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Chronic Diarrhea, No Diagnosis
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Chronic Diarrhea, No Diagnosis

I've now had diahrrea (very frequent bowel movements, 4-8X day, often flaky dissolving upon entering the water, sometimes formed but loose, and ocasionally but not often watery) for 8 months and running.
I am really frustrated because I've had extensive GI tests which were negative:

1. colonoscopy with biopsies- negative (but exess bile found in stomach)
2. endoscopy-negative (but showed severe acid reflux/hiatus hernia)
3. small bowel ex-rays-negative
4. CBC- normal counts
5. HIV test- i had done early on and was told it was negative though this was before all these diahrreal symptoms happeneed (though i have NOT has sexual intercourse b4 or since, am not a drug user, have not had transfusions).

here are some things that DID show on my tests:
1. Sonogram showed-Gall stones
2. Hida Scan showed what my Dr. said was anonfunctional gall bladder
3. I tested ASCA positive for IGG (62) and IGC (58.1) -but what does this mean with all my negative biopsies??

I also took cholestyramine for the Bile found in my stomach which my dr said was from the GB problem. it did not help the diahrrea.
Early on i also tested positive for e. hystolitica which i later tested negative for after treating with metronidazole etc, yet the diahrrea persisted.
My intestinal biposies were all negative and my dr. said it likely wasnt crohn's because i has no elevated white blood cells in my stool and also my biopsies were negative.
At first my Dr. said i tested positive for celiac/sprue marker but then the biopsies (what he called the "gold standard") were negative for that. also a non-gluten 2 week diet didnt help me.

my continued diahrrea and recent symptoms continue to make me very worried about my situation and even HIV because u have had some difficulty breathing for the past 3-4 weeks and every time i type diahrrea into the internet HIV comes up as the main cause. but i really should not be a risk for this and I DID test negative! plus my lymphocite #s were normal according to my new GI and yet even he asked me if i had been getting mouth sores and/or rashes! (why would he ask this haveing seen all my tests?!)

so i dont know what to do. this just cant be IBS. its too consistent, always is diahrrea (not constipation), and i just know its not. can you help me? do you have any ideas? where do i go from here? does anything jump out at you from my tests as to what this might be?
Amazingly I have not been losing weight AT ALL. not a pound. nor do i have fevers (actually my fever is usually LOWER - like 97.5, is that meaningful?). my muscles esp in my upper arms are often sore. what should i do? repeat any of these tests? take another HIV?? some nights i do get sweats on my neck and back!
Please tell me what you make of all these tests and symptoms?
what should i do? what could this be?
PLease, please help.
Sam
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With a negative HIV test, it would be unlikely that the virus is present - the test is pretty sensitive.  However, if this is still a concern, you can repeat the test.

The positive ASCA test can occur in cases of Crohn's disease.  This can sometimes be difficult to diagnose - especially in cases of the smal bowel.  

You can consider some markers of inflammation - like a C reactive protein - which can be elevated in cases of IBD.  Also, ensure that the colonoscopy involved intubation of the terminal ileum (the last part of the small intestine).  This should be evaluated to determine Crohn's disease.

If this workup is negative, you can consider other causes for diarrhea.  This can include tests for malabsorption and celiac disease, which can be evaluated with stool studies and blood tests respectively.

These options can be discussed 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.

Kevin, M.D.
http://www.straightfromthedoc.com
24 Comments
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Sam,
Chronic diarrhea is one of the most difficult things to pinpoint a cause for (and I know that personally!).  Do you have any abdominal pain?  Any blood in your stools?  Are you taking any medications at the moment?  Your temperature of 97.5 is normal; anything from 97-99.5 is considered normal, and can fluctuate during the day.  I usually hover around 97.5 as well.  If they try to calculate an osmotic gap from stool and blood samples, it can help in differentiating whether your diarrhea is caused by malabsorption due to a certain food (such as lactose intolerance) or not.  

But you had positive blood tests for Crohn's.  Dr. Pho should be able to tell you how sensitive and specific those tests are.  I wonder whether your gallbladder might the root of, or part of, the problem.  They might do a CT scan so they can visualize your abdomen to see if there are structural abnormalities.  

In the meantime, try taking an Imodium (immodium) every morning to see if that helps the diarrhea, and if it doesn't, ask for Lomotil - this works best for me.  If it's watery diarrhea, make sure you're drinking enough fluids, but make sure they are not too sugary, since sugar can exacerbate diarrhea.  Gatorade diluted with water is a good bet, or Pedialyte from the drugstore.  

I totally sympathize with you!  Keep us updated.

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Sarikate,
   thanks so much for your comments, they are really appreciated. no blood in my stools and not much abdominal pain, though every few months (maybe 5 times year) i will get am AWFUL stomach ache hours after i eat. but this is so infrequent that i always thougt it was unrelated.
Medications- not really, i have tried pentasa (dont thnk it worked) and now am trying Xifaxan which some days i think helps and others not. Thanks for the comment on the temperature-- i was thinking that a consistentely low temp meant something about the immune system, but i didnt know what. i wonder if its significant that both you and i have low temps. it wasnt long ago that i  did avg a higher 98.6-type temp. i rarely reach that high now.
What is the osmotic gap? what does that mean, i enever even heard the term and non of my docs mentioned it. howveer the weird part is that im not losing ANY weight, so i doubt its from malabsorption. plus my GI actually told me after one of my vistits that my colon did not have absoprtion problems. does this mean he did that osomotic gap test?
i've never been lactose intolerant, though i do have many allergies, so thats intriguing....
i think i actually did have a cat SCN whicg showed now inflamation (inflammation) or was otherwise normal.
i did have those positive blood markers but for the reasons  i was saying above, my doc ruled out disease because of the negative biopsies. so im racking my brains as to what the positive ASCA could mean. and the posityive hida scan. it can drive u nuts!!!!

my diahrrea is not watery. not normally. it is often powedry which i find odd. but id ont feel like im losing fluids. partially bec of the weight maintenance.

thanks so much for your input, it means So mych to me. incidentaly, i am also jewish (but male) and around your age. i have read these GI diseases are more prominent among ashkenazi jews.......

sam
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Have you been tested for iron deficency?
Check this link it maybe of interst to you

http://polish-jewish-heritage.org/Eng/July_04_Jerusalem_Post_online.htm#
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shen,
appreciate the feedback and link, but my iron's normal....
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Avatar_m_tn
Hey Sam, we Jews always seem to get the raw end of the deal, don't we? :) African-Americans have the same problem with sickle-cell anemia.  

I'll try to explain the osmotic gap as best I can...keep in mind it's still very confusing for this pre-med.  Basically, your doctor can tell whether you are absorbing electrolytes or not based on results from blood tests and subsequent stool tests.  If your doc finds an excessive amount of electrolytes in your stool, that means you are not absorbing them and the diarrhea is categorized as secretory - your osmotic gap will be quite small.  If your doc finds that your electrolyte levels are normal in the stool, your diarrhea is osmotic.  This is generally caused by carbohydrate malabsorption (such as lactose or sorbitol intolerance) or laxative abuse.  In this case your osmotic gap would be large.

When my doc did this study for me, he found a negligible osmotic gap.  Usually, secretory diarrhea is caused by bacterial or viral infections.  When you get "traveler's diarrhea," for instance, it is secretory.  You're not absorbing electrolytes.  However, chronic secretory diarrhea is a little more difficult to pinpoint.  There are many causes for it.  IBD can cause it, and so can IBS.  My doc has ruled out an infectious process and does not think it is IBS.  So now he's in the process of checking for the presence of a host of neuroendocrine tumors, a more rare cause of this kind of diarrhea.

In the meantime, I just make sure to drink plenty of fluids when I'm having a bad day.  I've ended up in the ER twice because I can't keep them in and become severely dehydrated; however, this is the exception, not the rule.  

Did you doc say anything about your gallbladder causing these problems?  Have you thought about a second opinion?

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Sarikate,
   Do you by any chance live in NY? I'm womdering if you'd be willing to talk to me. your eperience and kindness has been so helpful to me i cannot even tell you what its like to speak to someonme who knows what i'm going through. i know im a stranger to you, but if you like we could email or IM so you can see I (if not my colon) is normal.
Your intuition (and perhaps medical background) are good--- my first GI thought it was the gall bladder because he explained that since it was nonfunctional, bile was escaping into the intestines and caused the diahrrea. however, he gave me meds for the bile (cholestrymine) which did not work and so he thought the diagnosis may not be right as that being the cause. i have had 3 opinions. one dr. just say "IBS" without even bearly looking at all my tests. the first one didnt diagnose anything because he was baffled. and now my 3rd dr. the most caring, said he couldnt understand how the other doctors could not pursue crohns after seeing a positive ASCA. so he gave me a capsule endoscopy of which i am still awaiting the results, but i suspect that they didnt see anything on it because the dr has had the results for days and hasnt called me to tell me what they are. i bet they found zip and i am back to square one. :-)
thanks for your input again and please let me know if you can chat...
sam
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Dr.Kevin,
   Thanks for the response. I know that a positive ASCA test can occur in cases of Crohn's disease, but what does a positive ASCA actually mean? How often can someone test positve ASCA but have normal bowel function? My dr. i believe did, i believe, involve the terminal ileum and my biposies were negative.

I believe my dr. mentioned that i did not have malabsorption based on my tests and although the blood test i had showed a positve celiac marker, the biopsies (gold standard as he called it) were negative for celiac.

Also, what, if anything, do you make of the gall bladder situation? I have gall stones, sludge, thicjening of the gall bladder wall and the Hida Scan showed a non-functional gall bladder!

I appreciate if you could follow up with these further explanations of my history.

Thanks,
Sam
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Avatar_n_tn
Gallbladder disease is more common in people with Crohn's disease than in the general population. In a study in Sweden, patients with Crohn's had a risk of developing gallbladder disease that was almost double that of individuals in the general population.

Hope that helps.
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For a excellent  self study of all the details you have been discussing. This is a free online reference book.
http://gastroresource.com/GITextbook/en/chapter7/7-11.htm
Example..
11.1 Pathogenesis

The four basic mechanisms that cause chronic diarrhea are osmotic, secretory and exudative factors, and abnormal intestinal transit (Table 11).

If the diarrhea ceases when fasting, or if there is a significant osmotic gap in the stool water, then an osmotic cause for the diarrhea is suspect. Examples include diarrhea after ingesting milk (a result of lactase deficiency) or drugs such as laxatives and antacids, or the excessive use of artificial sweeteners such as sorbitol and mannitol, which contain polycyclic alcohols.

If the patient's diarrhea persists when fasting (such as may occur at nighttime when the diarrhea awakens the person from sleep), a secretory diarrhea is likely.


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Hello. A few summers ago, I had your problem.
A gastroenterologist admitted me to the hospital
immediately. He had me hooked up to a basic
minerals and fluids drip, and for a week,
I couldn't have anything but water. Now, this
is the "answer" part... They studied every little
thing that came out of me, and after a week,
declared that I had an inidentifiable parasite.
My cousin was in the hospital at the same time,
for the same reason, on a different floor.
Same diagnosis. And we lived in the same neighborhood.
The problem disappeared after the one week fast
and rest in bed. Maybe the fluid and minerals
in my system were really out of balance! Who
knows - they did not. Maybe you should ask to be
admitted and lay in bed for a week and have healthy
sterile fluids flow through. I felt wonderful for
the next few weeks!!!
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Avatar_n_tn
Hello. A few summers ago, I had your problem.
A gastroenterologist admitted me to the hospital
immediately. He had me hooked up to a basic
minerals and fluids drip, and for a week,
I couldn't have anything but water. Now, this
is the "answer" part... They studied every little
thing that came out of me, and after a week,
declared that I had an inidentifiable parasite.
My cousin was in the hospital at the same time,
for the same reason, on a different floor.
Same diagnosis. And we lived in the same neighborhood.
The problem disappeared after the one week fast
and rest in bed. Maybe the fluid and minerals
in my system were really out of balance! Who
knows - they did not. Maybe you should ask to be
admitted and lay in bed for a week and have healthy
sterile fluids flow through. I felt wonderful for
the next few weeks!!!
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Avatar_n_tn
Liver failing from Hepatitis, and complicated
by AIDS in my brother, who is also a Hemophiliac.

That is his problem, and mine, because I love him.

He is panicking about whether to start interferon.
He can hardly eat. He lives on "Boost." He is
keeping his emotions pent up. He's had a hard life,
with constant health problems.

Can anyone address
the subject of the side effects of Interferon
treatment, how I can respect his privacy, but
help him somehow, or help me with my perspective?
He lives at my Mom's. Another brother is there,
and they are very codependent.
Can anyone relate to this?

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Avatar_n_tn
check out for any parasites,h pylori bacteria and if you have been on antibiotics,your flora .
have you tried eating yogurt with live culture?/
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Avatar_m_tn
Hey Sam, I'd be happy to chat, just let me know if you have Yahoo!  I actually grew up in the northeast but now I live in the land of moose and the midnight sun (Alaska).  

It's good that they did a capsule endoscopy.  Call up the doc's office yourself and tell them you're waiting for the results - they should be able to give you an answer relatively quickly.  But you're right, usually they will call you if they notice something significant.  

Did your doc tell you what would happen next if your CE is negative?  They might put you on some drugs for the symptoms.  How are you feeling at the moment?
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http://www.aegis.com/
they have a forum where you can ask doctors on AIDS issues
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Hello,  I just happened upon this website today and thought I would throw out my situation and see if anyone has any thoughts BESIDES sending me to see a doctor for testing.

I have had diarrhea since I was a kid and am always amazed on those very rare occassions when a normal poop comes out. As a kid I had diarrhea everyday.  As a youth it continued and worsened. So, that when I went running for cross-country practices, I made it a regular route to pass by the porta potty in the park (Sometimes I just had to stop in the woods).  It has continued off and on as an adult also.  I noticed that during this last winter i started to gain weight for the first time because, for the first time I did not do any real exercise.   However, now that its summer and I take a walk with my husband each night, I end up running home and just barely making it to the restroom. This happens on a nightly basis and as you can imagine my husband, besides myself is very tired of it.  (However, due to past experiences and my desire to not be someone's pin cushion,I am un willing to go into the doctor for various testing.)  I am willing to live with it, rather than see a doctor, but if I can get some ideas as too what it could be then I may be able to sorta test myself and perhaps remedy the situation on my own by what I eat or what I do etc. (which would delight my husband) I have investigated some information about this subject online and discovered that I could be lactose intolerant.  I do eat a tremendous amount of sugar, which worsens my diarreah (diarrhea) and tons of milk (drink a gallon a week, sometimes more).  Two items which I have eaten a lot of my whole life.  In fact my mom was once very concerned about it when I was a kid and tried to take my milk away, but my dad said let her drink as much as she wants and so I have.  Anyway, I have been taking lactaid pills, but am unsure if they are working just yet.  I am 30 and generally healthy, but not necessarily a healthy eater, although that is very slowly changing.  Anyway, I wondered why the exercise sets off the diarreah (diarrhea)?  Do you have any thoughts or suggestions on this that do not involve seeing a doctor.
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If you are eating a lot of sugar and drinking tons of milk, that is indicative of yeast in your digestive track. You definitely have a toxic colon and you can go to your local herb shop or GNC for colon cleanse and yeast cleanse information. If you must drink milk, switch to the organic brands. Milk is full of antibiotics and hormones that are given to the cows to increase milk production. Even organic dairy isn't all that great for you. Milk increases mucous production and causes stomach upset in most people. Everyone suffers from diarreah (diarrhea) at different times in their lives but having it constantly is definitely a red flag. You may consider doing a parasite cleanse as well. If you do detox, it's imperative you drink LOTS of pure water and if the diarreah (diarrhea) continues, you might consider colonics. A qualified colon hydrotherapist wil be able to tell you what they are seeing and the source(s) of your problem. Good luck and good health to you!
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Thank you for the suggestions. I will look into them.
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What are they doing for that non-functioning gallbladder with gallstones?  That is probably the source of the diarrhea.  I would not leave that thing in there to create more problems.

I listened to "IBS" dx's for years and endured off and on diarrhea.  When they finally had to take my gallbladder out it was packed with hundreds of stones and inflamed.  I think the recurring pancreatitis I am now having is due to leaving those stones in for so long.  THey will occasionally pass, some may cause a LOT of pain, some may block the ducts, and some may just cause scar tissue which over time can create all sorts of biliary and pancreatic problems.  

If the gallbladder is non-functioning anyway -- I would talk to the doc about removing it.

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I had a similar problem for years, though generally not quite as frequent as you describe, but it turned out to be Diverticulitis - everyone thinks its main symptom is constipation but it can also be the trots. I'm only 38 so no one thought that might be the cause - mind you, when I'd had peritonitis for a week no one cared much what the cause was, only how to keep me alive. Ten days later about a foot of bowel was removed, I had a temporary colostomy for a few months, and now I feel much better than I ever did. Good luck with sorting it out.
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For about a three week period once a year I take (these are at a health food store) One tablet each of a two part colon cleanse formula (Ultimate Cleanse, by Nature's secret), I follow that in about twenty minutes with a 16 oz of juice containing two rounded teaspoons of psyllium husk powder (dietary fiber, like Citrucel etc) and 1 tbs. of Colloidal bentonite (Sonne's No.7: an absorbent aid in detoxification). The fiber and clay (bentonite) absorb the toxins and mucous that the Ultimate cleanse removes. I found that I need to do this for a week following any antibiotic treatment and again after any surgery. Wisdom teeth and tonsillectomy in my case.
Please try this it works. There is nothing else out there, and there is so many people with the same problem. Why can't doctors help? Good Luck, I hope everyone reads this and does what it says.You will be so HAPPY, HAPPY HAPPY,HAPPY,HAPPY,HAPPY
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For about a three week period once a year I take (these are at a health food store) One tablet each of a two part colon cleanse formula (Ultimate Cleanse, by Nature's secret), I follow that in about twenty minutes with a 16 oz of juice containing two rounded teaspoons of psyllium husk powder (dietary fiber, like Citrucel etc) and 1 tbs. of Colloidal bentonite (Sonne's No.7: an absorbent aid in detoxification). The fiber and clay (bentonite) absorb the toxins and mucous that the Ultimate cleanse removes. I found that I need to do this for a week following any antibiotic treatment and again after any surgery. Wisdom teeth and tonsillectomy in my case.
Please try this it works. There is nothing else out there, and there is so many people with the same problem. Why can't doctors help? Good Luck, I hope everyone reads this and does what it says.You will be so HAPPY, HAPPY HAPPY,HAPPY,HAPPY,HAPPY
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Avatar_n_tn
For about a three week period once a year I take (these are at a health food store) One tablet each of a two part colon cleanse formula (Ultimate Cleanse, by Nature's secret), I follow that in about twenty minutes with a 16 oz of juice containing two rounded teaspoons of psyllium husk powder (dietary fiber, like Citrucel etc) and 1 tbs. of Colloidal bentonite (Sonne's No.7: an absorbent aid in detoxification). The fiber and clay (bentonite) absorb the toxins and mucous that the Ultimate cleanse removes. I found that I need to do this for a week following any antibiotic treatment and again after any surgery. Wisdom teeth and tonsillectomy in my case.
Please try this it works. There is nothing else out there, and there is so many people with the same problem. Why can't doctors help? Good Luck, I hope everyone reads this and does what it says.You will be so HAPPY, HAPPY HAPPY,HAPPY,HAPPY,HAPPY
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Avatar_n_tn
For about a three week period once a year I take (these are at a health food store) One tablet each of a two part colon cleanse formula (Ultimate Cleanse, by Nature's secret), I follow that in about twenty minutes with a 16 oz of juice containing two rounded teaspoons of psyllium husk powder (dietary fiber, like Citrucel etc) and 1 tbs. of Colloidal bentonite (Sonne's No.7: an absorbent aid in detoxification). The fiber and clay (bentonite) absorb the toxins and mucous that the Ultimate cleanse removes. I found that I need to do this for a week following any antibiotic treatment and again after any surgery. Wisdom teeth and tonsillectomy in my case.
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