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Experiencing Nausea And Vomiting After Eating. Multiple EGD Normal Except 1.5cm Mass. Suggest

Posted on Thu, 19 Dec 2013

Question: My wife, 57 y.o., has 4 months of nausea, which begins about 15 minutes after eating. No vomiting. Weight loss >60 lb. Type of food/liquid does not seem to matter. Multiple EGD normal except 1.5cm mass, possible GIST, but unable to biopsy it. Gallbladder out several years ago (primary symptom then was nausea, no pain). No pain now. LFTs ok. Barium swallow ok, US and CT ok. Gastric emptying study normal. Domperidone and Marinol not helpful. Surgeon says GIST (if confirmed) not likely to be related. ERCP with stent suggested but reluctant with normal LFT and minimal pain. We're at wits end. Any ideas?

Answered by Dr. Dr. Klerida Shehu (3 hours later)

Brief Answer: Please follow the suggestions below.. Detailed Answer: Hi, I read your medical history carefully and understood your concerns. If the tests you did resulted normal, then, nausea you are experiencing is not coming from gastro-intestinal tract. At this point, further evaluation is advised to rule out extra-GI problems. You have unexplained weight lost and intake of less than 500 calories/day which are indicative of a neoplazic syndrome (main cause meta of breast Ca). I suggest to do Ct-scan of head to rule out brain injuries due to Ca meta. In addition, the medications you are taking (crestor, zyrtec) are also associated with nausea, but with no weight loss. I also suggest to do the biopsy of GIST as soon as possible. Could you please refer its gastric position? You can send to me the results of the tests to further assist you. At the end, I suggest to go in depth and evaluate the current situation of your breast Ca (ct-scan or MRI) to rule out possible meta. Hope it answered to your inquiries! Feel free to ask me again at the next follow up if you have more questions! God bless you and ease your suffering! Dr.Klerida

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Dr. Klerida Shehu (1 hour later)

Thank you for your suggestions. I want to be clear, the weight loss is not really unexplained. The nausea and early satiety prevent adequate intake, which has led to the weight loss. I neglected to mention that a recent PET scan, looking for metastatic cancer, was normal. The suggestion of a non-GI source of the problem is interesting. We will consider a brain MRI, although I don't think metastatic breast Ca is much of a worry. Worth checking, though. Nausea has been a problem even when Crestor was stopped, so it was restarted. She has been on Zyrtec for over 10 years. The GIST is very small, 1.5cm, and biopsy with endoscopic ultrasound was not successful. At some point she may have this tumor removed, anyway, although no one seems to believe it can cause her nausea. Although the indications are quite weak (nausea but little pain and normal LFTs), we are considering ERCP with stent for possible Sphincter of Oddi dysfunction.

Answered by Dr. Dr. Klerida Shehu (14 hours later)

Brief Answer: Please follow the suggestion below... Detailed Answer: Hi again, Thank you for sending in more of her medical data. Apart doing MRI to check for neurological problems, I'd also suggest other factors that could contribute in her nausea such as: - hypercalcemia: I suggest to check the levels of calcium in blood as he is taking calcium supplements - oscillations in blood sugar levels; you can check her blood sugar while she is having nausea episode. Usually cancers are associated with hypoglycemia especially in diabetic patients. - psychological status of your wife: anxiety, depression,etc. could cause nausea too. All the best! Dr.Klerida

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Above answer was peer-reviewed by : Dr. Shanthi.E