COUPLE with STOMACH PROBLEMS/RECOMMENDATION REQUESTED

I am hoping for some direction in addressing a long-standing stomach problem that affects both my husband and I. Our HMO has conducted some tests but they have not been able to identify a cause.

For myself, the problems started about 6 years ago living in Philadelphia when I was 34. I experienced about a week or so of intense stomach pain, cramping and diarrhea. When I went to the doctor, I was asked if I had been out of the country and my husband and I had been to Japan. I was not given any tests and my symptoms were dismissed as "stress."  I became lactose intolerant either shortly before or after this stomach event. Fatty or fried foods also began causing me to have next-day diarrhea. Over time, my lactose intolerance has become more pronounced and I have lost my prior ability to digest many foods without experiencing some degree of stomach pain and/or next-day diarrhea.

About the same time, my husband started having similar stomach problems including symptoms of lactose intolerance and problems eating fatty foods. His symptoms became more severe over time and interfered with daily life to where he could not eat out or with other people.  About 2 years ago, our HMO gave him a battery of standard tests including a colonoscopy, upper G.I., Giardia lamblia and Cryptosporidium screen, and others. The tests came back normal with the following exceptions: his Celiac Gliadin IGG, EIA was high(62), his Blood Urea Nitrogen was low (7), and his MCH was high (31.8). An important note--the doctor who conducted the colonoscopy said emphatically that his stomach problem is definitely NOT I.B.S.  

More details about our situation are at: http://www.medhelp.org/posts/show/593925.

We are frustrated with our continuing symptoms and are willing to go outside our HMO to get answers. We are hoping to get a recommendation to a well-regarded specialist in the Atlanta area. Can you give us a name or help us locate a doctor in Atlanta who is known for solving stomach problems?

[Kevin Pho, MD]

Unfortunately, I am not familiar with the doctors in Atlanta.  I would suggest someone at Emory, which is a major academic medical center.

I agree with the testing you have had thus far.  With the abnormal celiac disease test, you may want to consider a gluten-free diet and see if that improves the symptoms.

I would also send the stool off for fat malasorption studies, and obtain breath tests to see if there is indeed a component of lactose intolerance.  

These options can be discussed with a GI physician.

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.
www.kevinmd.com