Gastrointestinal Issues After Liver Transplant: A Patient's Journey

Gastrointestinal issues

Hello Doctor, I underwent a liver transplant in 2000.
After the transplant, I experienced stomach pain about once every 2-3 months.
Even when I don't have stomach pain, I am accustomed to getting an endoscopy once a year or every six months.
Each time I go to National Taiwan University Hospital for examination, they generally say there is mild mucosal erosion in my stomach.
For the past two years, I have been getting checked at Taipei Medical University, where they diagnosed me with mild gastroesophageal reflux disease (GERD).
In December of last year, after an endoscopy, the doctor also confirmed the presence of GERD and prescribed a PPI (proton pump inhibitor) for me, but I haven't taken it because I don't have any symptoms of GERD.
Additionally, the doctors at National Taiwan University Hospital have stated that I do not have GERD, only mild gastritis.

In early April of this year, I felt discomfort in my throat and collarbone, so I underwent another endoscopy at Taipei Medical University on May 6th.
The doctor mentioned that there is still mild GERD, and I have inflammation in my stomach with small nodules at the fundus.
They performed a biopsy, which scared me as I was worried about serious issues.
However, the doctor informed me that the biopsy report showed no bacteria or tumors and was normal.
I asked the doctor if the small nodules would heal, and he advised me to take the PPI he prescribed, stating that the nodules would improve, and it would take about 1 to 2 months for the mucosa to return to normal.
I have a few questions for the doctor:
1.
How do the small nodules at the fundus of the stomach develop?
2.
The doctor at Taipei Medical University prescribed me Emetrol (an antiemetic) to take one tablet every morning before meals and three tablets of Metoclopramide (a gastric emptying agent) daily.
Before taking these medications, I had no stomach discomfort, but since starting the medication, I have been experiencing frequent stomach discomfort.
Is this normal?
3.
Can I take the Sucralfate (a gastric protectant) prescribed by the doctor at National Taiwan University Hospital four times a day along with the Emetrol and Metoclopramide prescribed by Taipei Medical University?

Wenwen, 40~49 year old female. Ask Date: 2019/05/29

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, 1.
A nodule simply describes a raised structure, and a biopsy is a standard procedure; as long as the biopsy results are normal, there is no issue.
2.
For medication responses, it is advisable to consult your attending physician.
3.
Generally, it is not recommended to take medications prescribed by different doctors simultaneously; you should discuss this further with your attending physician.

Reply Date: 2019/05/29

More Info

Understanding gastrointestinal issues after a liver transplant can be complex, especially considering the unique challenges that arise from the surgery and the medications involved in post-operative care. Your experience with recurrent upper abdominal pain, gastroesophageal reflux disease (GERD), and the discovery of gastric nodules raises several important questions regarding the underlying causes and appropriate management strategies.

1. Gastric Nodules: The presence of gastric nodules, particularly in the context of a history of liver transplantation, can be concerning. These nodules may arise due to various factors, including chronic inflammation, which is often a result of gastritis or gastroesophageal reflux disease. In your case, the mild gastritis and reflux symptoms could contribute to the development of these nodules. The fact that your biopsy results were normal is reassuring, indicating that there is no malignancy or significant pathological process at play. Gastric nodules can sometimes resolve with appropriate medical management, particularly if they are related to inflammation or irritation of the gastric mucosa.

2. Medication Side Effects: It is not uncommon for patients to experience gastrointestinal discomfort when starting new medications, including proton pump inhibitors (PPIs) like the ones prescribed to you. While PPIs are effective in reducing stomach acid and promoting healing of the gastric lining, they can also lead to side effects such as abdominal pain, bloating, or changes in bowel habits. If you are experiencing increased discomfort after starting the new medications, it is essential to communicate this with your healthcare provider. They may need to adjust the dosage or consider alternative treatments to manage your symptoms effectively.

3. Medication Interactions: Regarding the use of Sucralfate alongside the new medications, it is generally considered safe to use these medications together, as they work through different mechanisms. Sucralfate acts as a protective barrier over the gastric mucosa, while PPIs reduce acid production. However, timing is crucial; it is advisable to take Sucralfate at least two hours apart from other medications to avoid potential interactions that could affect absorption. Always consult your healthcare provider before making any changes to your medication regimen.

In summary, your gastrointestinal issues post-liver transplant may be multifactorial, involving the effects of surgery, medication side effects, and underlying conditions such as gastritis or GERD. Regular follow-ups with your healthcare team, including gastroenterologists, are crucial for monitoring your condition and adjusting treatment as necessary. If your symptoms persist or worsen, further evaluation may be warranted to rule out any complications related to your transplant or other gastrointestinal disorders. Always prioritize open communication with your healthcare providers to ensure that you receive the most appropriate care tailored to your specific needs.

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