Diagnosis

My son is 31 years old.  He has not been diagnosed with Crones or Irritable Bowl Disease.  As a young child he's suffered with episodes of excessive gas, cramping and diarrhea.  He is 5'9", 115 lbs.    These symptoms have escalated in the last two years.  He has difficulty keeping a job because of the pain, and diarrhea - he doesn't have any health insurance.  For the last year, he has gone to the Veterans hospital.  He relocated from Fl to NC because he was hoping to get another opinion and help. He has just undergone his 3rd colonoscopy within the last 9 months.  These test aren't shows anything definitive.  The 1st colonoscopy only went up to the first bend - 45 degrees (?)They did find that he has acid reflux because of something on his esophagus.  However, they have not treated that. Just how is Crones or IBD diagnosed??  They really won't treat him because they can't get a concrete diagnosis.  He has taken prednisone and it worked.  But, the Dr.s at the VA are reluctant to put him on it because of the side effects and the fact that it could mask a "problem".  In the mean time, he is in excruciating pain and can't eat.  They tell him to go to the emergency room, where they don't do anything for pain.  Wasted trip.  His new employer doesn't understand and he is in jeopardy of losing this job too.  One doctor felt that he had a cross over of Crones and IBD, but, once again, will not treat it.  Imodium (immodium) doesn't work with the diarrhea - plus he is sore.  The thought of eating is discouraging, and everything has lost its taste and can't keep it in.  I'm trying to help him keep his spirits but, but its getting harder and harder.  Plus, he can not call a doctor with issues or concerns.  His appointments are usually only once per month.  If the medication doesn't work, OH Well!!  Eating solid foods hurt probably because his stomach has shrunk, but now comes the question of what he sould or shouldn't eat. Can't take vitamin pills, they don't stay in long enough to be absorbed.  And a doctor told him he didn't have an absorbtion problem. Some say fiber, others say no, some say stay off of dairy, other say no.  I suggested a liquid diet to get something nutritional in him.   This is a vicious circle.

I should mention that on his fathers side of the family they have a history of digestive problems and IBS along with my father.

He is losing his energy and his will.
Please, please HELP!!!

[Kevin Pho, MD]

Endoscopic and radiologic studies of the bowel are the major tools used to establish the diagnosis of Crohn's disease.  Although the diagnosis of ileal Crohn's disease is occasionally made by colonoscopy, a barium study of the small bowel remains the mainstay of diagnosing ileal disease as does the upper gastrointestinal series for gastroduodenal disease. These are usually done as initial studies if small bowel involvement is suggested by pain location and the absence of gross bleeding.

Another option for diagnosis would be an intestinal biopsy - but this is normally done to confirm presence of the disease rather than making the diagnosis.  

If there is question about IBD despite colonoscopies and X-ray studies, you may want to consider the diagnosis of malabsorption which can also present similarly.  Tests for celiac disease and fat malabsorption (via a fecal fat test) can be considered to evaluate for 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:
Peppercorn.  Clinical manifestations and diagnosis of Crohn's disease.  UptoDate, 2003.

[nadia]

There is a new procedure out now that is called a Virtual Endoscopy.  
It is a pill camera that is swallowed and observed by a specialist during an 8 hour process.
It is not as invasive as a colonoscopy and can identify problems with the small intestine as well as the the colon.
The prep is still necessary prior to the procedure and if there are any findings a further colonoscopy or endoscopy may still be necessary. However, it is very good at diagnosing potential problems in this area.
Here in Canada, it is not covered by health insurance and it costs approx $1200.00 CDN, however, when serious health concerns are present it is a very useful tool.
I hope your son finds some answers soon. Good luck!

[TJV]

Chrohns and IBD are diagnosed by colonoscopy, however a barium series with small bowel follow through can often diagnose Chrohns.

   There are no visable abnormlties with IBS. IBS is diagnosed by symptoms,doctors are supposed to follow the rome criteria--and when everything else is properly ruled out, then IBS is the assumed problem.

[PAJ]

Read the text then take a look at this site .
http://www.mercola.com/2003/sep/13/inflammatory_bowel_disease.htm


Lactose is milk sugar , feeds yeast. I reply regularly to undiagnosed gastro problems , I now use this as a standard reply .The forum doctor has acknowledged yeast infections [sort of] in past debate , I don

[tessa0825]

Hello, maybe you can answer a question for me about IBS....I get very confused about this diagnosis.....I have it and I wonder how something that feels so real can sound like something "so made up"?......I had a large surgery yrs ago that left me with a paralyzed bladder and bowel for a long time..Over time the bladder corrected but the bowel never did and it resulted in chronic constipation....My GI regularly does colonoscopies and removes polyps every time he does one....Im on miralax 17 gm. twice a day and zelnorm 6mg twice a day, zelnorm also seems to help with another medical condition I have.....My GI tells me the technical name for my chronic constipation is IBS........So IBS is what is diagnosed when everything else is ruled out even if the cause for the symptoms is known and documented? Is IBS a real diagnosis? If you have  a sore throat that doesnt go away and you have all kind of negative tests they dont decide you have "ITS" (irritable throat syndrome) they keep looking until they find out if it is GERD, asthsma, paryngitis, mono, or whatever....What is the percent of IBS pts that at some point end up having an IBD that was probably really there all the time but somehow missed? I'm asking these questions out of a geniune concern about this diagnosis...Everything from cramps, diahreah, constipation, bloating, etc....fit into this IBS category...Also, does it ever go away or is it a lifetime of pain and medication?.....I realize I should ask my GI these questions and I will but you seem knowledgeable and I wondered if you can shed some light...thank you for any advise...Tessa

[TJV]

   Hi Tessa you made a joke about irritable throat syndrome, but there actually is something called irritable esophagus,dealing with visceral hypesensitivity based on the  very same premise as IBS

   IBS is supposed to be episodic, and comes and goes. - typical onset, teens, early 20s. exacerbated by foods and stress,  People who have IBS are extra sensitive to pain-- and IBS is when nothing is found but the person still has symptoms.
  
     I don't know your entire case history, but  it doesn't sound like IBS to me, perhaps a complication to surgery --  

     I beleive  IBS is a diagnosis handed out too freely and easily by doctors without proper investigations
  
   Diseases or conditions on record as have been misdiagnosed by physicians in North America as IBS--when it wasn't........, Chrohns Disease, , ovarian cysts, cancer, endometriosis, celiac sprue , lactose intolerance , parasites, Irritable Bowel disease, , thyroid problems, urinary tract disorders,nerve damage, lactose intollerance, AIDS, gallbladder problems, ulcers, .worms, Diverticulitis , bacterial infections, food allergys (allergies), and bowel obstructions

  I know of 3 people who were told they had IBS and had  endemtriosis, early IBD and cancer respectively.

  The Rome criteria is used to diagnose, but many doctors don't follow it- or allow some leway. i think there is a problem with this free and easy diagnosis.-- among some doctors- not all.








      

[tessa0825]

Hi, Thanks for this explanation...I don't fit in to any of that criteria...I was 42 yrs old and it occured immediately following surgery....No problems prior to that....It wasn't a surprise or a shock, it was a planned and known complication of the surgery....What wasnt known was how long the duration would be....Bladder and bowel could have both came back after a few months or a yr. or maybe never as in the case of my bowel....It is also constant, as in almost 9 yrs., it has never once went away...It seems to be more of a nerve damage problem as I seem to not have any normal feelings in that area neded to make things happen.......I dont think I have IBS I think it is just a complication of surgery.....Period...thanks for your info.....Tessa

[sunny_one]

Has your son been tested for intestinal parasites? It's often overlooked in the US, but can be a problem for those who are symptomatic. You must have very specific testing from a reliable lab - often more than once to detect them. I have just found out I have Dientameba fragilis - an intestinal parasite. I have been through a year of hell without proper diagnosis. I encourage all who have ongoing gastro problems to be aware of this. This site has a lot of info about these critters: http://www.badbugs.org/

[Gastro_interest]

Tessa,
It sounds like if the surgery disabled some of your organs, it's possible it could have effected your intestines.  This would be a motility disorder, and not IBS.  You may have Chronic Intestinal Pseudo-Obstruction.  There is a test for this that a motility specialist can perform, but the treatments are the same as with gastroparesis.  Zelnorm, domperidone, etc.
Nicole

[stray77]

A related discussion, Get tested for Celiac Disease was started.