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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Is persistent upper abdominal pain a sure sign of pancreatic cancer?

Answered by
Dr. Bhagyesh V. Patel

General Surgeon

Practicing since :1999

Answered : 13013 Questions

Posted on Thu, 12 Jul 2018 in Digestion and Bowels
Question: I have upper abdominal discomfort for 5 weeks now. The pain is dull, in the middle. The pain is not sharp; not cramp. I have severe chills.

My primary doctor ordered full chemistry blood work along with CA-19-9 marker. Everything including the CA19-9 marker came back normal. The ultrasound did not find anything abnormal. The MRI without contrast did not find anything except for a cyst on kidney.

I asked both my primary care doctor and the GI doctor for the Endoscopic Ultrasound (EUS) but they both said I don't need it because they don't thank I have pancreatic cancer. Instead, they prescribed Pepcid (Primary doctor) and Protonix (GI). I don't think I have acid reflux or GERD because my discomfort is not cramping or burning pain.

I am frustrated that my doctors did not listen to me. Am I unreasonable or are they unreasonable? From what I read on the internet, GERD symptoms are burning pains, sour taste in the throat; pains are worse when lying down. Whereas, the pain of pancreatic cancer is dull. This is why I am scared because my pain is dull.

1. What do I need to do to convince my GI doctor to perform EUS for me?
2. Do Protonix and Pepcid belong to the same family of drug to treat GERD?
When I asked my GI doctor why he would not order EUS for me, he said my blood work and MRI do not indicate that I have pancreatic cancer and therefore no need for EUS. However, from what I read, blood work (including CA19-9) and MRI are not sensitive enough to pick up small pancreatic tumor. When the CA19-9 is elevated, it's too late.

I don't understand why can't I have EUS before it's too late
Answered by Dr. Bhagyesh V. Patel 30 hours later
Brief Answer:
You do not need EUS at present . find details in answer .

Detailed Answer:
Hello dear

Warm welcome to
I have evaluated your query thoroughly with attached reports .

* Dull upper abdomen pain has so many possibilities , even gastritis or ulcer can
be there without burning also .
* Only dull ache involving upper abdomen does not indicate to be afraid of
pancreas cancer .

* There are associated other features to doubt for the same as
- jaundice - low appetite - nausea - vomiting - weight loss - back pain
- gall bladder , liver enlargement - others .
Depending upon the symptoms of the patient , your consultant decides certain
diagnosis and needed investigations best suitable for you .

1. I do not consider that you require to convince your GI doctor for EUS , as you
are not in need of that .
Presently continue medications for around 7 - 10 days , observe for the
progress of the symptoms along with dietary management .
Later on during follow up with the doctor , discuss about further need of upper
GI endoscopy or EUS .

2. Protonix is proton pump inhibitor group medicine pantoprazole , while
Pepcid is H2 receptor antagonist medicine famotidine , both has different
mechanism of action . Protonix grades better above pepcid .

* My recommendations at present for you

- Do not panic at present , only upper abdomen pain is not relevant to fear of
pancreas cancer .
- Always clinical experience matters most above internet findings .
- Dietary precautions with avoidance of oily , spicy , non veg , junk foods .
- Regular walking in fresh air , exercises , YOGA help great .
- Avoid smoking , alcohol if consuming .
- Manage to have regular smooth bowel evacuations .
- Check to have sound regular sleep of 8 hours .
- Maintain your blood sugar , body weight , cholesterol levels .

Wishing you fine health ahead .

Welcome for any further assistance .
Regards take care .

Above answer was peer-reviewed by : Dr. Vaishalee Punj

The User accepted the expert's answer

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