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Post-Cholecystectomy issues - nausea, and GI pain
Hello. I am 30F, no history of pregnancy, normal BMI. Grandfather and Grandmother on each side has had their gallbladders removed due to issues.
About 4 years ago I first started having GI pain in the RUQ that was felt more in the back. Lots of burning when I would eat anything remotely acidic, spicy, or fatty. Had a endoscopy done and found mild gastritis and bile in my stomach. Had an ultrasound of my gallbladder and noticed no issues. Had a HIDA scan of my gallbladder that had it at 78% EF. Tested for H. Pylori, which was treated with antibiotics with no change in pain. Took a SIBO test, which I tested positive for, and treated with antibiotics, with no change. History of constipation. Had a colonoscopy done with no issues (other than some benign polyps). Tested negative for Celiacs and other GI related autoimmune diseases.
Tried treating symptoms PPIs with no success, including anti-spasmodics, sulcrafate, various TCA anti depressants (bounced off them due to them causing too much GI burning even when taking them with food).
Lived for years eating the most blandest of foods, such that I was only eating a number of foods you could count on one hand and was barely hovering above underweight. Ate mostly chicken soup and bread every day for every meal.
Went to see a sphincter of oddi expert, who did a ultrasound endoscopy of my bile ducts and found no issues. Over a year ago I also redid a HIDA scan and my EF% was 84. Got on Trulance to address my constipation issues, which did reduce some pain, and was having BMs every other day, pretty much, but did not resolve my GI pain.
After years of suffering I opted to try removal of my gallbladder to see if this would resolve the issues, particularly because I have heard word of hyperkinetic gallbladders above 80 EF% being a potential issue and it felt like I had tried literally everything else.
I felt 100% cured for a few weeks after surgery. I could eat acidic things no problem and wasn't having pain eating other things. Then the slow descent began back to pain, and now the issue of nausea about 3 months in. I could eat like 20g of fat per meal no issues, but now I can barely eat 5g, probably less. My meals consist of chicken breast, rice, and beans for the most part, with a bit of oatmeal mixed with a little brown sugar. I can't eat fruits without nausea, even in small portions, nor can I eat any acidic foods.
I was able to get on mirtazapine (tetracyclic anti depressant), which has helped with the strong onset of depression that has plagued me since the surgery. However, it has not resolved any of my GI issues. I have tried taking colestipol in the evenings to see if the nausea and pain was related to bile but it's a little uncertain if it even helps. I take Zofran on occasion to help with the nausea, but it's not quite the solution I'm looking for.
(Side note, I also take plaquenil for about a year now due to being diagnosed with Sjogrens.)
Wondering if anyone had similar GI issues and had found relief or answers for their nausea and GI pain.
Thanks!
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@chattycat
Welcome to Mayo Connect!
I hope you’ll hear from other members with similar problems- there are many of us with confusing GI issues.
I have been through most of the testing and treatment steps you describe.
Life after gallbladder removal has not been easy- I had to learn what fats I definitely could not eat. I also ended up with sludge in the bile duct - had 2 procedures to enlarge the opening into the intestine. Because of blockage I also ended up with chronic pancreatitis.
Have you had follow up ultrasounds to check the common bile duct?
I’ll just mention another problem I had that’s not very common but caused all symptoms you mention plus others. It’s MALS- blockage of the celiac artery. Caused pain, nausea, lack of appetite, fullness etc.
Let’s wait to see what other members have to share.
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1 ReactionIt's possible you have bile acid gastritis which does not respond to typical PPI treatment. It can cause all of the symptoms you mention. Colestipol and the like are bile binders that activate in your intestine and typically cause chronic diarrhea and fat malabsorption. They will not bind with bile acid in your stomach. When you condensed your diet to bland and non-fatty foods it would have felt better from that. I had a bad stomach ache and pain when I learned I had stones and sludge in my duct and bladder so I had emergency gallbladder surgery. But after that I still had an upset stomach when I was really hoping it would stop it. Eventually it died down on its own but they did order a test called an MRCP to make sure there were no remaining issues with the duct. Given you've had these symptoms well before your gallbladder was taken out, I wouldn't think this is a post surgery issue. It's just sad the gallbladder wasn't what was causing you misery. I do get bad stomach aches after eating. I take Mirtazapine as an appetite stimulant ironically. I wonder if you notice you're hungrier than usual.
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2 ReactionsYeah, the major depression that I've been dealing with has mostly been surgery regret; it's been really tough. Mirtazapine has been a godsend because it helped me gain weight due to increased hunger so I'm at a normal BMI now. Also helps me sleep at night. Does nothing but positives for me, but wish I could go above 30mg to 45mg to address remaining depression issues without concerning ear pain side effects though.
Yeah the stomach pain in particular seems unrelated to the gallbladder, and the nausea is just a new symptom post-surgery. Interesting on what you said about colestipol not binding in your stomach; I assume you're talking about the big fat pill variety? I've heard there's an alternative gross-tasting powder variety you dissolve in a cup of water, and I'm wondering if that would bind to any bile reflux in my stomach if that was the issue?
Thank you!
I have not had any follow-up testing done in regards to bloodwork or ultrasounds after surgery, which seemed odd to me. At most I've done a gastric emptying test that ended up with "normal" results. Sorry to hear you had issues with your post-cholecystectomy.
I have heard of MALS but I'm not sure if I've been assessed for it. Thank you for mentioning it, I will have to ask my doctor the next time I see them.
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1 ReactionTrulance relieves constipation. Very interesting. Thank you. Is that a rx? I'm on same diet. Ondansetron relieves nausea immediately. Need rx. I hope you can try that. The only thing i do different re diet is no rice. Sets like cement, BRAT diet; (bread, rice, apples, toast) for diarrhea. & yes I can't digest raw vegetables, raw fruits, everything is canned or earth foods like sweet potatoes, squash, apple sauce & anything liquid. 2 boosts 30mg protein.
Interesting note about the rice. I'll keep that in mind to see if reducing rice helps.
Yeah Trulance is an RX. I know linzess is usually first prescribed for constipation issues, but I had severe reaction to it where it made my colon feel like it was on fire. Trulance doesn't have a generic yet so it's very expensive but I keep with it because I had no negative side effects with it.