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hepatologist Vs gastroenterologist ?

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Posted 4/27/2024 4:28 PM (GMT 0)
(TMI warning mid-post).

I’ve pretty much given up on Gastro docs. Unfortunately, in my experience, they are just generalists of the digestive system, and don’t really know any of it that well.

When they just tell me I probably just have EPI (Exocrine Pancreatic Insufficiency), (English: digestive enzyme, insufficiency), without any further digestive organ investigation, that doesn’t really tell the whole story.

Two years ago, my Digestion changed. My normally shaped brown stool that sunk in the toilet changed to light Caramel color, fluffy and floating. Symptoms of EPI, or something more. EPI doesn’t really tell you what caused it.

———————
Like many here, I like answers, instead of covering things up with health Band-Aids. In my opinion, digestive enzymes, supplemental bile, and probiotics, are just digestive Band-Aids, not addressing the real cause.

I Would prefer state of health details of my:

1)pancreas,
2)liver,
3) bile ducks,
4)and gallbladder.

I have no pain.

There are always non-standard health tests that are better than the first ones they do. Some doctors never do these even though they’re out there they are probably doing what insurance companies tell them to do, nothing more.

Without me googling all day, I’d appreciate if anyone knows any deeper specific tests that they do for the above information.

My pancreas enzymes were low. But they did not test bile. If they could or not I don’t know. My abdominal cavity MRI from two years ago, looked good other than an adrenal tumor. They did the most basic H. pylori breath test which was negative. They didn’t do the other H. pylori test whatever that is.

I’m going to ask my primary doctor to repeat candida antibody testing, which has been positive several times in the distant past.

——————

Maybe I’ll have to change clinics and find a private Hepatologist to get these answers. I don’t understand why gastroenterologist have a lack of interest in figuring this out.

Would a tire shop tell you to just keep on filling up a leaky tire and go away?…no, they would fix the leak or sell you a new tire. 😊😊

Post Edited (astroman) : 4/27/2024 8:50:18 AM (GMT-8)

Posted 4/27/2024 4:52 PM (GMT 0)
in my experience gastroenterologists are gastroenterology surgeons - in other words plumbing specialists

so if you have some bad plumbing you want taken out - they are your man

everything that is not a plumbing problem- is to them entered on their chart as a "functional issue" and not something they deal with - so they treat it as their job is done if there is no gross blockage, hole, fistula, tumour etc that they can cut out etc

i think the US has some functional gut doctors - so that is the only direction i think that can offer some more insight

otherwise you are mainly just looking at clues from things like:
-OAT test ( shows gut microbial metabolites from things like yeast and bacteria )
-full panel of all 4 liver enzymes can give some clues as to blockage or other cause of liver enzymes
-SIBO breath tests
-stool tests can test for pancreatic enzymes ( protein remnants) , bile acids, inflammation markers etc etc
Posted 4/27/2024 5:11 PM (GMT 0)
It’s funny that this large gut clinic doesn’t even suggest a proper doctor.

But (no puns intended), There seems to be a shortage of doctors within their digestive clinical practice, so they just assign whoever is available to you as a patient.
Posted 4/27/2024 6:01 PM (GMT 0)
One thing I will try to focus on, basically make a test out of what separate supplements help when. Versus taking a bunch of digestive supplements altogether.

I’m dividing them as such:

1)probiotics,

2)three digestive pancreatic enzymes,

3)and supplemental ox bile(1000 mg capsules of Jarrow bile acid factors)

4) Anti-candida supplements, herbs

Taking larger quantities of each individually should help me focus a little on what the problem is.

Today I’m starting with taking only bile in larger quantities than in the past. If that turns the “pale flushers “ from caramel color to a darker brown, then I’m on track to bile insufficiency. I think it’s enzymes that make them more solid though. I will find out.

I should also get my Billy Rubin checked again.

Billy Rubin (iPhone) = bilirubin

———————-

(The above text Dictation is proof that iPhones do not learn, Even with operating system updates). I said that word and corrected spelling at least 20 times On this modern iPhone. I speak, and pronounce very clearly with no drawl or twang to the English language When using this phone. People with android phones, Don’t switch to Apple.

You can Google this to entertain yourself, it’s out there. 😳😂
.

Post Edited (astroman) : 4/27/2024 10:19:54 AM (GMT-8)

Posted 4/27/2024 7:10 PM (GMT 0)
The gastroenterologist who I’m under for EPI recommended MRI of pancreas, small bowel and abdomen so maybe do those?

Other potential causes of EPI are SIBO and celiac (I think) maybe check the last one

You might not be able to find the root cause but taking creon (pancreatic enzyme) is essentially replacing the issue which should resolve symptoms (it doesn’t always)

Dr Myhill has a page on her website about EPI

click here to view

I found this really helpful which is a guide for medical professionals for how to proceed with EPI. It also includes a list of potential causes

click here to view

Post Edited (pinkblossom) : 4/27/2024 11:14:59 AM (GMT-8)

Posted 4/27/2024 8:03 PM (GMT 0)
Pink - That doctors website has a pretty good description. I know my vitamin D is low, which is not uncommon in the winter time in the northern hemisphere, but I will test the other vitamins that possibly may be low as well.

From the second link, PubMed -

“……tests of exocrine pancreatic function but often in very specific circumstances. If used routinely in gastrointestinal practice, an abnormal result will frequently occur but this cannot be assumed to mean that the patient has PEI. This finding should prompt the clinician to arrange further investigations to identify whether there is evidence of primary PEI, secondary PEI or whether there is another reason why the Fel-1 level is low”

That’s my Point. If they just find that your Pancreas enzyme levels are low, their work is not done. They are only halfway there.
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