Gallstones and Gastrointestinal Issues: A Patient's Journey

Q: Gallstones and Gastrointestinal Issues: A Patient's Journey

Hello： 1. <br>If it is related to the pancreas, issues should be detectable in previous imaging studies such as a CT scan. <br>2. <br>Symptoms caused by gallstones typically occur after eating a large or fatty meal, or as abdominal bloating and pain 2-3 hours post-meal. <br>Irrit

Intestinal dryness or gallstones?

Hello doctor, I have a question that I hope you can patiently listen to.
Over the past six months, I have seen four or five gastroenterologists and undergone various tests including gastroscopy, ultrasound, colonoscopy, X-rays, fecal occult blood tests, electrocardiograms, and blood tests, all of which have shown no issues.
Initially, I had a poor appetite, and later I experienced bloating in my lower abdomen, sometimes feeling a tightness that made it hard to breathe comfortably.
I changed to a lighter diet and lost nearly ten kilograms during this time.
At first, I hardly ate, sometimes just a couple of bites at lunch, and then I stopped drinking soup.
After a while, I returned to a normal diet, but I also experienced stomach pain that led me to visit the emergency room at two different hospitals four times.
The first three visits did not reveal any issues, but during the fourth visit, after an ultrasound, blood tests, X-rays, and a CT scan, I was diagnosed with gallstones.
However, my gallbladder was not inflamed, and my bile ducts were not blocked.
The doctor referred me to an outpatient clinic, where the physician asked if I had had gallstones for a long time, to which I replied yes.
He prescribed medication for pain management and advised follow-up with an ultrasound and blood tests in three months.
My question is whether this is a gallstone issue, irritable bowel syndrome, or something else, possibly involving the pancreas? Additionally, given my significant weight loss, could there be other underlying problems, and how should I address this?

Jayen288, 40~49 year old female. Ask Date: 2022/01/17

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: 1.
If it is related to the pancreas, issues should be detectable in previous imaging studies such as a CT scan.
2.
Symptoms caused by gallstones typically occur after eating a large or fatty meal, or as abdominal bloating and pain 2-3 hours post-meal.
Irritable bowel syndrome (IBS) has a cyclical nature and is often triggered by emotional stress.
3.
If weight loss occurs without an apparent cause, a consultation with a metabolic specialist may be warranted to investigate potential endocrine issues.
Additionally, autonomic nervous system dysfunction may also lead to gastrointestinal symptoms, and a consultation with a psychiatrist or neurologist could be beneficial.
4.
Dietary and lifestyle habits are the key areas to examine.
Changhua Hospital cares about your health.
Dr.
Tsai An-Shun.

Reply Date: 2022/01/17

More Info

Understanding gallstones and gastrointestinal issues can be quite complex, especially when symptoms are vague and diagnostic tests yield inconclusive results. Your journey through multiple consultations and tests is not uncommon for patients experiencing gastrointestinal discomfort. Let’s break down your situation and explore the possible connections between your symptoms and the findings of gallstones.

Gallstones and Symptoms
Gallstones are hardened deposits that can form in the gallbladder, and they may or may not cause symptoms. In your case, the ultrasound and CT scan confirmed the presence of gallstones, but the absence of inflammation or blockage suggests that they may not be the primary cause of your discomfort. It’s important to note that many people with gallstones remain asymptomatic, and the risk of developing complications is relatively low unless symptoms arise.

The symptoms you described—loss of appetite, abdominal bloating, and discomfort—could be attributed to several factors. While gallstones can cause pain, especially after eating fatty meals, your symptoms may also indicate other gastrointestinal issues such as functional dyspepsia, irritable bowel syndrome (IBS), or even anxiety-related gastrointestinal disturbances. The significant weight loss you experienced is concerning and warrants further investigation.

Possible Gastrointestinal Issues
1. Functional Dyspepsia: This condition is characterized by persistent or recurrent pain in the upper abdomen, often accompanied by bloating, nausea, and early satiety. It can be triggered by stress, dietary habits, or even gallstones.

2. Irritable Bowel Syndrome (IBS): IBS is a common disorder that affects the large intestine, leading to symptoms like cramping, abdominal pain, bloating, gas, and diarrhea or constipation. Stress and dietary changes can exacerbate IBS symptoms.

3. Pancreatitis: Although your tests did not indicate pancreatitis, it can sometimes present with abdominal pain and discomfort. If gallstones migrate and block the pancreatic duct, they can lead to pancreatitis, which is a serious condition.

4. Gastritis or Peptic Ulcer Disease: These conditions can cause upper abdominal pain and discomfort, especially after meals. If you have a history of NSAID use or excessive alcohol consumption, these could be contributing factors.

Next Steps
Given the complexity of your symptoms and the significant weight loss, it is crucial to follow up with your healthcare provider. Here are some recommendations:
1. Consult a Gastroenterologist: Since you have already seen several gastroenterologists, consider seeking a second opinion from a specialist who focuses on functional gastrointestinal disorders. They may recommend additional tests, such as a gastric emptying study or breath tests for conditions like small intestinal bacterial overgrowth (SIBO).

2. Dietary Modifications: Keeping a food diary can help identify any specific triggers for your symptoms. A dietitian can assist in creating a meal plan that minimizes discomfort while ensuring adequate nutrition.

3. Psychological Support: If stress or anxiety is contributing to your symptoms, consider speaking with a mental health professional. Cognitive-behavioral therapy (CBT) has been shown to be effective for managing gastrointestinal symptoms related to stress.

4. Regular Monitoring: Since your doctor suggested follow-up imaging and blood tests in three months, it’s essential to adhere to this plan. Monitoring your condition will help determine if any changes occur that necessitate further intervention.

Conclusion
In summary, while gallstones are present, they may not be the sole cause of your symptoms. A comprehensive approach that includes dietary management, psychological support, and close monitoring of your condition is essential. Your weight loss and ongoing discomfort should be taken seriously, and further evaluation is warranted to rule out other potential gastrointestinal issues. Always communicate openly with your healthcare providers about your symptoms and concerns to ensure you receive the best possible care.

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