IBS and Celiac

Here is some history:
I am a 39 y/o female, married with two young children.
I have had gastro issues on and off since I can remember.  Both parents and only sibling have gasto issues – neither can eat milk products and many foods (don’t have specifics) make them feel ill.  My grandfather died of colon cancer and my dad has been having pre-cancerous polyps removed since he was in his 40’s.
Since the birth of my first son seven years ago have had issues with bloating, gas and diarrhea on and off.  In AUG 06, I had my gallbladder removed as I was having some URQ pain and gallstones were identified.  Four weeks after this I had an emergency appendectomy.  Since that time I cannot go more than two days without having to take Imodium (immodium) or I will have uncontrollable and unpredictable diarrhea.  I have kept a food diary and there seems to be no real correlation with my immediate food intake (in other words, if I drink milk, I don’t immediately have an issue).  I was referred to a gastroenterologist for tests, see following results:

Colonoscopy  Negative
Upper GI Series  Negative
Stool tests - Guardia, fecal fat, etc  Negative
Blood work – my B-12 was mildly reduced and I was slightly anemic.  
Celiac Blood Panel – Negative

While the test was negative, my interest was piqued when he mentioned Celiac and after doing some research, I felt this condition best described exactly what was going on.    On the advice of some peers, I had a stool antibody test done through Enterolab.  While I know that this test is not yet “proven” within the medical community, it was worth a shot.  I also had a genetic test done.  I carry two copies of the HLA-DQ2 marker.
At my last appointment with my gastro doc, he felt that I had IBS and to reduce my stress levels.  I am not buying this.  Here are my questions:
1.  Based the above, do you think an Endoscope is warranted?
2.  If not, where do I go from here?  I am living on Imodium (immodium).

[Kevin Pho, MD]

I agree with the comprehensive evaluation you have had thus far.  

The negative colonoscopy and stool tests would make lower GI disease less likely.

I agree that an upper endoscopy may be helpful.  Bloating and gas can be caused by various forms of dyspepsia, which would be appropriately evaluated by the endoscopy.

If negative, I would optimize treatment for irritable bowel syndrome.  Increasing the amount of fiber in the diet, as well as antispasmodic agents can help.

These options can be discussed with your personal physician or GI consult.

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 patients education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com

[misulli]

I have already tried the fiber route and live on Imodium (immodium) now.  Any thoughts on the Celiac?  Is this something I should keep an eye on???

[Soonerman]

Although not a doctor, I think you should seriously consider Celiacs.  The antibody blood panel is not accurate and can give false negatives.  With your symptoms and the low B12 (common in celiacs) it could definitely fit.  Be aware the biopsy can also lead to false negatives especially if the samples are taken from the wrong area that has yet to be affected.  If you want to see for yourself, just go gluten free (Completely) for at least a month and if you feel better.  It may be a struggle, but it won't cost and it will be accurate.