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What Causes Left Upper Quadrant Pain Along With Weight Loss?
Question: Hello,
I am seeking a 2nd opinion on some issues regarding
my health. I went to see my primary care doctor a
few weeks ago due to worsening abdominal pain
(I've had abdominal pain about 4 years now, and was
diagnosed and treated for H Pylori Dec 2013. Stool re-test
confirmed eradication) and
worsening weight loss(down to 136 pounds at 5 11").
My doctor was initially concerned about cancer, so
he ordered a ct scan of the abdomen and pelvis, and
a set of labs(attached). The labs came back basically
normal except it showed I had antibodies for H Pylori
still. He then canceled the scan, since the other tests
were basically normal, and he felt H Pylori was behind
all this. Can you please look over my lab tests, then
give me your opinion on the following:
1) Regarding the H Pylori blood test: my understanding
was that once you have the infection, this test will show
up positive the rest of your life. But my doctor said recently
it has been found to not always be the case. I did some internet
research and found some sites saying the antibodies generally
can stay in the system from between 12-18 months after successful
treatment(it's been about 2.5 years since the treatment). Can you
research this (if needed) and tell me what you think the latest and
most reliable opinion on this is? I'd hate to undergo another round
antibiotics if it was not necessary.
2) one of the blood tests was the CA 19-9. The value was 21,
which I realize is normal. However, I took a CA 19-9 back in
November of 2012, and it was 13.7 I heard that a rising CA 19-9
is a very bad sign, but that was already in the context of a diagnosis
of pancreatic cancer(and possibly much higher values for this test).
Do you think this is anything to be concerned about, and does it
warrant some kind of scan(and would an ultrasound be okay instead
of a ct scan here, as I'm concerned about the radiation exposure).
I should also provide a few more details about the nature
of my pain:
- the last 6 months or so, the pain has been more in the
left upper quadrant and back, whereas in the previous 3 years it has mostly been
on the right side of the abdomen.
- the LUQ pain gets worse when lying down, and when in contact
with something(like a car seat)
- I also have almost constant acid reflux symptoms
Can you please advise me on what you suspect may be
going on, and what next steps I need to take?
Thank you very much,
XXXXXXX XXXX
I am seeking a 2nd opinion on some issues regarding
my health. I went to see my primary care doctor a
few weeks ago due to worsening abdominal pain
(I've had abdominal pain about 4 years now, and was
diagnosed and treated for H Pylori Dec 2013. Stool re-test
confirmed eradication) and
worsening weight loss(down to 136 pounds at 5 11").
My doctor was initially concerned about cancer, so
he ordered a ct scan of the abdomen and pelvis, and
a set of labs(attached). The labs came back basically
normal except it showed I had antibodies for H Pylori
still. He then canceled the scan, since the other tests
were basically normal, and he felt H Pylori was behind
all this. Can you please look over my lab tests, then
give me your opinion on the following:
1) Regarding the H Pylori blood test: my understanding
was that once you have the infection, this test will show
up positive the rest of your life. But my doctor said recently
it has been found to not always be the case. I did some internet
research and found some sites saying the antibodies generally
can stay in the system from between 12-18 months after successful
treatment(it's been about 2.5 years since the treatment). Can you
research this (if needed) and tell me what you think the latest and
most reliable opinion on this is? I'd hate to undergo another round
antibiotics if it was not necessary.
2) one of the blood tests was the CA 19-9. The value was 21,
which I realize is normal. However, I took a CA 19-9 back in
November of 2012, and it was 13.7 I heard that a rising CA 19-9
is a very bad sign, but that was already in the context of a diagnosis
of pancreatic cancer(and possibly much higher values for this test).
Do you think this is anything to be concerned about, and does it
warrant some kind of scan(and would an ultrasound be okay instead
of a ct scan here, as I'm concerned about the radiation exposure).
I should also provide a few more details about the nature
of my pain:
- the last 6 months or so, the pain has been more in the
left upper quadrant and back, whereas in the previous 3 years it has mostly been
on the right side of the abdomen.
- the LUQ pain gets worse when lying down, and when in contact
with something(like a car seat)
- I also have almost constant acid reflux symptoms
Can you please advise me on what you suspect may be
going on, and what next steps I need to take?
Thank you very much,
XXXXXXX XXXX
Brief Answer:
Progressive upper RUQ to LUQ-Abd Pain with weight loss/ Under Evaluation
Detailed Answer:
Brief Ans-Progressive upper RUQ to LUQ-Abd Pain with weight loss/ Under Evaluation
Hi Dear !! Thanks for the query to HCM.
Read and reviewed your lab reports and query facts in context to your health concerns of weight loss and acid reflux with LUQ pain.
Briefing Up--My Opinion about Your History and lab reports-
Weight loss the function of the abdominal pain over last 4 yrs in your case.
Progress of abdominal pain from RUQ to LUQ with constant acid reflux, indicates the perpetual existant stimulus for the Entero-colitis which was limited to RUQ initially 4 yrs ago.
This indicates continuing conditions of stress- may be from food induced infections/ or of and accompanied with anxiety/ lifestyle stress from jobstyle and lifestyle stress.
The condition seems to have changed over last 1 yr from RUQ to LUQ.
Your Ca-19-9 is indicative of change to rising trend and is higher normal, and NEED NOT BE Worried as its still Normal.
Besides this the persistence of Acid reflux with shift of Pain from RUQ , to currently to LUQ and back, indicates the undetected stool pathology,which is not submitted here in these Lab profiles.
In My opinion-(about the queries asked)-
Ans-1-H.Pylori- being ubiquitus spiral bacterium,the H.pylori antibody blood tests need to be worked up with UBT and Stool Tests.
In your case, just Don't worry about the validity and accuracy of theses tests.They are just guiding tools.What is more important is the clinical condition, which is persistent and is not relieved.
This indicates perpetual H.Pylori infection loads via water and food route, which is the commonest mode of transfer of this infection in humans.
In this scenario, I would suggest repeat holistic treatment courses for Entero-Colitis(LUQ abd pain) and Gastro-Duodenitis(RUQ abd pain)- and change of food and life style, whatever -but is the cause for its persistence.
Ans-2-If you are really worried about the pancreatic or other cancer, Go for thourough check by endoscopic gastric / duodenal / colonic biopsies,Which I would not suggest.
If I would like to suggest-you the Scan-it would be -Contrast MRI -MRCP-MR cholanigopancreaticography- to rule out cholangio-pancreatic malignancies but after thorough clinical work up
Unless you maintain painless status for 2 months with negative H.Pylori Stool and UBT tests with your negative H.Pylori tests , I would not rest from discontinuing your treatments.This is my practical protocol for your case.
Ans-About your Clinical pain progress / history , I have briefed My opinion in the beginning brief up. I stand by that.
My Suggestion for your case- is very clear from above discussions.
Hope this would resolve your worries.If you have any more queries You are welcome with more
queries in this regard.
Do Contact for any further query in this regard by a direct question to ME, at following HCM link-
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=70229
Do close this query with your words of praising /excellent comments to boost the morale of My visiting patients at HCM Virtual forum.
Good Day!!
Wishing Good Healthy Life!!
Dr.Savaskar M.N. XXXXXXX Surgical Specialist
M.S.Genl-CVTS
Progressive upper RUQ to LUQ-Abd Pain with weight loss/ Under Evaluation
Detailed Answer:
Brief Ans-Progressive upper RUQ to LUQ-Abd Pain with weight loss/ Under Evaluation
Hi Dear !! Thanks for the query to HCM.
Read and reviewed your lab reports and query facts in context to your health concerns of weight loss and acid reflux with LUQ pain.
Briefing Up--My Opinion about Your History and lab reports-
Weight loss the function of the abdominal pain over last 4 yrs in your case.
Progress of abdominal pain from RUQ to LUQ with constant acid reflux, indicates the perpetual existant stimulus for the Entero-colitis which was limited to RUQ initially 4 yrs ago.
This indicates continuing conditions of stress- may be from food induced infections/ or of and accompanied with anxiety/ lifestyle stress from jobstyle and lifestyle stress.
The condition seems to have changed over last 1 yr from RUQ to LUQ.
Your Ca-19-9 is indicative of change to rising trend and is higher normal, and NEED NOT BE Worried as its still Normal.
Besides this the persistence of Acid reflux with shift of Pain from RUQ , to currently to LUQ and back, indicates the undetected stool pathology,which is not submitted here in these Lab profiles.
In My opinion-(about the queries asked)-
Ans-1-H.Pylori- being ubiquitus spiral bacterium,the H.pylori antibody blood tests need to be worked up with UBT and Stool Tests.
In your case, just Don't worry about the validity and accuracy of theses tests.They are just guiding tools.What is more important is the clinical condition, which is persistent and is not relieved.
This indicates perpetual H.Pylori infection loads via water and food route, which is the commonest mode of transfer of this infection in humans.
In this scenario, I would suggest repeat holistic treatment courses for Entero-Colitis(LUQ abd pain) and Gastro-Duodenitis(RUQ abd pain)- and change of food and life style, whatever -but is the cause for its persistence.
Ans-2-If you are really worried about the pancreatic or other cancer, Go for thourough check by endoscopic gastric / duodenal / colonic biopsies,Which I would not suggest.
If I would like to suggest-you the Scan-it would be -Contrast MRI -MRCP-MR cholanigopancreaticography- to rule out cholangio-pancreatic malignancies but after thorough clinical work up
Unless you maintain painless status for 2 months with negative H.Pylori Stool and UBT tests with your negative H.Pylori tests , I would not rest from discontinuing your treatments.This is my practical protocol for your case.
Ans-About your Clinical pain progress / history , I have briefed My opinion in the beginning brief up. I stand by that.
My Suggestion for your case- is very clear from above discussions.
Hope this would resolve your worries.If you have any more queries You are welcome with more
queries in this regard.
Do Contact for any further query in this regard by a direct question to ME, at following HCM link-
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=70229
Do close this query with your words of praising /excellent comments to boost the morale of My visiting patients at HCM Virtual forum.
Good Day!!
Wishing Good Healthy Life!!
Dr.Savaskar M.N. XXXXXXX Surgical Specialist
M.S.Genl-CVTS
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Thanks so much for your answers, Dr. Savaskar.
I have a few followup questions...
- Regarding the CA 19-9 test:
- is it fairly normal for it to go up(and down)
from time to time, as long as it's in the normal range?
- Regarding H Pylori:
- I have read that the H Pylori antibodies only stay in the system
for about 18 months after eradication. Do you agree?
- does the blood test, given that it's been over 2 years
since it was treated, have any validity to it?
- if I took a stool or UBT test, and it comes up negative,
which test result should I believe: the stool/UBT test
or the blood test?
- Regarding taking a scan:
- would an Ultrasound have any diagnostic value
for my situation? I fear my doctor may not order
an MRI due to the cost.
Thanks again!
Best regards,
XXXXXXX
I have a few followup questions...
- Regarding the CA 19-9 test:
- is it fairly normal for it to go up(and down)
from time to time, as long as it's in the normal range?
- Regarding H Pylori:
- I have read that the H Pylori antibodies only stay in the system
for about 18 months after eradication. Do you agree?
- does the blood test, given that it's been over 2 years
since it was treated, have any validity to it?
- if I took a stool or UBT test, and it comes up negative,
which test result should I believe: the stool/UBT test
or the blood test?
- Regarding taking a scan:
- would an Ultrasound have any diagnostic value
for my situation? I fear my doctor may not order
an MRI due to the cost.
Thanks again!
Best regards,
XXXXXXX
Brief Answer:
Just Leave RUQ and LUQ abdominal Pain to GI Expert !!
Detailed Answer:
Brief Ans-Just Leave RUQ and LUQ abdominal Pain to GI Expert !!
Let your expert attending doctor take proper decisions.
Hi,Dear XXXXXXX !! Thanks for your query updates to HCM.
Thanks for the proactive thanking gesture being satisfied with My last reply to this query.
Following are the Replies to your -Update / follow up questions-
- Regarding the CA 19-9 test:
- is it fairly normal for it to go up(and down)
from time to time, as long as it's in the normal range?
Ans-Dear, rising CA 19-9 Test does not mean Pancreatic Cancer Possibility in each of such case.There are many other non-cancerous causes which can rise these levels.It needs to be correlated with clinical data by expert doctor, to be labelled as Pancreatic Cancer.Yours being in normal range and without other corroborative factors. Hence just neglect this rise.
- Regarding H Pylori:
- I have read that the H Pylori antibodies only stay in the system
for about 18 months after eradication. Do you agree?
Ans-It Could stay for 12 -18 mths, but indicate the body's response to past H.Pylorie, but is not indicative of any active infection.So relax and leave it for your attending doctor to take decision on your queries and don't google and confuse yourself and don't disturb your doctor.
- does the blood test, given that it's been over 2 years
since it was treated, have any validity to it?
Ans-blood test is very weak test for H.Pylori active infection.Hence its validity if done 2 yrs back, can not be considered for the current complaints.
- if I took a stool or UBT test, and it comes up negative,
which test result should I believe: the stool/UBT test
or the blood test?
Ans-UBT and Stool Antigen Tests are more confirmatory and as said, Blood test- only confirms old or current infection with body's response by antibody- which comes in 3-6 weeks and remains for 12-18 mths in the blood.
So just believe in SAT and UBT in such a negative reply.
- Regarding taking a scan:
- would an Ultrasound have any diagnostic value
for my situation? I fear my doctor may not order
an MRI due to the cost.
Ans-In reference to detection of Cancer- CA 19-9 is normal in your case.
In that case, doing USG or MRI-for that detection- is un-indicated procedure.
It's being advised to you, to take a chance by MRI-which could detect hidden cancers of Stomach/ pancreas to relieve your anxiety, which is undue as the clinical data does not lead to its need.
Alerts-
Unless you maintain painless status for 2 months with negative H.Pylori Stool and UBT tests with your negative H.Pylori tests , I would not ask you to discontinue your treatments.This is my practical protocol for your case.
Hope this would resolve your worries.If you have any more queries You are welcome with more queries in this regard.
Do Contact for any further query in this regard by a direct question to ME, at following HCM link-
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=70229
Do close this query with your words of praising /excellent comments to boost the morale of My visiting patients at HCM Virtual forum.
Good Day!!
Wishing Good Healthy Life!!
Dr.Savaskar M.N. XXXXXXX Surgical Specialist
M.S.Genl-CVTS
Just Leave RUQ and LUQ abdominal Pain to GI Expert !!
Detailed Answer:
Brief Ans-Just Leave RUQ and LUQ abdominal Pain to GI Expert !!
Let your expert attending doctor take proper decisions.
Hi,Dear XXXXXXX !! Thanks for your query updates to HCM.
Thanks for the proactive thanking gesture being satisfied with My last reply to this query.
Following are the Replies to your -Update / follow up questions-
- Regarding the CA 19-9 test:
- is it fairly normal for it to go up(and down)
from time to time, as long as it's in the normal range?
Ans-Dear, rising CA 19-9 Test does not mean Pancreatic Cancer Possibility in each of such case.There are many other non-cancerous causes which can rise these levels.It needs to be correlated with clinical data by expert doctor, to be labelled as Pancreatic Cancer.Yours being in normal range and without other corroborative factors. Hence just neglect this rise.
- Regarding H Pylori:
- I have read that the H Pylori antibodies only stay in the system
for about 18 months after eradication. Do you agree?
Ans-It Could stay for 12 -18 mths, but indicate the body's response to past H.Pylorie, but is not indicative of any active infection.So relax and leave it for your attending doctor to take decision on your queries and don't google and confuse yourself and don't disturb your doctor.
- does the blood test, given that it's been over 2 years
since it was treated, have any validity to it?
Ans-blood test is very weak test for H.Pylori active infection.Hence its validity if done 2 yrs back, can not be considered for the current complaints.
- if I took a stool or UBT test, and it comes up negative,
which test result should I believe: the stool/UBT test
or the blood test?
Ans-UBT and Stool Antigen Tests are more confirmatory and as said, Blood test- only confirms old or current infection with body's response by antibody- which comes in 3-6 weeks and remains for 12-18 mths in the blood.
So just believe in SAT and UBT in such a negative reply.
- Regarding taking a scan:
- would an Ultrasound have any diagnostic value
for my situation? I fear my doctor may not order
an MRI due to the cost.
Ans-In reference to detection of Cancer- CA 19-9 is normal in your case.
In that case, doing USG or MRI-for that detection- is un-indicated procedure.
It's being advised to you, to take a chance by MRI-which could detect hidden cancers of Stomach/ pancreas to relieve your anxiety, which is undue as the clinical data does not lead to its need.
Alerts-
Unless you maintain painless status for 2 months with negative H.Pylori Stool and UBT tests with your negative H.Pylori tests , I would not ask you to discontinue your treatments.This is my practical protocol for your case.
Hope this would resolve your worries.If you have any more queries You are welcome with more queries in this regard.
Do Contact for any further query in this regard by a direct question to ME, at following HCM link-
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=70229
Do close this query with your words of praising /excellent comments to boost the morale of My visiting patients at HCM Virtual forum.
Good Day!!
Wishing Good Healthy Life!!
Dr.Savaskar M.N. XXXXXXX Surgical Specialist
M.S.Genl-CVTS
Note: For further follow up on digestive issues share your reports here and Click here.
Above answer was peer-reviewed by :
Dr. Sonia Raina
Answered by
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