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Gastroenterology (Expert Forum)
Chronic Diarrhea_Husband and Wife
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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Chronic Diarrhea_Husband and Wife
by BradandMarina, May 02, 2003 12:00AM
Hi,
My wife and I began experiencing occasional diarrhea about 4 or 5 years ago. The diarrhea was accompanied by nausea, dizziness, stomach cramps and fatigue. We assumed it was just a passing bug. However, the incidences became more frequent.
When we started having bouts of diarrhea every 2 or 3 weeks, we started going to an MD who practiced holistic medicine. We did stool tests, which turned up the parasite- blastocystis hominis. The doctor prescribed Gentian, Pro Biotics and Wild Oregano. He said that low-level infection was diificult to treat and could take a while to get rid of.
The possible causes we discussed- my wife working with very young children and changing diapers, improperly washed organic vegetables, travel and using drinking water collected from an outdoor spring (the source for Great Bear spring water)
We followed the treatment with mixed results. We continued to get lab tests of our stool samples. Two different labs did the tests. One was a very complete test. The b-hominis did seem to be going away. However, the diarrhea persisted along with the symptoms. We told the doctor we were concerned about our persistent symptoms. He still did not recommend the use of antibiotics.
Then this past fall, my wife had a lab test done by a different lab(lab #3). This test showed the presence of Citrobacter and Campylobacter. At this point, we started seeing a new doctor. She saw the spring water as the likely cause for the infection. She looked at the lab results and immediately put us Cipro for 5 days.
Within 2 or 3 days, we felt better than we had for a long time. Our bowel movements returned to normal as well. When we went off the antibiotic, the diarrhea and symptoms returned. The doctor then prescribed 3 weeks of Cipro.
This time, the results were less dramatic. Our symptoms improved but never totally went away. After going off the antibiotic, the diarrhea and symptoms returned. We did more lab tests that came up negative for campylobacter. My wife did a blood test that showed increased levels of Eosinophil.
We are both experiencing frequent bouts of diarrhea or gloppy bowel movements accompanied by headaches, dizziness, fatigue and nausea. I am finding it harder to get through each day due mainly to the dizziness and fatigue, which is now occurring on a daily basis.
My wife is going through menopause and is experiencing difficult periods which I am sure are compounded by our diarrhea problem. I am 47 yrs old. My wife is 45. We are definitely experiencing the same symptoms. The symptoms often seem to be occurring at the same times for both of us.
Have you ever heard of cases of campylobacter infection that are chronic like this? Why did it only turn up in one test? Was Cipro the best choice? Can b-hominis still be considered? Can we get a more definitive lab test done somewhere? (7 tests each so far)
How do we proceed if our tests are negative but our symptoms persist?
Thanks,
Brad
My wife and I began experiencing occasional diarrhea about 4 or 5 years ago. The diarrhea was accompanied by nausea, dizziness, stomach cramps and fatigue. We assumed it was just a passing bug. However, the incidences became more frequent.
When we started having bouts of diarrhea every 2 or 3 weeks, we started going to an MD who practiced holistic medicine. We did stool tests, which turned up the parasite- blastocystis hominis. The doctor prescribed Gentian, Pro Biotics and Wild Oregano. He said that low-level infection was diificult to treat and could take a while to get rid of.
The possible causes we discussed- my wife working with very young children and changing diapers, improperly washed organic vegetables, travel and using drinking water collected from an outdoor spring (the source for Great Bear spring water)
We followed the treatment with mixed results. We continued to get lab tests of our stool samples. Two different labs did the tests. One was a very complete test. The b-hominis did seem to be going away. However, the diarrhea persisted along with the symptoms. We told the doctor we were concerned about our persistent symptoms. He still did not recommend the use of antibiotics.
Then this past fall, my wife had a lab test done by a different lab(lab #3). This test showed the presence of Citrobacter and Campylobacter. At this point, we started seeing a new doctor. She saw the spring water as the likely cause for the infection. She looked at the lab results and immediately put us Cipro for 5 days.
Within 2 or 3 days, we felt better than we had for a long time. Our bowel movements returned to normal as well. When we went off the antibiotic, the diarrhea and symptoms returned. The doctor then prescribed 3 weeks of Cipro.
This time, the results were less dramatic. Our symptoms improved but never totally went away. After going off the antibiotic, the diarrhea and symptoms returned. We did more lab tests that came up negative for campylobacter. My wife did a blood test that showed increased levels of Eosinophil.
We are both experiencing frequent bouts of diarrhea or gloppy bowel movements accompanied by headaches, dizziness, fatigue and nausea. I am finding it harder to get through each day due mainly to the dizziness and fatigue, which is now occurring on a daily basis.
My wife is going through menopause and is experiencing difficult periods which I am sure are compounded by our diarrhea problem. I am 47 yrs old. My wife is 45. We are definitely experiencing the same symptoms. The symptoms often seem to be occurring at the same times for both of us.
Have you ever heard of cases of campylobacter infection that are chronic like this? Why did it only turn up in one test? Was Cipro the best choice? Can b-hominis still be considered? Can we get a more definitive lab test done somewhere? (7 tests each so far)
How do we proceed if our tests are negative but our symptoms persist?
Thanks,
Brad
Doctor's Answer
by Kevin Pho, MD, May 03, 2003 12:00AM
, May 03, 2003 12:00AM
Hello - thanks for asking your question.
You note chronic diarrhea. Possible blastocystis hominis, citrobacter and campylobacter. Treatment with an extended course of Cipro. Possible increased eosinophils.
Typically infection with campylobacter do not last this long, especially with treatment with antibiotics (Cipro). Cipro can treat campylobacter appropriately, but resistance frequently develops. Erythromycin and azythromycin are antibiotics of first choice and should be considered if you are continuing to have symptoms.
Regarding B-hominis - I would repeat the ova and parasite tests on the stool to document whether it is still present or not. Typically a concentrated stool sample is used. Metronidazole, furazolidone, trimethoprim-sulfamethoxazole (TMP-SMX), quinacrine and pentamidine are used to treat this parasite and may be considered if the Cipro is ineffective. The fact that the eosinophils are elevated may be suggestive of a parasite.
If the infectious route is a dead end, then it is time to consider endoscopy - either a colonoscopy or flexible sigmoidoscopy. Tests for Clostridium difficile (a bacteria associated with antibacterial use) and malabsorption (i.e. fecal fat tests, lactose intolerance tests) should be considered.
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.
You note chronic diarrhea. Possible blastocystis hominis, citrobacter and campylobacter. Treatment with an extended course of Cipro. Possible increased eosinophils.
Typically infection with campylobacter do not last this long, especially with treatment with antibiotics (Cipro). Cipro can treat campylobacter appropriately, but resistance frequently develops. Erythromycin and azythromycin are antibiotics of first choice and should be considered if you are continuing to have symptoms.
Regarding B-hominis - I would repeat the ova and parasite tests on the stool to document whether it is still present or not. Typically a concentrated stool sample is used. Metronidazole, furazolidone, trimethoprim-sulfamethoxazole (TMP-SMX), quinacrine and pentamidine are used to treat this parasite and may be considered if the Cipro is ineffective. The fact that the eosinophils are elevated may be suggestive of a parasite.
If the infectious route is a dead end, then it is time to consider endoscopy - either a colonoscopy or flexible sigmoidoscopy. Tests for Clostridium difficile (a bacteria associated with antibacterial use) and malabsorption (i.e. fecal fat tests, lactose intolerance tests) should be considered.
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.
For your information.
Search “Dr Orion Truss The Missing Diagnosis” for more.
Lack of energy and digestive disturbances, arthritic joint pains, skin disease, menstrual problems, emotional instability and depression. All symptoms of what I call the 'antibiotic syndrome' which have greatly increased in frequency in recent years.
On further examination, more symptoms may be discovered. Most of the gastro-intestinal tract is tender when pressed, especially the small intestine, liver and gall bladder. There may even have been a gall bladder operation that failed to improve the condition, sometimes even worsening the symptoms.
There could be a history of thrush or oral, anal or vaginal itching. When these are present the diagnosis of Candida is obvious but it may also be present in the absence of these manifestations and that can be somewhat confusing. The yeast or fungus Candida albicans, of course, thrives during antibiotic treatment. I regard it as reckless negligence to prescribe antibiotics without simultaneous fungicides and replacement therapy with lactobacilli afterwards. I believe that this practice has greatly added to our vast pool of a chronically sick population.
However, the 'antibiotic syndrome' is not just due to Candida. I regard it more generally as a 'dysbiosis' where the wrong kind of microbes inhabit the intestinal tract, not just Candida and other fungi, but many types of pathogenic bacteria including coli bacteria which are normal in the colon but become disease-forming when they ascend into the small intestine.
If the problem has existed for years, there is usually a lack of gastric acid which then allows the stomach to be colonised by microbes, causing inflammation with pain and later, ulcers. The toxins released by the microbial overpopulation cause in addition chronic inflammation of the liver, gall bladder, pancreas and intestines. I regard it as rather likely that a chronic inflammation of the pancreas is a major contributing factor in the development of insulin-dependent diabetes.
Bacterial attack
Specific types of pathogenic bacteria appear to cause or contribute to specific auto-immune diseases. One variety of coli bacteria, for instance, produces a molecule that is very similar to insulin. When the immune system becomes activated against this molecule it may then also attack related features at the beta cells of the pancreas
Another type of bacteria, Yersinia enterocolitica, induces an immune response that attacks the thyroid gland and leads to Grave's disease with a serious overproduction of thyroid hormones.
Ulcerative colitis is linked to overgrowth with pathogenic microbes, the same as Crohn's disease, osteoporosis and ankylosing