The Indigestion Question …

During Cholangiocarcinoma Awareness Month, CC Symptoms were covered on Day 5 of our Facebook Facctoid feature:

“CC’s symptoms can be vague … Because cholangiocarcinoma (bile duct cancer) arises from the bile ducts, either within the liver or after the main bile duct leaves the liver and links the liver to the duodenum, the commonest symptoms are due to blocking of the flow of bile in the bile ducts – jaundice (yellowing of the eyes and skin), often in association with dark urine or pale stools, a pain or ache under the right ribs, and sometimes itching. There may also be unexplained weight loss, general malaise and fatigue. Whilst several of these symptoms can be non-specific and could be caused by benign conditions, they do require urgent assessment (especially where jaundice is present).”

This prompted the indigestion question

After the Symptoms Facctoid, we were contacted by several people mentioning that indigestion (often ongoing and that no remedy prescribed by their GP would settle) had seemed to be their first symptom – but it isn’t one of the listed ones.

AMMF put this to various specialists, asking, “Is this a known symptom? – it would seem logical.”

We’ve had several answers – including one from a specialist mentioning he had indigestion right then! – to the effect that “indigestion” is such a non-specific symptom affecting up to 40% of the adult population at any one time that adding it to the list of possible symptoms would send out the wrong message – because in “999,999,999 cases out of 1,000,000,000, it isn’t cholangio.”

However, we’ve also had, “Indigestion, which is a very widely interpreted term, may well be a symptom of CC, but is also a symptom of so many other things … I am not surprised that it is a common symptom in CC as well. But it’s also akin to saying headaches are a symptom of brain tumours, which is true, but most people will experience headaches at some point … very rarely will it turn out to be due to a brain tumour.”

So, in the same way a headache doesn’t mean a brain tumour then, of course, indigestion doesn’t mean CC – but sometimes (fortunately very rarely) it would seem that these can indeed be initial symptoms of those more serious conditions …

Dr Juan Valle of The Christie, Manchester, commented: “Interesting – the issue here is that “indigestion” means different things to different people. Although strictly it should relate to acid-related reflux (so discomfort in the midline, just under the breast bone) it may in fact be liver capsule pain (from primary tumour or metastases) or indeed an episode of low-grade cholangitis. Thankfully, most people with “indigestion” do indeed just have acid-related problems with nothing any more serious. So, … one to add to the “vague” list!”

And a further specialist’s comment, “I certainly agree that persistent dyspepsia, not responding to standard therapy warrants further investigation. I also do agree that it can be added to the list of non-specific, “vague” symptoms that may be experienced in CC.”

And the conclusion is:

As many have mentioned it as being one of their first most noticeable symptoms, and from the medical comments we’ve received, it does seem the general consensus is that unexplained, ongoing indigestion (especially in someone who doesn’t normally have indigestion), should indeed be added to the list of those “vague” CC symptoms.

As always, we’ll keep asking the questions …

For further information on CC symptoms and diagnosis, click here

November 2020