Gastrointestinal Issues After Liver Transplant: A Patient's Journey

Gastrointestinal tract

Hello Doctor, I had a liver transplant 15 years ago and sometimes experience stomach pain, so I have been getting endoscopies every six months.
At National Taiwan University Hospital, the doctors have consistently told me that I have mild mucosal erosion, but everything else is normal.
However, for the past two years, when I went to Taipei Medical University, they diagnosed me with gastroesophageal reflux disease (GERD) and did not mention any erosion.
Last year at National Taiwan University, they again said I had gastric inflammation and erosion, but in December at Taipei Medical University, they reiterated the diagnosis of GERD and said everything else was normal.

Today, I had another endoscopy at Taipei Medical University, and the doctor mentioned that I have a small nodule at the fundus of my stomach.
I asked him about the previous diagnosis of inflammation and erosion from National Taiwan University and whether that could have caused the nodule.
The doctor said the nodule appears superficial and seems to be new.
When I inquired about the possibility of it being something serious, he said it is unlikely.
I also asked why the nodule might have developed, and he mentioned it could be related to alcohol consumption or smoking, but I do not smoke or drink.
He also suggested it could be due to a bacterial infection, which could be treated with medication, or it might be caused by not chewing food properly, leading to inflammation and the formation of the nodule.
He advised that if I chew my food thoroughly and eat slowly, the nodule should improve.

Is this information correct? I am very worried that it might be something serious.
I tend to overthink things and am easily stressed.

Wenwen, 40~49 year old female. Ask Date: 2019/05/07

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Based on the description, it is likely that the condition is a fundic gland polyp.
These types of polyps are benign and generally do not pose significant issues, so they typically do not require special treatment.

Reply Date: 2019/05/07

More Info

After undergoing a liver transplant, it is not uncommon for patients to experience gastrointestinal issues, including abdominal pain, gastritis, and gastroesophageal reflux disease (GERD). Your case highlights the complexity of post-transplant gastrointestinal health, especially given the conflicting diagnoses from different medical institutions regarding your condition.

Firstly, it is important to understand that the liver plays a crucial role in digestion and metabolism. After a liver transplant, the body undergoes significant changes, and the gastrointestinal system may react in various ways. The symptoms you describe, such as stomach pain and the presence of erosions or inflammation, can be attributed to several factors, including the medications you are taking (such as immunosuppressants), dietary habits, and potential infections.

The fact that you have been diagnosed with mild erosions in your stomach lining at one institution and GERD at another suggests that there may be variations in interpretation of your symptoms or the results of your endoscopic examinations. It is not uncommon for patients to receive different opinions based on the nuances of their medical history and the specific focus of the examining physician.

Regarding the small nodules found in your gastric fundus, it is reassuring that your physician indicated they appear superficial and are unlikely to be malignant. Small gastric nodules can arise from various causes, including benign conditions such as hyperplastic polyps, inflammation, or even reactive changes due to chronic irritation. The suggestion that these nodules could be related to dietary habits, such as not chewing food thoroughly, is plausible. Poorly chewed food can lead to mechanical irritation of the gastric lining, potentially contributing to inflammation and the formation of nodules.

The recommendation to chew food thoroughly and eat slowly is sound advice. This practice can help reduce the mechanical stress on your gastrointestinal tract and may improve digestion, thereby minimizing irritation. Additionally, if there is a bacterial infection, such as with Helicobacter pylori, appropriate antibiotic treatment can indeed lead to resolution of gastric inflammation and associated nodules.

It is also essential to consider the psychological aspect of your health. You mentioned being prone to anxiety and stress, which can exacerbate gastrointestinal symptoms. Stress can lead to increased gastric acid production and may worsen conditions like GERD or gastritis. Therefore, managing stress through relaxation techniques, counseling, or mindfulness practices could be beneficial for your overall well-being.

In summary, while the presence of small nodules in your stomach may be concerning, the likelihood of them being serious is low, especially if they are superficial. Continuing to monitor your condition with regular endoscopies, maintaining a healthy diet, and managing stress are all important steps in your recovery journey. If you have ongoing concerns or if your symptoms worsen, it is advisable to seek a second opinion or consult a gastroenterologist who specializes in post-transplant care. They can provide a comprehensive evaluation and tailored recommendations based on your unique medical history.

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