IBS or something else?

[questioning35]

Around 7 months ago I started having weird bowel symptoms.  These symptoms disappeared for a time and recently, maybe a month ago reappeared.  The symptoms include abdominal pain and bloating that frequently moves.  Now it is in my upper right quadrant.  This is accompanied by severe gas and variable bowel movements.  By viariable bowel movements I mean that sometimes it is diarrea and sometimes it is constipation.  Additionally the color of the bowel movements constantly change but they are never grey or white.  Urine is normal colar but is usually darker in the morning, which I believe is normal.  I also have a sort of chill in my joints (which concerns me).  Additionally twice I have had a severe episode of diarrea where I break into a cold sweet and feel like I'm going to die for 20 minutes or so.  I went to the emergency room following one of these and the doctor said it was some sort of nerve that can be struck.  I have been to many doctors and had many tests.  Blood tests show normal liver function AST and ALT.  I have had an HIV test and that was fine.  The doctors say that this is irritable bowel syndrome.  What I am concerned about is that it may be something else, like Hep B or another conditions.  They say that a Hep B test is unnecessary because I am not in a high risk group and because my liver tests are normal.  So I guess my question is if I should just accept these diagnosis or be more worried that this is some sort of larger problem.  What concerns me is that no one has been very specific as to what I should expect with IBS, it just seems like they can't explain the symptoms so this is the label that they have given it.  Thanks.

[tuff case]

The GI Dr.s and I have 2 believe that my symptoms of nausea since 12/02 everyday and abdominal pain (URQ and center) is IBS.  I have extensive procedures and test done.  The last being done in 2/03 was and ERCP where they cut the pancreatic value and the "Oddi" valve in again as it was cut for the 1st time in 6/03.  Diagnosis was SOD but caused from IBS.  While I did not have relief from the nausea after the any of the procedures, and the abdominal pain is now in my LUQ into the back.  They next thing was to try the Paxil for.  However for the 2 months I was on the Paxil I developed diahrrea that lead to hemmoriods.  It was my Primary care who has belived and supported me all this time in believing that this is not stress and IBS.  After a week of having really bad diahrrea he changed my medication and put me on "Reglan"  which has given me some nausea free days.  The Reglan may work on IBS also as it works on the nervous system.  But I say all this to say that, if you truly belive that this is not IBS then do not be afrais to press the issue.  My Primary Care has now referred me to Mayo Clinic, via a personal phone call.  His feeling being the same that this is not IBS.  Good Luck, TC

[Kevin Pho, MD]

I would suggest the abdominal ultrasound to evaluate the liver and gallbladder - things like stones as well as other liver diseases can cause your symptoms.  If would pursue hepatitis panels if the liver panels were elevated.  

If negative, you can certainly consider irritable bowel syndrome - which typically presents with an alternative constipation/diarrhea pattern.  Typically treatment is initially increasing the amount of fiber in the diet as well as anti-spasmodic agents.  If you are female, things like Zelnorm can be considered if the IBS is constipation-predominant.  

A colonoscopy or flexible sigmoiodoscopy can be considered if the diarrhea continues - to rule out things like inflammatory bowel disease or infectious colitis.

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.
Medical Weblog:
kevinmd_b

[questioning35]

Another question.  If it were hepatitis and it was in its chronic stage is it likely that normal liver tests would be elevated.  I also forgot to mention that my doctor has prescribed Paxil and seems to think that this is stress related.