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Developed Hoarse Voice. Prescribed Prilosec. Having Severe Stomach Pain. Had Endoscopy. Cause? What Can Be Done?

Posted on Mon, 3 Jun 2013

Question: Hi. I had my appendix and gall bladder out about 10 years ago. Since then I have had to have four ERCP's to remove sludge from the sphincter of oddi bile duct. Recently, I lost my singing voice and developed a hoarse voice 24-7. I went to an ENT who scoped me in the office and advised I have LPR (silent reflux) and GERD. He put me on 40 mgs of Prilosec 2x a day. Along with my hoarse voice I experienced severe stomach pain every time I eat - no matter if it is a solid meal, soup, or smoothie. So, I went to my Gastroenterologist who did an upper GI and found a medium sized hiatal hernia. He also dilated my esophagus because of an obstructing Schatzki's ring and switched me from Prilosec to Dexilant (60 mg once a day) and Zantec at night. After the endoscopy I could hardly swallow because of the pain in my throat. Approximately 6 days later I was able to swallow without pain. I was back to my normal diet (the GERD diet) by the following week and am again experiencing intense stomach pains everytime I eat! The pain is like no other as it feels like an intense cramp and like someone is twisting it like a wet washcloth they are trying to ring dry!! I am at my wits end. I don't know what to do anymore as I am feeling very helpless and depressed. I just want my life back...

Answered by Dr. Pavan Kumar Gupta (5 hours later)

Hello,
Thanks for the query.
I really feel very sorry for your troubles.
In fact I have read your history twice and I feel that since you have already undergone endoscopy,taking GERD diet and taking proper medications and so there is a strong possibility of sphincter of oddi ( SOD ) recurrence.
Since you have already undergone 4 ERCP procedures to remove the sludge,the chances of scarring of sphincterotomy are very high,if you had a sphincterotomy done earlier.
Further cutting ( repeat sphincterotomy ) is sometimes possible but obviously there are limits.
However a procedure called as TRANSDUODENAL SPHINCTEROPLASTY can be done which may be able to alleviate your symptoms.

Sphincter of Oddi Dysfunction is a difficult condition, which should be approached and managed with considerable care.
I advise you to go to a specialist centre who have special works done on SOD.
I hope it helps however you may revert to me for any further query.
Best of luck
Thanks

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Pavan Kumar Gupta (33 hours later)

Thank you, Dr. I think that you are right. I called my gastroenterologist yesterday to advise that I am still in a great deal of pain every time I eat. He ordered a stat CT Scan and stated depending on the results of the CT Scan he will want to do another ERCP - this will be my fifth. I love my doctor and don't want to offend him. How do tell him that I want a second opinion on the matter or how do I bring up the transduodenal sphincteroplasty without offending him?

Best regards,
XXXXXX

Answered by Dr. Pavan Kumar Gupta (7 hours later)

Hello,
There are two ways of solving this riddle.
Either you tell him straight away that you came across a procedure called as trans duodenal SPHINCTEROPLASTY done for repeated attacks of SOD while surfing on Internet or you can say that some friend of yours mentioned about this procedure.
Just ask your doctor what this procedure is about and what does he think about it?
Thanks

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar