MRI scan of lower bowel for B12? Confusing phone consultation with gastroenterologist

[Luac]

I had a scheduled appointment with the gastro last saturday by telephone. I had previously met him once last october - I had gastro issues and was unsure if these were connected to B12 or not, he took that on board.

He requested a CT, and took urine and stool samples at that time.

He was quick and to the point on the phone and gave me time to ask questions but I did not feel relaxed and had the instant impression he wanted to get off the phone as soon as possible - probably to get to the bottom of a long list of calls to make on a saturday afternoon. I know these specialists are overwhelmed.

As a result, I did not get to ask all the questions I wanted and am now confused about some of the answers he gave.

The scan brought up a hiatus hernia and also gastritis and I was prescribed omezaprole for three months (last november) at the hospital. This was not brought up in the conversation at all.

The urine sample was fine but the stool sample showed low elastase and I was prescribed Creon/aritficical enzymes last february. These made an immediate impact and my bowel movements are a lot better but not 100% - I will try taking more creon to see if that helps.

An MRI scan was requested upon getting these results. That was cancelled due to lockdown - it was meant to be at the end of march. He has now put me on the list again. I asked why I was having the MRI scan (I thought it was because of the pancreas/enzyme issue) and he said the scan is because of the B12.

Do any of you have any experience in this or know what he might be looking for?

I asked him if H Pylori had been tested for and he honestly sounded like he had never heard of it. After a while he said something about the camera during the scan but I don't know if it was tested for. I repeated my question three times.

The MRI for B12 threw me a bit - I thought he was examining the pancreas for blockages, I asked about what was causing the pancreas problem. There are a number of things that can cause this. He said that it was probably because I am HIV or it is related to HIV medicines. I really don't think that this is the case, I will consult with the specialist there.

I inferred that the ct scan would have shown inflammation or blockages in the pancreas and therefore there was no issue with that. I asked if I could do anything to heal the pancreas and he said to stop drinking alcohol. He asked some questions about my alcohol consumption in the past and I did drink a lot in my 20s - typical student life extended by working in bars and in the popular music profession - but I have had no major issues. I have my liver checked frequently and it is all good. I don't doubt that alcohol can be the issue here - every body is different and even a moderate drinker could develop this, but I want to be as certain as I can be that there isn't another reason. The major causes of the pancreas issue have been ruled out.

He did not mention exocrine pancreatic insufficiency as a diagnosis for the pancreas issue. He did not discuss vitamin deficiencies which are commonly connected to EPI, particularly A, D, E and K deficiencies.

I also forgot to mention that a paternal uncle died of pancreatic cancer, which was particularly horrible.

Anyway, I am left with more questions than answers although we talked about cancer and how that has been ruled out by more than one test.

What should I expect from a MRI for the small bowel as part of an investigation into my B12 deficiency?

Do I need to take vitamin supplements?

Have I been tested for H. Pylori?

Do I need to be diagnosed with EPI?

Should I pursue the cause of the EPI or just take it as alcohol?

Did the CT scan bring anything up - is my pancreas swollen or blocked?

I feel so frustrated for the specialists and for myself.

I will have another review in 6 months time.

[Hidden]

You need to know if you have EPI or not and that is a gastroenterologist issue. I have EPI and PA both diagnosed. My EPI is of unknown nature. Apparently in patients where gastric acid is eliminated (such as in PA) the duodenum can become faulty and not ‘request’ the enzymes from the pancreas or at least the signals for them are weak so they’re not produced. Doctors know very little about this it is still an area of research and there is at least one study on it on ncbi. I don’t worry about it now I just take the Creon. As we age the pancreas reduces its capacity to produce enzymes anyway. You should however have a special type of mri called a MRCP. This is a scam of the Ian read which should be done in EPI patients to check there is no blockage in the biliary tree or fluid filled sacs or cancer in the pancreas. I would insist on it. I have had 2 done. Good luck

[Luac in reply to Hidden]

Thanks Martin - that is good to know. Now I have to figure out how to contact his office. They are not easy to get hold of. I may try it through my GP.

[Nackapan in reply to Luac]

I would get in contact. You need alot of answers . Or list then in an email .

Good idea to go over everything with the HIV specialist.

[Hidden in reply to Hidden]

That should read 'this is a scan of the biliary tree'. Clearly need to check my responses!

[scnuke]

Hello Luac. It's all very confusing at times and very frustrating when the physicians seem too rushed or not even interested in your problems. I would imagine that they are looking for some issue in your small bowel, such as some form of IBD such as Crohn's, etc. That can certainly cause issue with your B12 absorption. The camera he mentioned may not have anything to do with the MRI, but the endoscopic "pill cam" that you swallow and it takes pictures of areas that upper and lower scopes cannot reach. MRCP is a good test to check biliary issues. The MRI is a good test and easy to do. Depending on protocol, you may get oral contrast, maybe IV. But overall, no big deal. I was in radiology field for a long time before I retired, so I'm familiar with most of these things. Good luck on your journey.

[Luac in reply to scnuke]

Hi scnuke, I don't know what you mean by camera - who mentioned that? Good information anyway - thank you!

[scnuke in reply to Luac]

You said that the physician mentioned something about the camera. Not sure if he might have referenced the MRI machine as a camera, or the small bowel camera pill they use if nothing is found in stomach or colon.

[Luac]

A quick update - the HIV specialist phoned me just now and we had a really comprehensive chat which I am grateful for.

They have reviewed the meds I have been taking and one of them potentially could cause acute pancreatitis but I stopped taking that in Sep 2018. I haven't had pain issues, I certainly haven't had acute pancreatitis and I have not been diagnosed with anything so they are happy to rule out the medication. They don't see how being HIV+ could cause pancreatitis - but again I am not diagnosed with that anyway.

I am even more confused now - the CT scan apparently did not show up any inflammation, damage or blockages in my pancreas.

I have been advised to get in touch with the secretary of the specialist and I can request a call back or discuss other means of correspondence. That could take months... but at least the creon and B12 are working well.