IBS Symptoms?

  A few questions about sysmptoms please:
  1.  If I have a malabsorption problem, would it necessarily be accompanied by a malodorous stool?
  2.  If I have celiac disease, does the accompanying rash always have blisters?  I have a rash, but it looks and acts more like hives than blisters.
  3.  Could a severe unexplained weight loss be caused by IBS, or do I need to look for a more serious cause?  I started out weighing 215 lbs and I now weigh about 150 lbs over the last two years without dieting.  Diabetes has been excluded as a possible cause.
  4.  If I have IBS, what will the prognosis be if I continue to consume wheat and dairy products?  I am lactose intolerant and no longer drink whole milk;  I do eat low- or no-fat yogurt however.  I chew sugarless gum sweetened with sorbitol and Nutrasweet.  I am on a number of cardiac medications, and until recently, I took an aspirin a day along with my Coumadin.
  5.  I have had chronic diarrhea for several years.  This problem has gotten somewhat better since I stopped drinking milk.
_Dear Sylly,
I will answer each of your questions in order.
1. Most patients with malabsorption have diarrhea and weight loss. Patients with fat malabsorption or steatorrhea more commonly have malodorous stools, which are oily, greasy and tend to float to the top of the toilet.
2. The rash associated with celiac disease is called dermatitis herpetiformis. It is a small raised lesion (papulosquamous) that is very itchy. If a skin biopsy of the rash is performed this clinical entity can be easily diagnosed. About 80 percent of patients with the characteristic rash have a mild form of celiac sprue. On the other hand, less than 10 percent of patients with celiac sprue have dermatitis herpetiformis. A gluten free diet eventually reverses both the skin and intestinal lesions in most patients with dermatitis herpetiformis.
3. Weight loss is not considered part of the irritable bowel syndrome. If weight loss is present an investigation for another cause should be initiated.
4. The prognosis of patients with the irritable bowel syndrome is good. It does not predispose patients to the development of cancer. Nevertheless, most patients have ups and downs in terms of symptoms of abdominal pain or change in bowel habits (constipation, diarrhea or both). Many patients with irritable bowel syndrome have lactose intolerance as well. Most patients with lactose intolerance can tolerate some yogurt and small amounts of milk. If you have diarrhea foods or medications that contain sorbitol can worsen your symptoms.
5. I'm glad that your diarrhea has improved with dietary changes. You may not have to totally abstain from dairy products if you take Lactaid tablets prior to dairy products and drink Lactaid milk. This product contains the enzyme necessary to help digest the sugar in milk called lactose. If you continue to have diarrhea and weight loss I would recommend that you have an evaluation to rule out infection, inflammatory bowel disease or malabsorption (secondary to celiac sprue or some other disorder). You may need to see a gastroenterologist for further testing and evaluation.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you wish to be seen at our institution please call 1-800-653-6568, our Referring Physicians' Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
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*Keywords: malabsorption, diarrhea, irritable bowel syndrome, celiac sprue, lactose intolerance

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