“Postprandial diarrhea?”
Every time I eat a meal, I get severe pain in my left abdomen, then have to run because of severe watery diarrhea.
I’ve had IBS-d for 30 years. It’s caused such dehydration & pain, that I’ve been hospitalized numerous times. Lest time was 1 year ago. I had obvious blood in my diarrhea, plus the following positive tests: stool lactoferrin, CRP, sed rate, & CT scan showing colitis. My tests for infectious agents were negative.
Still, since I’ve had many colonoscopies that showed little or no abnormalities, my doc still treats it as IBS, not IBD. I’m frustrated because all the normal IBS treatments don’t work.
What should I do?
I’ve had IBS-d for 30 years. It’s caused such dehydration & pain, that I’ve been hospitalized numerous times. Lest time was 1 year ago. I had obvious blood in my diarrhea, plus the following positive tests: stool lactoferrin, CRP, sed rate, & CT scan showing colitis. My tests for infectious agents were negative.
Still, since I’ve had many colonoscopies that showed little or no abnormalities, my doc still treats it as IBS, not IBD. I’m frustrated because all the normal IBS treatments don’t work.
What should I do?
Female | 51 years old
Complaint duration: 30 years
Medications: Benedryl, clonazipam
Conditions: IBS, asthma, heartburn, dystonia
4 Answers
Gastroenterologist|GastroenterologyGastroenterologist
You should get another opinion from another GI doctor. Either a diagnosis has been missed or you have not gotten optimal treatment for IBS. Either way, another opinion would be worthwhile.
I would be suspicious of underlying inflammatory bowel disease. Would opt for a second opinion evaluation and make sure you bring copies of your past labs described above, procedure notes and path reports. It may be worthwhile to evaluate your small bowel with CT/MR enterography and potential capsule endsocopy if you have not had these tests.
You need a consultation with a gastroenterologist. Take all these reports with you when you go for your visit. My office is open for urgent cases during this pandemic, and I think it’s the same for other gastroenterologists as well. Telemedicine is also available, but that’s for follow-up visits with existing patients.
I understand how frustrating your situation can be. I see patients that come to my office with similar long-standing symptoms and no real answers. In reviewing your symptoms and test results, I would mention the following: Your test results are non-specific, meaning the positive lactoferrin, slightly elevated sed rate, and borderline CRP, can be seen in certain conditions, even if you don't have IBD (infections, rheumatologic conditions, other autoimmune conditions). I would suggest getting a fecal calprotectin (which is slightly more specific than lactoferrin), as well as one of the commercially available IBD serology (blood) tests (Prometheus and Mayo labs are two labs that run these). If these are elevated, that would make it more likely that you have IBD and not IBS. You also need to be ruled out for celiac disease and microscopic colitis. Microscopic colitis is diagnosed with random biopsies during the colonoscopy (especially right sided biopsies). Stool tests for infection (C diff, giardia, cryptosporidium) also need to be done. Now, assuming all of the above come back normal, I encourage my patients to try a low FODMAP diet. I also like to test for (or empirically treat) SIBO (small intestinal bacterial overgrowth).
Hope that helps!
Hope that helps!
