Brief Answer:
pain of pancreatitis and duodenal ulcer differentiated

Detailed Answer:
Hi XXXX! Good morning. I am Dr Shareef answering your query.

As I could follow from your question, you wanted to know about the symptoms of pancreatitis or duodenal ulcer and if the pain you get every time you eat is such a pain or not.

Well, there is a likelihood that you might get a pancreatitis pain in light of the past history of gall bladder surgery, and especially so if you consume any kind of alcoholic beverages of which you did not mention. If you do, you might have to discontinue the same with immediate effect.

The pain of pancreatitis in acute case is very severe and the patient might rush to the ER to get it treated, but in chronic pancreatitis, the pain might not be so severe and might be an annoying abdominal pain sometimes radiating to the back.

The pain of duodenal ulcer would also be in the mid abdomen, but typically it would come when you would be in empty stomach, in the late night or early morning hours sometimes awakening you from your sleep if so severe. Intake of food should relieve you of this pain.

In your case the pain is in the chest triggered by eating, this could be due to a pancreatitis attack, but only when a cardiac cause was ruled out as your chest pain radiates to the left arm as well. Pain both from pancreatitis and duodenal ulcer could also sometimes mimic pain from a cardiac cause, which has to be excluded with careful clinical examination and related investigations.

If I were your doctor, I would after a general physical examination including a blood pressure measurement, would advise you for some investigations like a CBC, ESR, blood sugar (both fasting and post prandial), liver function test, a serum amylase and lipase , cardiac enzyme estimations, an ECG, an echo cardiogram considering the past history of aortic valve replacement, and an ultrasound of abdomen /CT scan abdomen to either confirm/rule out chances of a calculus in the common bile duct or a pancreatitis. If all these tests come out to be normal and the cardiologist excluded a cardiac reason for your pain chest with radiation to the left arm, I would then refer you to a gastro enterologist for a possible endoscopic evaluation of the intestinal tract. In the mean time, if the pain increases in intensity, or you get any breathlessness, I would advise you to visit a ER of the nearest hospital in your area.

Till you are fully investigated to know the cause of this pain, I would advise you to go for a bland diet with more of roughage and enough liquids, avoid alcoholic beverages and smoking completely if you do, go for a proton pump inhibitor and continue with the carafate.

I hope this information would help you in discussing with your family physician/treating doctor in further management of your problem. Please do not hesitate to ask in case of any further doubts.

Thanks for choosing health care magic to clear doubts on your health problems. I wish you an early recovery. Dr Shareef

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Brief Answer:
For six weeks post relief of symptoms.

Detailed Answer:
Hi XXXX! Good evening. Good to listen from you and to know that you are better.

Even though carafate is a relatively harmless drug (unless you get disabling constipation), you could continue it for about four weeks post relief of your symptoms as the symptoms may vanish before the actual healing of an ulcer which might take at least six weeks. Once you are completely relieved, you might discontinue it.

Hope you would be relieved soon of your discomfort. All the best. Dr Shareef.

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