Suggest Alternative Of "Ganaton" For Pain After Gallbladder Removal?

Posted on Tue, 21 Jan 2014

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Tue, 21 Jan 2014 Answered on

Fri, 7 Feb 2014 Last reviewed on

Question : Hi I was diagnosed with having a bile reflux this week after an endoscopy looking to find source of my pain below right rib.I have had my gallbladder removed. Doctor has prescribed Ganaton 3x day but I see it is banned in UK/USA. Can you recommend an alternative? Liver enzymes/tests all appear normal. Doctor showed me photos of the bile which came through into my stomach no evidence of ulcer etc in stomach.

Answered by Dr. Rakesh Karanwal (1 hour later)

Brief Answer: Metoclopramide/Ondensetron are alternatives Detailed Answer: Hi XXXXXXX Thanks for your query. You are suffering from a condition called "Post-Cholecystectomy Dumping syndrome" (PCDS) following gall bladder removal. It is likely to persist lifelong. Instead of Ganaton, you can take Metoclopramide or Ondansetron thrice daily, 30 minutes before meals. A LOW fat diet is also strongly recommended. Consult your doctor and apprise him of my opinion. He will prescribe the advised alternatives in appropriate doses. Hope I have addressed to your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. Fond regards and have a nice day, Col (Dr.) Rakesh Karanwal

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Karanwal (39 minutes later)

Hi, I had this problem and pain for one year prior to my gallbladder removal. The gallbladder was removed due to chronic inflammation (no stones on scans, or on dissection at time of surgery). The pain has only reduced a little post gallbladder removal. I've taken the ganaton for a couple of days now and the symptoms have reduced a little but are still there. Do you think it is still PCDS? Noted on the meds suggestions. Thanks

Answered by Dr. Rakesh Karanwal (49 minutes later)

Brief Answer: It is PCDS Detailed Answer: Hi XXXXXXX Nice hearing back from you. Earlier, the pain was due to chronic inflammation of gall bladder. The present pain is due to bile reflux. The function of gall bladder is to hold bile, produced in the liver, until it is needed for digesting fatty foods in the duodenum of the small intestine. Hence, the entire amount of bile released is utilized in fat digestion. In the absence of gall bladder, the produced bile continues to flow into the duodenum, even if there is no fatty food for digestion. Hence, the bile reflux. IT IS 100% PCDS (the name is self-suggestive :Post= after; cholecystectomy = removal of gall bladder; dumping = continuous dribbling of bile into the duodenum)! Take care Col (Dr.) Rakesh Karanwal

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Karanwal (13 hours later)

Hi, sorry one last question, I don't suffer from nausea, vomiting, heartburn or other symptoms of PCS. The pain is less with the tablets. Should I seek further investigation of pancreas, biliary tract, or other parts in order to see if more in depth problems? also I like to have a glass of wine at the weekends, can I still do so with these problems? Thanks

Answered by Dr. Rakesh Karanwal (4 hours later)

Brief Answer: Absence of other symptoms is a good sign Detailed Answer: Hi XXXXXXX Absence of PCS symptoms is a good sign, as this indicates only mild bile reflux, limiting the consequences of gall-bladder removal, to mild gastritis (inflammation of the inner lining of stomach/duodenum). Ganaton, Metoclopramide and Ondansetron are Prokinetic drugs, stimulate the gut motility to propel (push) food and bile forward into the intestine and thereby, reducing bile reflux into the stomach or lower end of esophagus. The possibility of Pancreatic and Biliary tract problems are less. Therefore, let your treating doctor decide if further tests are indicated. I would advise you to also take a Proton Pump Inhibitor, such as, Omeprazole or Pantoprazole along with one of the Prokinetic drugs. Fond regards, Dr. Rakesh Karanwal Lastly, a glass of wine once a week is OK.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar