complicated problem ...HELP!!!!

Hi. This is somewhat complicated. Sorry in advance.

I am a 49 y.o. Hispanic Female, Obese, with Type 2 diabetes. I take metformin 1 gram bid, and an ARB for renoprotection. I have hypothyroidism, and I take Synthroid daily. I had a lap Chole in 2001. I am lactose intolerant.

I have had diarrhea since 2001 on and off, esp. after a large or fatty meal, or after dairy product intake. Lots of mucus is present at times. I sometimes have mild and intermittent RUQ abdominal pain. Pain does not change with position change, but will be slightly worse after a meal. Pain does not radiate, but at times I have a feeling that can best be compared to having an inflated balloon under my rib cage in the back on the right. It's not pain...it just feels abnormal. No nausea, no vomiting, no jaundice, no weight loss. **No** constipation, ever. All non-diarrheal bowel movements are thin or ribbon like.

I had 2 CT scans of the abdomen, an abdominal ultrasound, and an amylase (no lipase) a year and a half ago. All were normal. One month ago, I had an upper endoscopy, which noted GERD with esophageal erosions. I also had a colonoscopy, which noted a polyp, which was determined to be benign. Also, there was diverticulosis. No cultures or stool for O&P have been done.

The gastroenterologist prescribed Colestid, and Librax, Aciphex and a fiber supplement. He also prescribed a low lactose/high fiber diet, and the usual lifestyle modifications for GERD.

I am complying with my treatment. (Well, OK, I cheat sometimes and take lactase tablets before I have cheese.)

The problem is: with all of this, I still have had no change. The GERD is somewhat better, but the diarrhea/thin/flat stools are still present. The abdominal pain is still present.

I do not feel overly comfortable with my GI guy. I am really at my wit's end, to be putting my story here for the world to see. So please, if you can, give me some ideas.  

Thanks in advance.

[Kevin Pho, MD]

You have had a pretty comprehensive evaluation, including CT scans and endoscopies.  

The amylase/lipase/CT scan would make chronic pancreatitis less likely, and the normal colonoscopy would make inflammatory bowel disease or colitis less likely.

You can consider more uncommon diseases like fat malabsorption or celiac disease.  

Malabsorption can be caused by lactose intolerance, fat malabsorption or bacterial overgrowth.  Stool tests looking for fat malabsorption, or breath tests to evaluate for bacterial overgrowth can be considered.  

A blood test can be done to evaluate for celiac disease.

These options can be discussed with your GI physician - or in conjunction with another opinion.

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.

Kevin, M.D.
http://www.straightfromthedoc.com