastric reflux was lost. The norm is to load these folks with acid suppressants but this can actually worsen the symptoms because there is no longer any acid to neutralize the alkaline bile refluxing into the stomach. Coating agents like sucralfate are much more effective in this situation.

Bottom line is that I would agree with cholecystectomy with a 94% ejection fraction and good reproduction of the patients typical symptoms.
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