Digestive Issues: Back Pain, Bloating, and Anxiety Concerns

Back pain, occasional nausea, and bloating issues?

Hello Doctor: Last May, I sought medical attention for gastrointestinal bloating after consuming too much milk.
Due to a family history of diabetes (grandfather, mother, and father), the doctor arranged for a colonoscopy, an endoscopic ultrasound (EUS) to check the condition of my pancreas, and some blood tests.
The results were as follows: 1.
Colonoscopy - A small hyperplastic polyp was removed, and the biopsy results were normal.
2.
Gastroscopy - There was a small ulcer, but it was just tiny red spots; the doctor determined that a biopsy was unnecessary, and there was no Helicobacter pylori.
3.
Endoscopic ultrasound of the pancreas - The size of the pancreatic and biliary ducts was normal, with pancreatic fat infiltration.
4.
Glycated hemoglobin - 8.1 (which later tested at 7.4 three months later).
My symptoms disappeared afterward, but at the beginning of this year, I accidentally consumed too much milk again and started experiencing bloating.
After seeking medical attention again, the doctor tested my glycated hemoglobin, which had dropped to 6.0, and my pancreatic lipase and amylase levels were normal, as well as total bilirubin, but direct bilirubin was 0.4.
The clinician believed there was not much of a problem at that time.
However, in the past two weeks, I have started to feel: 1.
Sometimes excessive stomach acid, with acid reflux occurring about once or twice a day, occasionally accompanied by some food, especially in the morning.
2.
I do not have symptoms like coughing, difficulty swallowing, or hoarseness, but I occasionally feel nausea, which resolves on its own after about 30 minutes.
3.
Sometimes I experience intermittent pain in the upper left back, but it does not last long, occurring about once every 2-3 days and resolving within 1-2 hours.
4.
Occasionally, I experience gastrointestinal bloating, along with left lower back discomfort (mostly when fasting in the morning or afternoon).
5.
In recent weeks, my bowel movements have been formed, with only one instance of diarrhea.
6.
The stool color varies from yellow (not greasy) to healthy brown, with a few instances of brownish-green.
7.
The stool often contains food remnants, sometimes being soft and sometimes in round clumps (I consume high-fiber foods at every meal).
8.
I frequently feel fatigued, having difficulty getting up in the morning, sleeping longer on weekends, and feeling tired easily after work.
In recent months, I have suspected that I might have anxiety disorder (hypochondria) and have been taking some anti-anxiety medications (Xanax, Prozac, Abilify, and Buspirone).
I would like to ask the doctor: 1.
Is it possible that my condition is related to pancreatic cancer? 2.
If pancreatic lipase and amylase tests are normal and blood sugar has decreased, is there still a possibility of suspecting pancreatic cancer? 3.
Do my symptoms indicate gastroesophageal reflux disease or irritable bowel syndrome, or should I continue to worry about pancreatic disease? 4.
Could my upper left back pain possibly be referred pain from the stomach or pancreas? 5.
I am somewhat overweight with a BMI of 27, and I vape.
Given my family history of diabetes and my blood sugar levels, how often should I monitor my pancreas? 6.
If I need to monitor pancreatic health, is it necessary to have an MRI or CT scan? Is EUS accurate? 7.
How painful is pancreatic cancer? Is it a persistent pain? Thank you, doctor, for taking the time to read my lengthy inquiry.
I apologize, but I am genuinely worried and do not have the means to seek constant medical attention...
not even the means to be sick...
I hope you can help me...

Mr. Zhang, 30~39 year old female. Ask Date: 2024/02/29

Dr. Chen Shidian reply Gastroenterology and Hepatology

It should not be related to pancreatic cancer; managing with medication and dietary control is sufficient, so there is no need to worry.

Reply Date: 2024/02/29

More Info

It's understandable to feel anxious and concerned about your health, especially when dealing with digestive issues and a family history of diabetes. Let's break down your questions and concerns regarding your symptoms and the potential implications for your pancreatic health.

1. Could my symptoms be related to pancreatic cancer?
While it's natural to worry about serious conditions like pancreatic cancer, your symptoms and the results from your recent tests suggest that this is unlikely. Pancreatic cancer often presents with more severe symptoms, such as significant weight loss, jaundice (yellowing of the skin and eyes), and persistent abdominal pain. Your tests, including normal pancreatic enzyme levels and a decrease in your blood sugar levels, are reassuring signs.
2. If pancreatic enzymes and blood sugar are normal, can pancreatic cancer still be suspected?
Normal levels of pancreatic enzymes (like lipase and amylase) and stable blood sugar levels significantly reduce the likelihood of pancreatic cancer. These tests are crucial indicators of pancreatic function. If these levels are normal, it is less likely that there is a malignancy affecting the pancreas.

3. Are my symptoms indicative of gastroesophageal reflux disease (GERD) or irritable bowel syndrome (IBS)?
Your symptoms, such as acid reflux, bloating, and changes in bowel habits, could indeed suggest GERD or IBS. GERD is characterized by acid reflux and can cause discomfort in the chest and throat, while IBS often presents with bloating, gas, and changes in bowel habits. Given your history of digestive issues, it may be beneficial to discuss these possibilities with your healthcare provider.

4. Could the left upper back pain be referred pain from the stomach or pancreas?
Referred pain is a phenomenon where pain is perceived in a different location than its source. While it's possible for gastrointestinal issues to cause discomfort in the back, the intermittent nature of your pain and its association with digestive symptoms suggest it may be related to your gastrointestinal issues rather than a direct problem with the pancreas.

5. How often should I monitor my pancreatic health given my family history and BMI?
Given your family history of diabetes and your BMI of 27, it's advisable to have regular check-ups with your healthcare provider. Typically, monitoring every 6 to 12 months is reasonable, especially if you have symptoms or changes in your health status. Your doctor may recommend blood tests to monitor your glucose levels and pancreatic function.

6. Is MRI or CT necessary for pancreatic monitoring, or is endoscopic ultrasound (ESU) sufficient?
ESU is a valuable tool for assessing pancreatic health and can provide detailed images of the pancreas. However, if there are ongoing concerns or if your symptoms persist, your doctor may recommend further imaging, such as an MRI or CT scan, for a more comprehensive evaluation.

7. What does pancreatic cancer pain feel like? Is it constant?
Pain associated with pancreatic cancer is often described as severe and persistent, typically located in the upper abdomen and may radiate to the back. It is usually not intermittent like the pain you describe. Patients often report that the pain does not improve with over-the-counter medications and can be associated with other symptoms like weight loss and jaundice.

In conclusion, while your concerns are valid, the evidence from your tests and symptoms suggests that serious conditions like pancreatic cancer are less likely. However, it is crucial to maintain open communication with your healthcare provider, who can guide you through monitoring your health and addressing any ongoing symptoms. Managing anxiety is also important; consider discussing your mental health with a professional, as anxiety can exacerbate physical symptoms. Remember, you are not alone in this, and seeking help is a positive step towards better health.

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