Digestive problems

On Jan. 20, 2004 I was awakned with a burning  & rolling stomach.  I went to the bathroom and had diahrrea.   The next night the same thing happened but my stomach was distended and a lot of sounds comming form it.  It happened consistantly around 3:00 am for the next week.  I went to my GP and he said gastritis and prescribed pravicid.   It helped for about a few days but I keet on having diahrrea.  My weight has dropped from 185 to now 159 lbs in two months.  I went to a gastro and had a ton of tests done which all have been negative but are as follows: Esophagogastroduodenoscopy & biopsy - negative. Colonoscopy to terminal ileum w/ biopsy & specimin collection - negative. CT scan of abdomen & pelvis - negative. Ultrasound of abdomen - negative except hepatic parenchymal mild hyperechogenicity most likely due to fatty infiltration. Upper GI w/ small bowel series - normal air contrast upper GI & small bowel series. HIV test- neagative Hepatitis A, B& C - negative.   Thyroid - in range.  Cd4 & Cd8 - in range. A second endoscopy was done at University of Pennsylvania hospital - negative again.  doctor's say that there is no evidence of Crohn's.  I started taking metamucial an a natural product called Primal Defense ("good bacteria") and my stools have tightend up and are soft but formed.   When I eat my stomach bloats and distends at times and I do pass a lot of gas.  It is kind of nerve racking because I keep on loosing weight and doctors have no conclusive.  I was taking 25mg of paxil last year for "anexiety" as I do have high blood pressure (atenolol 50mg at night & cozaar 100mg in am).  I weaned myself off the paxil around the end of Nov 2003- early of Dec 2003.  This stuff started happening on and around the 20th of Jan 2004.  All docs say that it is IBS or anexiety related.  Doc's restarted me on paxil 2 weeks ago and I feel somewhat less nervous. Could this be early symptoms of Crohn's or any other disease?   I do have pain now at times right underneath my naval and after eating my stomach is very active. I am getting around 5 hours of sleep per night and I know this is not healthy. I am at my limit and I was wondering is there any kind of test that I should be asking for or could you give me any suggestions that would be of help.

[Kevin Pho, MD]

There are several considerations.  The first is that there already has been a comprehensive GI evaluation performed.  

I would also consider various causes for malabsorption which can also present with the symptoms you describe.  A blood test looking for celiac disease as well as stool tests looking at the fecal fat content can be considered.  

Regarding Crohn's disease, a small bowel series and colonoscopy was stated to be negative.  You can consider antibody testing as well which can suggest inflammatory bowel disease (i.e. P-ANCA and ASCA tests).  If Crohn's disease continues to be suspected despite negative tests, capsule endoscopy can be considered.

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.

[surgeon]

You didn't state your age, sex, or whether you've ever had any abdominal surgery. Adhesions could cause your problem, as could a tumor or other space-occupying lesion of the small intestine. CT scan doesn't do a great job of inspecting the small bowel, and doesn't show adhesions unless it happens to catch them in the act of causing obstruction. A small-bowel xray, of which there are a couple of types, or even laparascopy or open surgery might become indicated if you continue with the symptoms, weight loss, without and explanation.

[paulieone]

I am 35 year old mle with no abdominal surgery.

[paulieone]

what should I be asking my gastro for? A more specific test?  They keep telling me it is IBS but it came on all of the sudden after eating pizza or sushi....I can't remember.  My stomach is very active after I eat with some bloating.    Something is just not right....maybe an infection?