DEAR DR. GOTT: I have been ill for quite some time, and no one seems able to help me. It’s frustrating that I go to all these specialists and they will give me answers like “I couldn’t find anything, therefore you’re fine and should go to school.” I am 18 now, but when I was 13, I had my gallbladder removed because it was functioning at 13 percent. I have been ill ever since. Also, when I was 5, I was diagnosed with Hashimoto’s thyroiditis. I have a chromic problem of vomiting almost daily and, on bad days, several times a day. As of last spring, I have had a terrible pain that accompanies the illness and is enough to cripple me.
My doctors are at a loss and are now guessing at what it is. One doctor diagnosed me with GERD, another with IBS, and a third told me there was nothing wrong me with. I have been put on all sorts of medications, and nothing works or even helps with the symptoms.
I have recently discovered that even though I do not test positive for celiac, I react to flour in the same way, and if things are too processed, my body will not break them down. I eat healthfully and basically do the “caveman’s diet,” but nothing seems to help and, even though I am vomiting, I gain weight like crazy.
DEAR READER: My first impression is that you may have a condition known as sphincter of Oddi dysfunction. This ring of muscle is responsible for regulating bile and pancreatic flow into the duodenum (a short section of the small intestine attached to the stomach), preventing the contents of the duodenum from backwashing into the pancreaticobiliary tract and sending hepatic bile into the gallbladder.
There are two types of dysfunction. The first, papillary stenosis, occurs when the sphincter becomes narrowed, often due to fibrosis (scarring). The second, sphincter of Oddi dyskinesia, refers to a number of pressure-related abnormalities.
The primary symptom is abdominal pain. Nausea and vomiting may be present. Some patients may also experience acute recurrent pancreatitis.
It is estimated that up to 20 percent of patients who experience continued pain after gallbladder removal and between 10 percent and 20 percent of patients with idiopathic (unknown cause) recurrent pancreatitis may have sphincter of Oddi dysfunction.
There are two types of treatment: medication and surgery. Dyskinesia may respond to muscle relaxants that work on smooth muscle. Calcium channel blockers and long-acting nitrate drugs have been shown to improve symptoms. Despite this, side effects occur in up to one-third of patients, and only about 75 percent of patients will experience improvement, making this a hit-or-miss option. Those with papillary stenosis are not likely to respond to medication.
Surgery to remove excess tissue and/or relieve sphinctal pressure is often helpul. This provides long-term benefits for up to 70 percent of patients. A newer treatment with Botox is currently being used, but long-term effects are not fully known at this time.
Symptoms may also improve slightly by following a low-fat diet.
Request a referral to a gastroenterologist familiar with this disorder. This condition is fairly uncommon, so your best bet at finding a qualified physician is to contact your local teaching hospitals.
You mentioned sensitivity to flour. To the best of my knowledge, gluten sensitivity is not associated with vomiting, so you may simply be responding to your extreme diet because you are reducing your fat intake. You also mention weight gain. This may be related to your Hashimoto’s thyroiditis. You should be under the care of an endocrinologist to ensure that you are being treated properly.
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