What causes abdominal pain and diarrhea while treating diabetes mellitus?

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Posted on Thu, 18 Jun 2015 in Abdominal Pain
Question: I am having a fairly constant gnawing-type pain in the central-right area of my abdomen (plus eructations, occasional sub-sternal & central abdominal discomfort, & long-term diarrhea--which may or may not be related to the right-sided pain). I am hoping that I do not have a malignancy (esp. of the pancreas).

My history is that I am a 64-year-old male (non-smoker, non-drinker) with longstanding diabetes mellitus Type II, diverticulosis, hiatal hernia, marginally-controlled GERD, & a Schatzki's ring. Due to such digestive issues, I had a CAT scan done 11 months ago, which was normal for the pancreas & other abdominal organs (other than for a long-term hepatic cyst). Recently, a series of blood tests disclosed elevated amylase levels (sequentially, they were 102 U/L, 130 U/L, and then [I think] back to the normal range). Lipase remained at the top of normal range throughout, I believe. Doctors sent me for an abdominal MRI, which yielded ambiguous results (the radiologist wrote, unclearly, that while "no definite pancreatic pathology is seen, the pancreatic head is not ideally delineated") My clinicians were confused by these findings, & advised me to get another CAT scan and/or abdominal ultrasound. Would it be wise to receive additional ionizing radiation so soon (I have had a number of abdominal CAT scans over the years)? I would hope that the normal 6/14 CAT scan would at least lower my odds of a pancreatic neoplasm having developed since that time; one gastroenterologist did opine that this was very unlikely. What do you feel my problem might be, based on this history, & what would you recommend I do at this point?

(As a possibly separate issue, that last GI doctor did recommend that I undergo an esophagogastroduodenoscopy to address possible GERD-related issues. I have had such a test done a number of years ago, which did not disclose any Barrett's esophagus or related condition at that time. Would it be likely that such a disorder, or an esophageal adenocarcinoma, would have developed since? I probably will undergo this test again at some point, since it does not leave any radiation sequelae, but I hope that it does not disclose any pathology in that area of the digestive tract. What do you think is the likelihood of any abnormalities?)
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Answered by Dr. Grzegorz Stanko 4 hours later
Brief Answer:
EUS is the test which should be done.

Detailed Answer:
Hello!

Thank you for the query.

First of all please note that there will be very hard to help you from the point of this service. You have seen so many doctors (who were able to examine you) and have had so many tests (which I can not really see) that it is much harder to be the deciding voice.

But lets try. First of all, cancer usually does not cause any pain. Especially stomach cancer or small pancreas cancer. The pain appears when cancer spreads to nerves. To do that, it has to appear outside the primary organ.
Secondly, MRI is much accurate than CT. What can not be seen in CT is usually seen much clearer in MRI. So I do not think another CT is necessary at this point.

To make things clear, you need a test which is called EUS with pancreas biopsy. This test is performed during regular gastroscopy (or esophagogastroduodenoscopy which is the same test). During this test, special ultrasound probe is inserted to the area where stomach and duodenum meets the pancreas. It allows to rule out or confirm any pancreas lumps and what is more important it allows to take a sample for histopathology (collected by biopsy).

In my opinion you should also have colonoscopy done as well as stool culture test to diagnose your diarrhea issue.
And finally, you should consider fixing the hiatal hernia with Nissen fundoplication (done laparoscopically) and consider esophagus widen. You pain can be related to the ring or hiatal hernia or both. This is more possible if you have some discomfort right after swallowing the foods.

Hope this will help. Feel free to ask further questions.
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Grzegorz Stanko

General Surgeon

Practicing since :2008

Answered : 5768 Questions

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