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Gastroenterology  (Expert Forum)
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Unexplained diarrhea for five months
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D. Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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MedHelp Member's Question

Unexplained diarrhea for five months

by concernedmck, Mar 14, 2003 12:00AM
Tags: diarrhea
I am a 34 year old female. I suddenly developed diarrhea nearly 5 months ago - three months after I had my first baby (in case that's relevant).  Since then I have not had a normal bowel movement. Every movement is liquidy or at best, very loose. I have 5-10 episdoes a day. It's usually worst in the morning when I get out of bed. I have no other symptoms - no pain, no blood, no discomfort, no mucus. I am generally healthy, I sleep well, I eat a balanced diet, have a good appetite (although not quite a good as before this problem), I eat slowly and am a non smoker/drinker.



I have seen a specialist who has checked/put me on the following and is admitting that he is running out of options.  He is relucant to classify this as IBS due to the severity and continuity of the symptoms:



Treatments/Tests:



fasting - 4 days - no effect

Flagyl - 7 day course - no effect

Full investigation of stomach and colon (colonoscopy) and barium ultrasound - no abnormality found

Celiac test - negative

Stool culture - normal

Various blood tests, inc. anaemia - normal

Questran - no improvement

Pentaza - symptoms slightly worse

Steroids (deltacotril) - slight improvement but insignificant



If you have ANY Suggestions as to what could be causing this, please let me know. I really want to try and cure the problem and am worried that it is not ever going to go away.



Thank you

Doctor's Answer

by Kevin Pho, MD, Mar 15, 2003 12:00AM
Hello - thanks for asking your question.



Please understand my limitations over the internet as I have neither met nor examined you. This information is for patient education only. Please see your personal physician for further evaluation.



You are describing chronic diarrhea despite a battery of normal tests.  Here are some other tests to consider.  



You may be describing what is known as secretory diarrhea which characteristically continues despite fasting.  Further testing in patients with secretory diarrhea may include stool cultures to exclude chronic infection and imaging of the small and large bowel (which has been done).



Selective testing for secretagogues, such as gastrin or vasoactive intestinal polypeptide (VIP) can evaluate for endocrine tumors that can cause diarrhea.



Testing for bile-acid malabsorption or empiric treatment with a bile-acid binding resin may also be helpful in secretory diarrhea.



Fatty diarrhea (steatorrhea) should be suspected in patients who report greasy, floating, and malodorous stools.  A quantitative estimation of stool fat can be done to evaluate for malabsorption.  



If every single test continues to be negative, you then may want to consider the diagnosis of irritable bowel - as this is one of the more common causes for chronic diarrhea.  There are many options for treatment, but the patient response is variable.  You may want to discuss these options with your personal physician.  



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Thanks,

Kevin, M.D.

Member Comments (8)

by PAJ, Mar 15, 2003 12:00AM
You might consider a yeast infection , I must say your not a text book case but with Flagel not having much effect it’s worth considering. You wont get this information from the docs BTW they are [mostly] in denial over the condition . Doctors today are crippled by the politics of medicine , they practice what has been termed “Defensive Medicine” that roughly translates,  if it’s not in the book you don’t get treated.  

I speak from experience , yeast infections are endemic ,& and are believed to be the main missing link in many of our modern day diseases and sub health conditions.

I find it extraordinary that doctors especially on a gastro forum totally ignore the condition , Still Forums could have been invented for situations such as this .

Read this article , http://drcranton.com/CFIDS.htm#CFIDS%20Paper it turned out to be my personal “Rosetta Stone” it detailed most of the symptoms that had puzzled both myself and my doctors. As you see  he favours a trial on drugs for a diagnosis , from your symptoms if you have the condition you should react fairly dramatically to Nystatin .It’s a very safe drug ,but you must take doses  that are up to the job ,that is five million units per day [10 tablets ] try it for a couple of weeks. If you [or anyone] take this advise please report back so we may know how the theory is working out. Good luck



"WITH THERAPEUTIC USE 1. Toxicity from orally administered nystatin is extremely low. Dermal application or ingestion of even large quantities should produce only minor GI symptoms. Treatment is usually unnecessary.".........."Laboratory: Nystatin is not well absorbed orally. Unless GI inflammation is present, blood levels should not be detectable. Therapeutic or toxic blood levels have not been established."........"Toxicity due to nystatin is negligible. Even when large amounts have been ingested, ensuing symptoms have been minor. Charcoal, emesis and cathartic should not be necessary."......."ABSORPTION...FROM GI TRACT IS NEGLIGIBLE, & DRUG APPEARS IN FECES. WHEN DOSES OF 8 MILLION UNITS OR MORE ARE GIVEN, INDIVIDUALS WITH NORMAL RENAL FUNCTION MAY HAVE PLASMA CONCN OF ONLY 1-2.5 UG/ML. ... NYSTATIN IS NOT ABSORBED FROM SKIN OR MUCOUS MEMBRANES. [Goodman, L.S., and A. Gilman. (eds.) The Pharmacological Basis of Therapeutics. 5th ed. New York: Macmillan Publishing Co., Inc., 1975. 1236]**QC REVIEWED**"

http://toxnet.nlm.nih.gov/cgi-bin/sis/search/f?./temp/~AAAnTaaFg:1



by concernedmck, Mar 15, 2003 12:00AM
Thanks Paj for you advice. I'll look into that.  I used to suffer alot from sinus problems which were attributed by an "alternative" doctor to candida type symptoms, so I somewhat understand the background to yeast infections.  Thanks again - I'll look into it and let you know.

by karrie2020, Mar 15, 2003 12:00AM
SPEAKING FROM EXPERIENCE:



     Make sure your doctor rules out..HEPATITIS A !!!!!

     ALSO make sure he rules out...H. PYLORI with the proper

     tests.





by PAJ, Mar 16, 2003 12:00AM
To: Everyone concernedmck
A couple years ago Mayo clinic released a research proceedings claiming they had research indicating that almost all chronic sinusitus is ultimately caused by inflamation induced by a fungal infection. This research has now been independently reproduced by a lab in Europe.

http://www.mayo.edu:80/sinusinfo/index.html

Mayo clinic now has attracted  a massive grant to study the possibility that fungal infections are involved in more health problems. They are currently pursuing one such clinical trial investigating asthma... they believe that the same mechanism found in sinusitus is causing lung inflamation in asthmatics.

http://www.mayo.edu:80/research/crpad/trial_126.html

  Try this forum for more information



http://www.healthyawareness.com/_pages/forums.htm



by concernedmck, Mar 17, 2003 12:00AM
I've read quite a bit into the subject of yeast infections because I also have a condition called endometriosis which again is often related to Candida.  When I saw you're suggestion about checking yeast infections, I kicked myself for not having thought of that before - I just didn't realise one could have an isolated disgestive problem.  I've started a non yeast, non sugar diet to see if any improvement starts, and will be seeing my doctor in two weeks when I can talk to him about possible medication.  Thanks again for your advice Paj.

by Schmoopie, Mar 21, 2003 12:00AM
I too experienced diarrhea