Re: Is it IBS?

Posted By HFHSM.D.-rf on May 21, 1998 at 10:32:50:

In Reply to: Is it IBS? posted by Skorchee on May 16, 1998 at 21:52:28:






I am a 45 yr old female with a long history of GERD and chronic diarrhea.  In Sep 97 I had a fundoplication, and since the surgery I have lost my appetite, and have very PERSISTENT, and painful diarrhea.  It is much diffrent than the diarrhea I had prior to the surgery..this diarrhea is debilitating.  I have lost 32 pounds since the surgery.  I call them attacks...I start with nausea, then very painful abd cramps, then diarrhea with even worse cramps while I am having it.  The stools are often greasy and have mucous in them.  It has been like this since the day I left the hospital from the surgery. I just had an EGD done, and it was completely normal. I have also had a stool sample tested that was completely normal.  I no longer have insurance, so I am without medical care.  What can I do to help myself?  I have tried the obvious, like Lomotil, Ammonium, fiber etc. nothing has worked.   I can't figure out what the trigger is or find a pattern.   After the "attacks" I feel wiped out, and feel like I have a fever, but I don't. I also have Fibromyalgia, and Psoriasis.  I will have medicare in Nov of this year, and since I am local will come to your facility at that time.  Meanwhile, my life has been greatly affected by this.  What can I do?  Thank you in advance.   WITHOUT A DOCTOR
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Dear Skorchee,
Your letter appears to describe two different and possibly separate medical problems. After fundoplication, either by an open or a laparoscopic procedure, some people have vagus nerve injury, as Patty correctly writes.  It is difficult to determine from the medical  literature the frequency of this problem. Vagal nerve injury will often present as loss of appetite, eating a small amount and being full, weight loss, bloating, abdominal pain, nausea and occasionally with vomiting of undigested food that had been eaten more than 4 hours previously. These symptoms are often the result of impaired gastric emptying.  To confirm whether this problem is contributing to your symptoms, you will need a gastric emptying study.
Diarrhea can also be a manifestation of vagal nerve injury but is much less common.  There are several possibilities to consider while you wait to see a physician.  Could the diarrhea be an unexpected side effect from one of your medications?  You may want to stop all unnecesry medications and observe if the diarrhea resolves.  Under physician guidance you may even need to stop all medications.
Even though the EGD was normal, it is possible that you have the recent appearnace of small intestinal mucosal injury that is causing malabsorption.  The only way to exclude this possibility is by a small bowel biopsy and examination of the lining under a microscope.  Did the physician perform a biopsy at the time of the EGD?
Finally, one must carefully exclude infection (repeat cultures are needed and several must be done because sometimes people with infection can have a false negative study) and other intestinal illnesses such as Crohn's disease.  I do not believe that the symptoms are directly related to your fibromyalgia or psorriasis but this possibility must also be explored.
Unfortunately, there are no interim treatments to suggest.  The pain and weight loss mandate that we find the cause and initiate specific treatment for the illness rather than symptomatic care that does not address the underlying problem.
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 the investigation of diarrhea and abdominal pain.  He can be reached by calling the Henry Ford Physician Referral Line at [phone].
HFHSM.D.-rf
*keywords: fundoplication, diarrhea, weight loss, malabsorption, gastroparesis
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