Hi! I have been having pale, oily stool, and the pain that I almost always have on my left side at the ribs is worse. I had my gall bladder removed last year, and just started taking Lomotil (one or two a day). I also take Levsin occasionally, and Methotrexate once a week. The only other thing that's unusual right now is that for about a month I was trying a gluten free diet. It wasn't changing anything as far as I could tell, and I'm on vacation, so I've resumed my normal diet...not overboard on the gluten, but haven't been avoiding it either. I feel a little shaky, and the pale stool is kind of freaking me out!

thanks,
ellen

I would still vote for biliary obstruction. Just because you have your gallbladder removed, it does not mean that small stones or sludge cannot form and block the common duct. However, your pain would typically be on the right. That said, referred pain is not uncommon and it is also possible that an obstruction could cause pancreatitis, making your pain more diffuse and into the back. You need to see your doctor.

You also should be checked for side effects of methotrexate, since liver inflammation can be caused by it.

Jan

Thank you for this information! I'll follow up.
Ellen

Celiac disease maybe???

If it were celiac disease, symptoms should improve, not worsen, with a gluten free diet.

Jan

I was on a gluten free diet, with perhaps a few (2 or 3) mistakes that were part of the learning curve for me. After 3 weeks, I saw no change, so have in fact been eating gluten. I was going on vacation, and wasn't certain I had followed the diet carefully enough to have an effect, so I stopped. It's been about 5 days of eating gluten again. I think that the dr. said I tested borderline for gluten sensitivity. I intended to resume the gluten free diet more carefully when I got back home, and was going to study it carefully to avoid mistakes, and try it for longer, too.

I've been on a gluten free diet (only since last week) due to testing positive to a severe intolerance to Gliadin. It takes approx 3-4 weeks to detox and approx 3-6 months to repair the damaged villi which lines the small intestine. It was just a thought since grayish stool is a symptom of celiac disease. I know there's a saliva or blood test to confirm the illness. Gluten free is a huge obstacle with regards to having the pouch cause it really limits your intake. Let me know.

I completely agree that pale stools can be a symptom of celiac disease. But, if you did not have this symptom before and only tested borderline, it is not likely that a few days of resuming gluten would cause worsening of symptoms so quickly. I still think liver function studies are in order, especially since you are on methotrexate.

Also, another interesting tidbit is that there is an association between celiac disease and autoimmune liver disease.
http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/

Jan

This message has been edited. Last edited by: Jan Dollar,

Thanks for your responses. I stopped taking lomotil, and took my usual weekly dose of methotrexate. Everything seems back to normal now. That still includes going 10x a day, and very loose stool, but normal (for me) color etc. I plan to keep an eye on things, then call my dr. when I get back home. It doesn't seem like lomotil would be related, but I feel safer with the routine I followed before these problems. Can you have intermittent liver problems? I know the levels were off when I had my gallbladder removed. However, I was tested regularly for awhile because I was on Remicade for about 6 months, with no problem during that time.

Well, if things are back to normal, you are probably in the clear. Seems strange though that it would make that big of a difference. If anything, you'd think that the little bit of atropine in it would help open your common duct sphincter and release more bile. But, if you were sort of stopped up from too much bowel slowing, maybe that was the problem.

You don't have routine labs for your methotrexate monitoring?

Jan

I think I'm supposed to have tests every three months or so, and I'm probably about due.

I recall for a few years after my j-pouch surgery, I couldn't take lomotil. If I remember correctly, whenever I took it, I felt a lot of very uncomfortable pressure below my ribs, especially after eating. It did feel backed up, like nothing was progressing along the digestive tract. I also know that this isn't the first time I've had pale stool, though I can't say for sure if it was when I took lomotil or not. I tend to forget things like that, but I know I had told myself not to ever try lomotil again. The GI Dr. suggested I try anyway. My pouch is much bigger now, he says. At first it seemed OK. None of the pressure under the ribs. That was one pill a day. Two a day, one every twelve hours, is when the stool change came. Now, after a day or so back to normal, and no lomotil, I'm having some bleeding when I go. I guess I need to wait it out to see what happens, instead of getting so alarmed so quickly.