what is this?

[airman]

37 y/o m,symptoms started 8 months ago with severe headache lasting 17 days.24hr later symptoms of excessive belching, nausea fatigue weakness. After 17 days headache subsided but other symptoms remained. Nausea belching both pretty severe (belching 70-80 times daily) for two months. Then began urinating white sediment, which was diagnosed as mild renal tubular acidosis after 24 hr urine showed high ca,ox,phos. Stools began to be light tan in color with undigested food particles.Afteranother 6 weeks the nausea got alot better but the belching continued to be excessive until mid Oct when belching slowed down but one night in bed awoke to loud gurgling, popping sometimes repeated bowel gas sounds that has been going on since. Bowel gas noises90% of the time at night and throughout the night but stop after getting up and I start to burp again but only about twenty times daily now. Bowel movements are 1 or 2 daily. Sometimes 1 upon waking and then another 1or2 hrs later. Most of the time starts as hard dark brown balls and then looser somewhat normal consistency stool follows as part of the same bowel movement. Have been feeling not as fatigued the last few months but what remains is the bowel sounds, the belching, the altered bowel habits, some periodic mild nausea some periodic tremors in the hands, and just a feeling of not feeling close to my self as I did 8 months ago. I have had upper lower GI, 3 endoscopies colonoscopy, small bowel series, enteroclysis, tested for h pylori heavy metals stool culture O&P abdominal ct scan brain MRI tons of bloodwork including glucose tolerance, lactose intol,which came back flat but avoidance didnt change symptoms,hep, lyme titers,celiac blood test, sprue,d-xylose test, EUS, gastric emptying study, small bowel followthrough liver func, renal func,electrolytes.Giardia. The only things that have come back is slightly elevated immuglobulins RH factor slightly elevated which no one seems concerned about and the lactose test which diet didnt change. Gastro says its a general motility disorder like IBS but not IBS because no abd pain and dont fit classic IBS symptoms. Gastro and kidney doc say theres no connection between the motility disorder and the RTA but I just dont believe it. Two seperate physical problems start  apart and theres no connection? I didnt start with the bowel gurgling etc until 3 weeks after my enteroclysis. Could there be a SBO that was missed? What about a hernia of some type, or hepatitis undiagnosed lyme, some type of bact or fungal infection, candidas, mycotoxicosis, I am lost with where to go with all this. I have tried many antispasmotics and even antidepressants for the IBS type diagnosis but nothing has helped. I have asked for other doctors to look at EVERYTHING together but all I get is its got to be anxiety. Am I anxious or worried that something is being missed or just doesnt add up? Definately. Did anxiety come out of nowhere and cause all this no way.I welcome all comments ideas.

[Kevin Pho, MD]

You have a had a very comprehensive evaluation with pretty much every test I could think of.  I am unaware of RTA causing the GI symptoms you describe.  

As for the SBO - that would have been seen with the CT scan, GI series or endoscopy.

Hernia would have been seen with the CT scan.  

As for bacterial infection - there is a form of malabsorption known as bacterial overgrowth.  This is characterized by nutrient malabsorption associated with an increased number of bacteria in the upper gastrointestinal tract.  The classic manifestations of global malabsorption are diarrhea with pale, greasy, voluminous, foul-smelling stools and weight loss despite adequate food intake.  The majority of patients with malabsorption have relatively mild gastrointestinal symptoms, which often mimic more common disorders such as irritable bowel syndrome. In some cases, anorexia, flatulence, and abdominal distension may be the only complaints suggesting malabsorption; other patients may be asymptomatic.  

The gold standard for the diagnosis of bacterial overgrowth has traditionally been the demonstration of excessive bacterial concentrations in a jejunal aspirate, which can be performed during endoscopy or by fluoroscopy with jejunal intubation.

You may want to consider this test if your physician suspects 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:
Vanderhoof et al.  Diagnosis and treatment of bacterial overgrowth.  UptoDate, 2004.

[Pixie1969too]

Hi there,

I can relate to your frustration with not getting the answers you need.  It's true that most doctors don't seem to look at the whole picture... that's why I'm considering starting the homeopathic/complementary medicine route.  Practicitioners of this sort of medicine are trained in getting the bigger picture.  I myself have been plagued with so many GI issues over the past few years that it's ridiculous and I'm constantly being told it must be IBS, but I know there is more to it than that.  So as a last resort I'm trying something different; in fact, I'm probably going to start with acupuncture.  It's not for everyone, but you never know where you might get the key information you need to start feeling better..  Just something I figured I'd mention to you.  I really hope you feel better soon, good luck!

[kevinmd]

I'll be away until January 4th.  I will answer your question when I return.

Happy New Year,
Kevin, M.D.