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This question was answered on Wed 08, Oct 2008 08:41pm by Dr Paul S, MD

possible stomach or pancreatic cancer


    
Asked by grp (Female; 49; overall good health no major diseases; Relevant drugs:for inherited high cholesterol, I take 60mg Lipitor, 10 mg Zetia ) on Wed 08, Oct 2008 12:13pm
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I have had numerous tests done since mid-May for what started with chronic constipation. I could never go more than one or two days a week at best so I was taking Senokot twice a week for relief. I had experienced some tenderness and diffuse pain throughout abdomen with concentration on left side. All blood work was normal, so was FOBT and stool guaiac-all negative for blood. My first CT scan revealed a mild wall thickening of sigmoid-the CT was done with barium swallow and IV contrast dye. Then I started to get pain and pressure in middle of stomach-upper right quadrant below rib cage. I tried Metamucil and Benefiber to keep regular but they made me feel worse. I insisted on colonoscopy to put my mind at ease. Before test, even though I ran no fever, had no vomiting, and no diarrhea, my doctor put me on flagyl and cipro to ward off any infection. I got terribly nauseous, so he gave me augmentin, which gave me a lot of diarrhea. I had a second Ct and there was no colonic distention-this was also done with IV dye and barium. All organs were normal. Even my pelvic exam and transvaginal ultrasound revealed nothing-no masses or endo. I had my colonoscopy July 15, and it was normal. No biopsy was taken, no polyps, no cancer. They told me to repeat in five years. I started to feel O.K. again,and then about 2 and a half weeks ago, I had burning sensation in my stomach, so I demanded a blood test for h. pylori and a full CBC count. The blood count was immaculate, but I tested positive for h.pylori. I just finished a two week regimen on Saturday, October 4, of triple therapy-the PrevPav, one prevacid, one biaxin and two amoxicillin tablets twice a day-morning and night. I don't think the infection went away because I still feel the burn sometimes and pressure, mostly during the day. It does not keep me up at night. I sometimes have several bowel movements in one day. There is no blood in my stool, it is not diarrhea, but formed and normal color. I am scheduled with a follow-up with the gastroenterologist who performed the colonoscopy in November. Do you think I have a mass in my stomach or pancreas? I am scared an at my wit's end. Because of all the drugs, I have lost about 13 pounds since May-that's a five month period, but I have maintained my current weight for the past three months. I am having trouble gaining it back. Should I request an upper endoscopy, and a breath test to see if the infection went away and should I be worried about these frequent bowel movements? The discomfort does not keep me up at night. I stand 5 feet 5 inches and now weigh 118.3 I was around 131. It's as if right after I eat I have to have a bowel movement so I don't know if I am even keeping any nutrients in. Thank for your help.

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Answer by Dr Paul S, MD  on Wed 08, Oct 2008 08:41pm:

Hi. The battery of normal tests that you already had makes it really hard to think of anything else that can possibly be wrong, and even a stomach or pancreatic cancer would have shown up in one of the scans done. However, I agree with you that you may need an upper endoscopy since the initial H.pylori eradication had an ineffective or questionable outcome. You may need an actual gastric biopsy to test for H.pylori to confirm its persistence or eradication. Also, there are indeed forms of gastric malignancies that is associated with H.pylori which is called MALT lymphoma (mucosa associated lymphoid tissue) which cannot be seen reliably on CT scans. Other possibilities to explain your symptoms would include inadequacy of digestive enzymes from the pancreas and these may be tested quantitatively by your gastroenterologist. A full stool analysis may also be warranted to examine which nutrients you are unable to digest effectively. Celiac sprue can also be considered. If all of these new tests turn out to be negative (the upper endoscopy, the enzyme tests, the H. pylori tests, and the quantitative stool exam), then you may be diagnosed as someone with an irritable bowel syndrome (IBS) which would really have no definitive treatment save for diet and lifestyle modifications. I suggest you talk with your doctors regarding the above possibilities and also pursue upper endoscopy to settle things. For now, try to examine your diet closely and see which ones can provoke the symptoms or relieve them. Regards and God bless.

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