Digestive Issues: When to Worry About Pancreatic Problems

Unsure where the problem lies in the body?

Hello doctor, I am currently 22 years old, and I do not smoke or drink alcohol.
However, I have been experiencing alternating periods of constipation, bloating, and diarrhea.
Last week, I visited a gastroenterologist due to these issues, and I underwent an upper endoscopy and a test for Helicobacter pylori.
The doctor mentioned that I have mild gastroesophageal reflux disease (GERD), but the Helicobacter pylori test came back negative.
I am concerned that there might be other issues, such as with my pancreas, because I have been feeling discomfort in my back (it feels like it's inside my body).
I can't quite describe the sensation; sometimes it feels like a sudden sharp pain, other times it's a dull ache, and occasionally it feels like a cramp.
Additionally, I have noticed a decrease in appetite and weight loss (about 2 kilograms over the past two weeks).
The doctor performed an abdominal ultrasound and said there were no issues detected, but do I need more detailed tests to check for pancreatic problems? Should I go to a larger hospital for further examination? Could this be a sign of pancreatic cancer? I have heard that early symptoms are often not very obvious and can be overlooked.
Is it true that only when there are significant symptoms will doctors arrange for a CT scan or other tests? The doctor reassured me that I am still very young and that the likelihood is low, suggesting that my issues are more likely functional gastrointestinal problems, and that stress could be contributing to my symptoms.
He advised me not to worry and that no further tests were necessary.
However, after returning home, I still feel bloated and have some discomfort in my back, which deepens my concerns.
I am really afraid that I might have a serious illness...

Wang, 20~29 year old female. Ask Date: 2022/09/27

Dr. Chen Shidian reply Gastroenterology and Hepatology

Early-stage pancreatic cancer typically does not present any symptoms.
Pain is usually associated with advanced stages of the disease.
Ultrasound can easily detect abnormalities, but by that time, surgical intervention may no longer be an option.
Therefore, it is recommended to monitor the situation, and if there are still concerns, one might consider spending around $5,000 to $6,000 for a CT scan for peace of mind.

Reply Date: 2022/09/27

More Info

When it comes to digestive issues, particularly those involving the pancreas, it’s understandable to feel concerned, especially with symptoms like abdominal pain, changes in appetite, and weight loss. Your situation, given your age and lifestyle, does suggest that there are several factors to consider before jumping to conclusions about serious conditions like pancreatic cancer.

Firstly, it's important to note that the pancreas can be affected by various conditions, including pancreatitis, pancreatic cysts, and even tumors. However, the symptoms you describe—intermittent constipation, bloating, diarrhea, and discomfort in the back—can often be attributed to functional gastrointestinal disorders, such as irritable bowel syndrome (IBS), rather than pancreatic issues. IBS is common and can cause a variety of symptoms, including those you mentioned, often exacerbated by stress or dietary factors.

The abdominal ultrasound you underwent is a good initial step in evaluating pancreatic health. Ultrasound is effective for identifying gross abnormalities, such as cysts or tumors, but it may not detect smaller lesions or subtle changes in pancreatic tissue. If your ultrasound did not reveal any significant issues, it is a positive sign. However, if your symptoms persist or worsen, further imaging studies, such as a CT scan or MRI, may be warranted to provide a more detailed view of the pancreas and surrounding structures.

Your concern about pancreatic cancer is understandable, especially since early-stage pancreatic cancer can be asymptomatic. However, it is relatively rare in younger individuals, particularly those without significant risk factors such as family history, smoking, or chronic pancreatitis. The symptoms of pancreatic cancer often include jaundice, significant weight loss, and persistent abdominal pain, which you have not reported.

Given your symptoms of back discomfort and changes in appetite and weight, it would be prudent to keep an open line of communication with your healthcare provider. If your symptoms continue or worsen, or if you develop new symptoms such as jaundice or severe pain, it would be reasonable to request further evaluation. This might include more advanced imaging or even referral to a specialist, such as a gastroenterologist or an oncologist, for a more thorough assessment.

In the meantime, consider lifestyle factors that could be contributing to your symptoms. Stress management techniques, dietary adjustments, and regular physical activity can significantly impact gastrointestinal health. Keeping a food diary to track what you eat and how it affects your symptoms can also provide valuable insights.

In summary, while your symptoms warrant attention, they do not necessarily indicate a severe condition like pancreatic cancer, particularly given your age and lack of significant risk factors. Continue to monitor your symptoms, maintain open communication with your healthcare provider, and do not hesitate to seek further evaluation if your concerns persist. Remember, early detection and intervention are key in managing any health issue effectively.

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