Severe abdominal distension for over 2 years. What is going on?

More importantly: how is your pain right now?

Good you did a meticulous parasite/pathogen stool test! Happy doc did a 3 day sample (as so many don't).

So nothing found there (in PCR also covering the Bhominis and Ehistolytica), please always have a print out to see what was tested and how, not only 'culture'.

I have to say we also did a complete fecal stool assessment, but it has to be paid privately (to see % of non pathogenic bac distribution). Still waiting for results as it takes a month.

Throwing in L.rhamnosis  LGG currently in 15Billion units per day as a probiotica and 10ml Aloe vera just to support guts a bit. 

As to GGT,

that is one of the most sensitive markers/enzymes, you drink a glas and up it goes as alcohol is liver toxic,

sometimes even diet change can reverse a slightly raised GGT (look up fatty liver diets) when it is simply on its limit with work.

GGT-THE parameter to check on those, who were blood alcohol positive and are professional drivers.

Well 88U/L, yes elevated, but mind you, it can go into 100s.

Usually GGT is only false high in high hemolytic sera (=when red blood cells burst, be it blood sample got too hot or cold or taking was a squeezing effort, red cells have enzymes in them in higer levels than in plasma, hence wrong findings when red blood cells burst and release their content into plasma/serum)

GGT will also go up if you take medications though.

Do you take any meds? 

I personally would think of cardiovascular diseases as GGT is a pretty good marker to say 'take more care of me please with diet and meds' and

ask hospital/doc, for re-check and if they can do AST ALT and triglycerides then too?

Note all medications you were taking

and have a diet that supports your liver function.

Then you know more.

You had an upper abdo MRI (described stomach), so liver was seen, right? (I had a benign liver tumor, hence GGT was double upper limit)

I am startled that you got results posted.

Yes ring and ask please!

Normal  ALP is a good sign though, too.

Please cross check with doc and if possible at a point of time re-check with other parameters and have  a liver friendly diet till then.

And see then what your GGT does.

All the best!

Hi Sanya and thank you so much for your very helpful and thorough post. 

At the moment my pain is mainly at the discomfort level, although I have had a few episodes of severe upper abdominal pain that radiate through to my back and last anything from 15 mins to a couple of hours. It might be coincidence but these pain episodes only started up again when I was taking the probiotic Alflorex (Align in the US).

For the first 2 weeks of taking Alflorex the distension was worse, then I had 2 days of non-stop gurgling and 'movement', and then suddenly the distension was greatly reduced. Great I thought, and for 5 days I felt a lot better with hardly any discomfort. Then I started getting low level pain again, mainly in my lower abdomen and almost constant whereas previously it only started later in the day. I read that some users of Alflorex suffered digestive discomfort with it, so I persevered for another 3 weeks but then stopped taking it. After about a week the pain seemed to go, although I still had odd days when it returned for no obvious reason. However the distension also returned.

I have now just started taking another probiotic Vivomixx (also known as VSL3) in the hope that it will reduce the distension but without the pain. Too early to know yet as I am only on day 3. 

Getting back to the GGT level. I haven't had any alcohol since my abdominal troubles started, so almost 2.5 years ago. It was mentioned as a stomach irritant so I just cut it out, along with caffeine. Before then I was only an occasional drinker anyway. 

I am not on any meds other than HRT. Apart from my abdominal troubles I seem to be pretty healthy. Whenever my blood pressure has been taken it has been very good, I eat healthily and walk about 6 miles everyday. I have looked at the fatty liver diet and it seems pretty much in line with what I eat normally anyway.

The MRI scan was for small bowel motility. I know it showed some food remaining in the stomach but do not know how much of the liver was included in the scan. 

I will certainly do as you say and get more information from the doctor. ALT features on my blood test results (and is normal) but there is no mention of AST or triglycerides. 

Again, thank you for your help. I will post again when I have spoken to the doctor. 

 

Now I am curious as you replied, but needs moderation.

Hope you are feeling ok!

I'm curious as to why my post needs moderating. Nothing controversial in it. 

Yes, I'm feeling ok thank you - apart from the now usual pain and discomfort. 

How long does it take for a post to be moderated?

I think it is here now!

Ah, yes, usually brand names get grounded.

Had to look it up:

- Bifidobac infantis 35624 (no dose found, CFU), quite a raved product, claims to be against bloating, hm, unless you react to something of the fillers/packing: Maize Starch, Pregelatinized Maize Starch, Hypromellose, Magnesium Stearate, Titanium Dioxide

- other one a high 450 billion CFU mix (Streptococcus thermophilus, L. acidophilus, L. plantarum, L. paracasei, L. delbrueckii subsp. bulgaricus bifidobacteria breve, B. longum , B. infantis, (maltose), anti-caking agent (silicon dioxide))

We tried B. bifidum MIMBb75 for half a year with zero impact on guts, the oh so IBS cure. one gets so desperate.

If you have upper abdominal pain and an elevated GGT, I would enquire about liver, if it was looked at.

Or what other ideas doc had.

You are right, radiologists look very specificly at each indication/question and not at other also visible parts if not obvious to the blind eye as time is money.

(We had abdominal x-ray for fecal impaction question though, not only was the loading in ascending colon overlooked as if radiologist only looked at rectum, which is clearly a mistake re indication, but the hips were visible too and a problem visible, but not noted then since not in indication question to look at and not that obvious)

Oh yes please, let us know when spoken to doc again and which further direction or even diagnosis.

You are a very fit person, what else could you actively do.

Yes, get re-checked please. ALT normal is good too.

An upper belly ultrasound?

All all the best!!

Hooray! I didn't want to have to type all that out again.

Well, I rang UCLH yesterday (who were the ones that ordered the blood tests) only to find that I have been discharged from their care (although nobody had bothered to tell me this) and it is now over to my GP. So I rang the GP's surgery and they hadn't received a copy of the blood test results. So I rang UCLH back again and they said they'd send another copy to my GP. I'm not very impressed at the moment. It seems UCLH have exhausted their standard repertoire of tests and that I'm now something of an inconvenient nuisance. The consultant doesn't seem to have the time or inclination to think out of the box. :-(

In the meantime I've been reading up about GGT and I'm beginning to wonder if I've got two separate issues going on. I'm known to have gallstones which could account for the elevated GGT level. The severe upper abdominal pain that I get infrequently could be down to the gallstones. Whereas the distension and lower abdominal pain and movement are probably down to the functional GI disorder. 

Anyway I'll have to wait until my GP receives their copy of the blood test results. 

Uagh, yes,

the communication is so key and so often not working.

But you have your copy, you could also take that to GP to avoid further delays. ?

The moderate GGT elevation is something for the GP to further investigate or exclude, compare with previous GGTs if you have any.

(As said, I was your level for years until I got an upper abdomen ultrasound and it was a physical benign tumor squeezing the cells, nothing chemically going on.) 

Looking at heart disease parameters is a good start, too. (e.g. triglyceride, glucose...)

Yes, people can have as many diseases as they like,

the upper and lower abdo problems could be one and the same or be very different and not connected. Gallstones if silently not blocking should not make problems, but who knows, maybe they are blocking or irritating.

Yes, please, I hope your doc gets you started on looking up on liver/gallbladder/duct via further blood tests (bilirubin, all liver enzymes, CRP, triglyceride....), and ultrasound and go from there.

So far your few enzyme levels do not sound highly alarming, yet you need to know, if something was underlying.

All all the best!!!!

Take good care and pls keep us posted to see, where symptoms lead to which diagnosis.

TA!

PS: 

1) Common bile duct stone can simulate acute hepatitis and AST and ALT would be elevated immediately, GGT and ALP delayed.

--> your ALT is normal......

2)  if only GGT level is elevated (other liver enzymes normal), this can be via alcohol or aromatic medications with no actual liver disease. 

--> HRT is aromatic medication (ring structure), note: not all HRT get a higher GGT. Apparently those with Turner Sydrome -please don't take that personally, I see it plain factual and scientifically- actually tend to higher isolated (without other liver enzymes going up) GGT levels, too.

Please have a look into the leaflet of HRT of side effects. Maybe gives some clues to discuss with doc.

I still think an ultrasound

and a new blood sample covering all liver enzymes and more would be really good too.

 

Again, Sanya, many thanks for your help and information.

I didn't know what Turner Syndrome was but have looked it up and no, I don't have that.

The HRT I am on is a combination of estradiol hemihydrate and norethisterone acetate. I have left the brand name out to avoid further lengthy moderation. :-)

I will let you know what my GP comes up with. 

Just to let you know that despite chasing the GP's surgery for a week I'm still none the wiser as to what should be happening so have booked a telephone consultation with one of the doctors. First available is 21st June (which isn't very impressive either) so watch this space!

oh yes, can so relate to that, waiting, waiting, waiting. We have 7 or 14 months waiting times for specialists....only to find out, it was the wrong one.

Hope your waiting was all worth it and get an answer!!

BTW, side note:

we got our fecal microbiological analysis back, overgrowth of bifidus bacteria. ROFL. We should not take any bifidus or lactobacillus probiotica anymore! !! How funny is that. Who would have thought.

( stool is yeast free, rest was more or less good, too, maybe push some Butyrate producing bacteria as they were very low, but it is very hard to find those products as the market is flooded with lactobacilus and bifidus, closest was a clostridium butyricum probiotic product, that I could find. We are taking Aloe vera anyway and will add arginine as food for those butyrate producers. We have no FODMAP diet success, so had no fear of introducing Aloe vera slowly, which is a fructo-oligosaccharide, that others oh so have to avoid....balance act, always a very individual balance act)

for the FMA one has to be off probiotica and antibiotica and my patient daughter was, but a bifidus overgrowth....and too little butyrate producers....