How do I manage SLE along with mild stomach discomfort?

Question

Hello doctor,

I am 25-year-old suffering from SLE. The abdominal pain started three months ago. First, MRCP was done, and it revealed a stricture at the ampulla. Then, ERCP was done due to severe obstruction. At that time, the lipase level was 350 U/L, and amylase was 120 U/L. After three months, one more attempt was made, but there was no change. Now there is mild discomfort in the stomach, and my lipase level is 8.9. Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for your query.

I reviewed your query about SLE. Your lipase level is normal now, but checking your liver function tests, especially alkaline phosphatase levels and blood tests, is essential.

I have a few questions.

Did they dilate that stricture or place a plastic stent as well?
If a stent were placed, it would be removed in the future.
If no stent is placed, lipase is already normal, then check LFTs (liver function test).

I hope this has helped you. Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

Thank you for your query.

I have reviewed your reports in detail (attachment removed to protect the patient's identity).

The following is my assessment:

It is your pancreas, which is causing problems. Your biliary system is all fine.
There is some ductal anomaly in your pancreas or anatomical variation. Due to this reason, sometimes your pancreatic secretions cannot reach to the small intestine and get released within the pancreas itself, leading to inflammation within the pancreas. This is known as pancreatitis, the cause behind your pain.
There is a variant known as pancreatic divisum, similar presentation to yours, but I feel that your treating physician and radiology would have considered this as well.

Therefore I suggest you to follow a few things mentioned below.

Try to avoid fatty meals and avoid unnecessary medicine whenever there is a need.
Avoid alcohol consumption.
Avoid steroids. Use with precautions if suggested by your SLE (systemic lupus erythematous) treating physician.
If you are feeling well and the lipase level is first, take precautions, as mentioned.

Also, where have they placed the stent? Is it in the pancreatic duct?

I hope this has helped you. Thank you.

Answer 3

Hello,

Welcome back to icliniq.com.

Ampullary cannulation is expected to be difficult in your case. Your liver function tests were normal so nothing to worry about it.

I hope this has helped you. Thank you.