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Epigastric pain with nausea, loose stools. High blood sugar levels. EGD and CT negative. Taking Reglan and Phenergan. Advice?

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Gastroenterologist
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53 yr old female with nausea, epigastric pain, and some loose stools for more than a month now. EGD and CT neg except for mild reflux. CMV IGg 42.1, CMV IGm 1.3, a couple of weeks ago. Repeated and now CMV is Neg in the plasma. Also weak and shaky, so checked glucose 5 hrs after a pbutter and jelly sandwich. It was 166! Fasting glucose this morn 136. Have been off work for over 3 weeks. Unable to go out or do much of anything due to the nausea and gnawing epigastric pain. Have a follow-up GI appt, but don't think they are going to do much else, although SOMEBODY HAS to help me get better!! Taking Reglan, but doesn't seem to help much. Also not much relief from Phenergan or Zofran either. Your thoughts?
Posted Wed, 18 Apr 2012 in Digestion and Bowels
 
 
Answered by Dr. Poorna Chandra K.S 14 hours later
Hi,
Thanks for posting your query
Epigastric pain with nausea in the context of loose stools may actually indicate an intestinal inflammation rather than the so called acidity. The symptoms may be due to gastric or intestinal dysmotility secondary to the intestinal inflammation. Hence, get a stool routine examination done
Rarely, a liver abscess following a diarrhoeal episode may present similarly. Hence an ultrasound abdomen may help get a closer look.
If the two are disconnected, then you could be having non-ulcer dyspepsia. This is usually treated with a proton pump inhibitor and a prokinetic agent.
I would suggest that you consult your gastroenterologist and discuss these to arrive at the proper diagnosis
Regards
Dr XXXXXXX
Above answer was peer-reviewed by
 
Follow-up: Epigastric pain with nausea, loose stools. High blood sugar levels. EGD and CT negative. Taking Reglan and Phenergan. Advice? 18 hours later
I have already been taking Prilosec 20 mg.bid and Zantac 300 mg. bid. My stomach continues to growl and also have the continued nausea and gnawing epigastric pain.
They have done no stool cultures. They suggested I may have non-ulcer dyspepsia, but I am getting NO better.
Should I suggest a stool culture and an Ultrasound of the abdomen. They, the GI Drs. seem to think that since my EGD and CT scans were basically neg. that they are just throwing up their hands!!
I have been off work almost a month. I'm an RN, and there is SOMETHING wrong....
If it was gastric dysmotility, wouldn't the Reglan be helping more? Also what about my IGg being 42.1? My Gyn APN drew that lab, and I will take those results to my follow-up GI appt.
Thanks so much for any help you can offer, XXXXXXX K
 
 
Answered by Dr. Poorna Chandra K.S 15 hours later
Hi,

Thanks for the clarification.

If the CT scan was normal it is unlikely that an ultrasound will add anymore information. I would certainly like you to do your stool examinations.
Now a days you have better prokinetics like levosulpiride and cinatapride than Reglan. You can discuss about these with your GI. Sometime helicobacter infection may lead to persistence problems and it is a good idea to get a breath test for it.

Blood CMV IgG tells about a CMV infection - present or past and a CMV antigen test or DNA estimation is a better way at looking at active infection. Even with these it is better to have a tissue evidence of active infection - cytopathic changes

Hope I have answered your query. Please accept my answer in case you do not have further queries.

Regards
Dr XXXXXXX
Above answer was peer-reviewed by
 
Follow-up: Epigastric pain with nausea, loose stools. High blood sugar levels. EGD and CT negative. Taking Reglan and Phenergan. Advice? 55 minutes later
Yes, they treated me for HPylori already.
Thanks for your advice. I'm hoping I can print your replies to take to my appt.
Appreciate your time. XXXXXXX K
Follow-up: Epigastric pain with nausea, loose stools. High blood sugar levels. EGD and CT negative. Taking Reglan and Phenergan. Advice? 46 hours later
Re: this statement, "Blood CMV IgG tells about a CMV infection-present or past and a CMV antigen test or DNA estimation is a better way at looking at active infection. Even with these it is better to have a tissue evidence of active infection-cytopathic changes." What sort of tissue are you referring to? Should this have been done when they did my EGD, or are you talking about some other sort of tissue?
I am going to ask them to do the CMV antigen or DNA estimation. I'm assuming this is a blood test. Also will ask them to do some stool cultures.
Will also mention the other meds besides Reglan.
Should I insist on an US of the abdomen, or an abdominal xray? Would MRI be helpful?
As I told you , they DID treat me for H Pylori.
My friend and I are RNs, and we are thinking the worst, pancreatic ca or something horrible. I've also lost a lot of weight without trying....
Thanks for your reply please. XXXXXXX K
 
 
Answered by Dr. Poorna Chandra K.S 24 hours later
Hi
A normal good contrast CT abdomen considerably rules out malignancy of pancreas, gallbladder, stomach or intestines. Hence I think you can remain assured on that front. If the stools are still abnormal go ahead with the stool routine examination and cultures. Also get a quantitative C reactive protein.
Systemic CMV infection is uncommon in normal individuals and is usually seen in people with immunosuppression - Primary or secondary. Hence before going for further testing with Respect to CMV i would want you to discuss with your GI
Regards
Dr XXXXXXX
Above answer was peer-reviewed by
 
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