Dr. Ajeet Kumar
Medical Gastroenterology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I have a history of long-standing GERD, and I am taking Omeprazole, Carafate, Metoprolol, Losartan, and Pepcid. These have helped somewhat. But now, there is also pain in the pancreas, especially after eating. Other symptoms include intermittent tender neck gland (left side), night sweats, and occasional diarrhea. Recent X-ray and EUS suggested hyper and hypoechoic foci in the pancreas. I will upload the files and images. My doctor advised me not to worry. We are very concerned about malignancy or something that might develop into a malignancy. My symptoms are persistent. Are these symptoms consistent with the images? Is there something to be done for the condition?
Concurrent symptoms include clear urine for several months and occasional burning lower back pain.
My GERD started about six years ago and was successfully treated with Omeprazole. However, the pancreas problem is since the last six months.
Hi,
Welcome to icliniq.com.
I have seen the images and thoroughly reviewed the report (attachment removed to preserve the patient's identity).
Well, at this age, such parenchymal changes in the pancreas are common and do not suggest a diagnosis of chronic pancreatitis, for which this end ultrasound was basically performed.
One has to have parenchymal changes and pancreatic duct-related changes for chronic pancreatitis. However, you do not have those changes. That is why your physician refrains from saying it is pancreatitis. Your pain can be due to some vascular changes in the abdomen vessels called mesenteric ischemia. Stiffening of the aorta (a large artery at the back of your tummy that supplies all structures of the abdomen and below it).
This stiffening can cause intermittent pain, particularly after meals, that is severe and sudden in onset. For that, a computed tomography (CT aortogram) is required. It also helps to rule out the possibility of mesenteric ischemia, celiac artery syndrome and super mesenteric artery syndrome (SMA syndrome). Since you do not have features of pancreatitis, so I do not think you need any medications. For vascular causes, I suggest you tablet Cilostazol 100 mg twice to thrice daily. This relieves the vasospasm of the vessels and thus helps in pain. But I would recommend going for a CT scan first before starting this medication. Also, discuss with your treating gastroenterologist.
For now, continue the medications you were taking. If there is a possibility of mesenteric ischemia, low-dose antidepressant medications can be started to uplift the pain threshold in the brain. This sometimes helps in patients with functional abdominal pain syndrome (FAPS). It is a condition of chronic daily abdominal pain that any other disease can not explain.
I hope this will help.
Patient's Query
Hello doctor,
Another gastroenterologist suggested that the foci shown on the EUS are fat instances. Does this imply pancreatic steatosis or fatty pancreas? Should a special pancreatic diet be undertaken? Since my GERD and gastritis persist, would that explain the night sweats?
Again, my thanks for your extraordinarily lucid response. It is the first clear explanation of a long and troubling condition.
Hi,
Welcome back to icliniq.com.
Yes, these are fatty changes. As age advances, the pancreatic tissues are replaced by fat, which is secondary to tissue loss. It is atrophy.
I do not think GERD (gastroesophageal reflux disease) or gastritis explains your night sweats. Secondly, GERD and gastritis usually do not cause abdominal pain; they instead cause a burning sensation.
How would you rate your abdominal pain on a scale of one to ten? What character is the pain, like duration of pain, spasm or crushing or pinching, or stabbing nature? Does it go anywhere from its site of origin? You told me that your lump is on the left side of the neck. Is it the thyroid gland? And did you have some blood tests for it? That might explain your excessive sweats.
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Medical Gastroenterology
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