Have high EOS count and deep ulcer. Having pain in neck and back. Having weight loss. Suggested laproscopy. Chances of gastric lymphoma?

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Posted on Tue, 23 Jul 2013 in Abdominal Pain
Question: Hello I have a high EOS count and a deep ulcer that went away a year ago, but them came back this year really big. I dont feel good all over, but specicially have alot of pain in neck and back as well. i am young 31, but my health began to decline last year. I lost weight last year. They did a endo and took biopsies and they were neg for cancer the only thing high is my eos. The dr wants to do a laproscopy and do a deeper biopsy. What are the chances this is gastric lymphoma, or a bad ulcer. It neg for h pylori
doctor
Answered by Dr. Grzegorz Stanko 2 hours later
Hello!

Thank you for the query.

The chances of gastric lymphoma without H.Pylori infection are really low. Moreover, there biopsies which were collected should give positive result (if not year ago than this time). So this really does not sound like a gastric lymphoma.
Such recurring stomach ulcers can be caused by a tumor which secretes gastrin (it is called gastrinoma). With recurring ulcers, also severe diarrhea appears.

Elevated eosynophiles level can be caused by gastrointestinal parasites (I hope you have been tested for that) or by allergies.

Laparoscopy might be a good idea, however in my opinion before this surgery, abdominal CT should be done.

If your ulcer will be recurring again and again, you should consider partial stomach removal and vagotomy (vagal nerve cut, this nerve stimulates stomach acid secretion)

Hope this will help. Feel free to ask further questions.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Grzegorz Stanko 15 hours later
Thank you so much for your response. They did do a CT scan and took multiple biopsies during the endoscopy which came back fine. I've been on protonix pretty much this whole time and my gastrin level was lower then normal range when they sent me for bloodwork. Could it still be gastrinoma?

So while I was on protonix this time the ulcer remains maybe kept growing. Also I have no diarreaha. Wouldn't they see parasytic infection on endoscopic biopsies. The pathology came back neg.
doctor
Answered by Dr. Grzegorz Stanko 10 hours later
If the gastrine level is low, and no diarrhea is present, gastrinoma is impossible. So we can rule it out.

Eosynophiles elevated level can be caused by parasites present in the small or large intestine, not in the stomach. There might be a coincidence that you have an ulcer and elevated EOS. That is why you should have stool tests for parasites. Endoscopy wont tell anything about parasites.

You need to know that Pantoprasole (Protonix) can be very effective to some patients and can be completely ineffective for other patients. Very often the dosage prescribed is also not sufficient. You should be taking Protonix 40 mg twice a day for one month to give a chance for your ulcer to heal.

If Pantoprasole does not work for you (it looks like it does not), you should try other medicine. I suggest you to discuss with your doctor about it and try Omeprasole 40 mg twice a day.

You should also avoid coffee (this is very important), fruit juices, fatty foods, alcohol.
After a month, gastroscopy should be repeated. If the ulcer will be still present, surgery and partial stomach removal (with Vagotomy) should be considered.

Hope this will help.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Grzegorz Stanko

General Surgeon

Practicing since :2008

Answered : 5768 Questions

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