Please Help.

  For some 25 years now I have had various complaints relating
  to digestive disorders.  I have had Upper GI, Lower GI, Barium
  Enema, Gall Bladder, Colonoscopy, visual viewing of the interior
  of the stomach.  I had a ruptured appendix removed in Nov/94.
  This surgery was done as a laproscopy as they were unable to
  determine the cause of the pain.
  Since then the digestive complaints have escalated.  I have
  frequent bouts of gas and acid stomach to the extent that I
  turn white from pain. Bowel movements are loose and sporadic.  
  The last episode the pain was so intense that when the  stool and
  gas were passed that I nearly passed out from the pain.  This
  pain continued and I then developed a high fever and ended up
  with my clothing being saturated.  Within 8 hours I was passing
  Bloody mucous.  At this point I went to Emergency and was told
  that I had a bladder infection and a bowel infection.
  For the last 4 years the terms colitis, ileitis and crone's(s)
  have been bandied about with no real solution.  I continue to be
  in pain and, at this point, during another apparent accute attack,
  absolutely afraid to eat anything for fear of increasing the pain.
  I might add that I have also had a 30 year battle with recurrent
  cystitis and yeast infections.  I was also diagnosed as having
  endometriosis and carried 3 out of 6 pregnancies to term.  
  I am currently on Premarin .625mg once daily and Serzone 150mg
  twice daily and for this latest attack I am being treated with
  Stemitil 5 mg.(b.i.d.), Cipro 250mg (b.i.d.), and Acidophils Plus
  (t.i.d)
_________________________
Dear Joan,
Thank you for your recent question.  You have already had an extensive workup (upper GI, lower GI, endoscopies).  Many of the common causes of abdominal symptoms have been excluded.  Specifically, if you had Crohn's disease or ulcerative colitis (inflammatory diseases of the small intestine and/or colon), there should be definitive evidence after such a complete investigation.  
I have several thoughts that could explain different aspects of your problem.  If you use antibiotics frequently, you may develop an infectious colitis due to an organism called C. difficile.  The diagnosis can be made easily and noninvasively by a stool test.  The acid stomach may represent esophageal or gastric inflammation, although there should have been some evidence for inflammation at the endoscopies.  You may want to try over the counter H2 receptor antagonists e.g Pepcid AC, Tagamet HB to determine if the drugs improve the symptoms.
As I have written in this forum previously, abdominal gas is usually the result of swallowed air, although certain foods can cause bloating and distention (cabbage, carbonated beverages, milk or milk products). The combination of gas, abdominal pain and an alternating bowel pattern (i.e. periods of constipation alternating with loose stool) suggest the diagnosis of Irritable Bowel Disease.  This condition represents an example of good news, bad news.  The good news is that the symptoms, although they are distressing do not represent fatal illness. The bad news is that the multiple medications on the market do not work for everybody. Different treatments are tried until the one that best improves your symptoms is identified.
As initial treatment, you should try to increase the amount of fiber in your diet.  I would purchase Metamucil or a similar compound.  The dosage should be gradually increased until your symptoms improve.  One warning: When you start the Metamucil you will notice an increased sensation of gas and bloating.  You must continue to take the medication despite your discomfort.  As your bowel pattern becomes regular and your stools soften, the gas problem should improve.
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.
If you want, we would be happy to see you in the Division of Gastroenterology at Henry Ford Hospital, in order to review your records and initiate treatment to improve your symptoms.  You can arrange an appointment with Dr. Fogel, one of our experts in Irritable Bowel Syndrome by calling the Henry Ford Physician Referral Line at [phone].
HFHSM.D.-rf
*keywords: irritable bowel syndrome
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