The albatross with pain post lap Nissen - Forum

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Grandpa Phil

The albatross with pain post lap Nissen - Ärzteforum

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I have the following test results on the 40ish lady with left upper quadrant pain post lap Nissen (and bezoars plus gastric ulcers):

1) Social history: Recently separated from her husband and children and quite lonely plus having financial problems, 1 teenage son is about 300 pounds and beat her up when he was angry, another son just started at Yale law school

2) This most recent pain started after lifting multiple returns (dog food etc) at KMart

3) gastric pH 3 off Prilosec

4) Gastric emptying (nuclear med) normal off Propulsid

5) Chronic intermittent diarrhea (predates lap Nissen)--all studies negative and has had normal colonoscopy in past by gastroenterologist

6) My upper endoscopy after off Prilosec and Propulsid for 4 days showed:
a) Bile throughout stomach
b) Undigested vegetables
c) Gastritis
d) Shallow pyloric channel ulcer
e) Most of stomach turned Congo red black after pentagastrin--one patch of mid-stomach did not turn black (Congo red clearly stayed red in just this one area)
f) Proximal duodenum had the white velvety appearance characteristic of celiac sprue (but most often small bowel (distal duodenal) biopsies do not show celiac sprue even with this proximal duodenal mucosal pattern)--Path pending
f) pH of initial gastric aspirate pending but should be high since this was bile
g) Clo test and Pathology for Helicobacter pending

Any thoughts? This is much less clear than I thought it would be when I saw her last weekend.

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