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Gastroenterology (Expert Forum)
Diagnosis
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
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.
Diagnosis
by DebbieT, Oct 12, 2003 12:00AM
My son is 31 years old. He has not been diagnosed with Crones or Irritable Bowl Disease. As a young child he's suffered with episodes of excessive gas, cramping and diarrhea. He is 5'9", 115 lbs. These symptoms have escalated in the last two years. He has difficulty keeping a job because of the pain, and diarrhea - he doesn't have any health insurance. For the last year, he has gone to the Veterans hospital. He relocated from Fl to NC because he was hoping to get another opinion and help. He has just undergone his 3rd colonoscopy within the last 9 months. These test aren't shows anything definitive. The 1st colonoscopy only went up to the first bend - 45 degrees (?)They did find that he has acid reflux because of something on his esophagus. However, they have not treated that. Just how is Crones or IBD diagnosed?? They really won't treat him because they can't get a concrete diagnosis. He has taken prednisone and it worked. But, the Dr.s at the VA are reluctant to put him on it because of the side effects and the fact that it could mask a "problem". In the mean time, he is in excruciating pain and can't eat. They tell him to go to the emergency room, where they don't do anything for pain. Wasted trip. His new employer doesn't understand and he is in jeopardy of losing this job too. One doctor felt that he had a cross over of Crones and IBD, but, once again, will not treat it. Imodium doesn't work with the diarrhea - plus he is sore. The thought of eating is discouraging, and everything has lost its taste and can't keep it in. I'm trying to help him keep his spirits but, but its getting harder and harder. Plus, he can not call a doctor with issues or concerns. His appointments are usually only once per month. If the medication doesn't work, OH Well!! Eating solid foods hurt probably because his stomach has shrunk, but now comes the question of what he sould or shouldn't eat. Can't take vitamin pills, they don't stay in long enough to be absorbed. And a doctor told him he didn't have an absorbtion problem. Some say fiber, others say no, some say stay off of dairy, other say no. I suggested a liquid diet to get something nutritional in him. This is a vicious circle.
I should mention that on his fathers side of the family they have a history of digestive problems and IBS along with my father.
He is losing his energy and his will.
Please, please HELP!!!
I should mention that on his fathers side of the family they have a history of digestive problems and IBS along with my father.
He is losing his energy and his will.
Please, please HELP!!!
Doctor's Answer
by Kevin Pho, MD, Oct 14, 2003 12:00AM
, Oct 14, 2003 12:00AM
Endoscopic and radiologic studies of the bowel are the major tools used to establish the diagnosis of Crohn's disease. Although the diagnosis of ileal Crohn's disease is occasionally made by colonoscopy, a barium study of the small bowel remains the mainstay of diagnosing ileal disease as does the upper gastrointestinal series for gastroduodenal disease. These are usually done as initial studies if small bowel involvement is suggested by pain location and the absence of gross bleeding.
Another option for diagnosis would be an intestinal biopsy - but this is normally done to confirm presence of the disease rather than making the diagnosis.
If there is question about IBD despite colonoscopies and X-ray studies, you may want to consider the diagnosis of malabsorption which can also present similarly. Tests for celiac disease and fat malabsorption (via a fecal fat test) can be considered to evaluate for this.
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.
Bibliography:
Peppercorn. Clinical manifestations and diagnosis of Crohn's disease. UptoDate, 2003.
Another option for diagnosis would be an intestinal biopsy - but this is normally done to confirm presence of the disease rather than making the diagnosis.
If there is question about IBD despite colonoscopies and X-ray studies, you may want to consider the diagnosis of malabsorption which can also present similarly. Tests for celiac disease and fat malabsorption (via a fecal fat test) can be considered to evaluate for this.
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.
Bibliography:
Peppercorn. Clinical manifestations and diagnosis of Crohn's disease. UptoDate, 2003.
It is a pill camera that is swallowed and observed by a specialist during an 8 hour process.
It is not as invasive as a colonoscopy and can identify problems with the small intestine as well as the the colon.
The prep is still necessary prior to the procedure and if there are any findings a further colonoscopy or endoscopy may still be necessary. However, it is very good at diagnosing potential problems in this area.
Here in Canada, it is not covered by health insurance and it costs approx $1200.00 CDN, however, when serious health concerns are present it is a very useful tool.
I hope your son finds some answers soon. Good luck!
Chrohns and IBD are diagnosed by colonoscopy, however a barium series with small bowel follow through can often diagnose Chrohns.
There are no visable abnormlties with IBS. IBS is diagnosed by symptoms,doctors are supposed to follow the rome criteria--and when everything else is properly ruled out, then IBS is the assumed problem.
http://www.mercola.com/2003/sep/13/inflammatory_bowel_disease.htm
Lactose is milk sugar , feeds yeast. I reply regularly to undiagnosed gastro problems , I now use this as a standard reply .The forum doctor has acknowledged yeast infections [sort of] in past debate , I don’t think he treats the condition though . pity it’s the cause of much illness .Take a look at this article ,the authors link fungi with degenerative disease in general , Believe me I have researched yeast/fungal infections for 4 years their conclusions are correct. . You might consider a yeast infection , 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 C3 concernedmck(15-Mar-03) .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. C4 rose25(15-Mar-03) .SPEAKING FROM EXPERIENCE:Make sure your doctor rules out..HEPATITIS A !!!!!ALSO make sure he rules out...H. PYLORI with the proper tests. C5 paj(16-Mar-03) Everyone concernedmckA 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 C6 concernedmck(17-Mar-03) .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.