7 months, 3 colonoscopies, healthy before

Hello,

25/m, no previous medical or family history of gi issues, always considered myself healthy until 7 months ago.  Sudden onset of GI symptoms - predominately diarrhea, cramping, and good amounts of red blood in stools/water- 7 months ago.  Finally tested stool, positive for Cryptosporidium.  3 days of Alinia.  Symptoms subsided for a few days, but returned.  Symptoms, mostly the blood, made me go to the ER.  

Primary sent me for colonoscopey with Gastro #1, who noted "missing folds" and "small ulcers lower colon".  Said blood test suggested Celiac.  Said to try gluten free diet.

Soon after, got appt at teaching hospital with Gastro #2, second colonoscopy.  Noted ulcerations appeared to be healing, biopsies returned mostly normal (only one mild inflam).  Prescribed Loperamide for diarrhea.  Suggested Ulcerative Colitis based on symptoms, but biopsies did not confirm.  Loperamide helped some, but the red blood returned with stools, back to the ER.  Performed sigmoidoscopy, noted ulcers healed, found hemmroid, asacol suppositories.  Negative stool tests.

Frustrated with lack of diagnosis and continuing symptoms, went to experienced Gastro #3.  Stool test for crypto negative again.  Based upon previous colonoscopy results, believed a diagnosis of "Post infectious IBS" would be most likely.  Continuing Loperamide.  Recently blood returned, exam showed hemmroid, asacol again.  Recent "capsule endoscopy" (swallowed camera), awaiting results.  (Gastro 2 and 3 do not believe Celiac)

Frustrated.  Was healthy, hiv negative, no history of GI/Cancer.  Wondering if diet needs more time, if ulcerative colitis despite biopsies, or PI-IBS caused by crypto.  Would an infectious disease specialist help?

Please help.

[Ratnakar ., MD]

Hi  giproblems7months,
Your problem looks more likely to be IBD. Post-infectious IBS is more common in females, with prolonged history of infective diarrhea.
Bleeding is not a feature of IBS ( But in your case though the presence of hemorrhoids may explain the bleeding, it is more associated with constipation rather than diarrhea).
I would suggest you stick on your 3rd gastro and discuss with him regarding the possibility of IBD.
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The information provided is for patients’ education only and is not a medical advice. Always consult your personal physician for complete evaluation of your health problem.

- Ratnakar Kini M.D.