Any Ideas?

[SASSY-30]

I am 30 years old, female.  At the start of my problems I suffered terrible stomach cramping which would leave me doubled over for 5-60mins, occasionally. This went on for about 6 months, then I was told I had alopecia areata when a bald spot occurred on my scalp.  For the next 18 months my stomach cramping was getting more frequent (almost daily) then had three weeks of diahorrea. I was sent to a GI doc and had a colonoscopy which revealed a polyp and was removed. Things never improved with the stomach cramping but the diahorrea did stop. The next six months I lost all my scalp hair & eyebrows & lashes, my weight had gone from 57Kilos to 45kilos but this was from the onset of pain. Since then I have had numerous blood tests all negative, another colonoscopy negative apart from 'no muscosal pattern at terminal ileum', endoscopy - mild eosphagitis, small barium negative and barium x-ray negative also malabsorption and celiac disease have been ruled out and I had a CT scan on my pancreas which was negative. During the four years since my first colonoscopy, domperidone was the only thing to subside this pain. My BM's are also painful whether hard or soft motions are passed and find I get constipated when on domperidone. Ive now decided not to go back to my GI doc as nothing has been found as to what is the cause of my pain or weight loss and also stopped taking domperidone as the constipation is more painful than the pain I already suffer. My Question is-

No muscosal pattern at terminal ileum - Could that be the reason for my painful BM's?

Am I wrong to believe that my weight loss and alopecia are associated with my ongoing stomach problems with the obvious causes ruled out?

What would cause normal then hard to pass stools (in the same day) on an almost daily basis?

I was told that I do not have the classic symptoms of IBS. I'm pretty much at a loss but I do cope with the pain (which is under the left ribcage) daily, but when the cramping hits it is hard to cope luckily that only happens afew times in a week.

I was also informed recently that the polyp found during my c/scopy 4 years ago is the type that turns cancerous if not removed and i'm on a 5 year suvellance program, does that mean I am at high risk of getting more polyps which can turn nasty?

I eat a very balanced diet and drink about 10 units a month and I smoke about 15 aday.

Sorry its so long!
Any suggestions would be greatly appreciated.

[Kevin Pho, MD]

To answer your questions:
1) This suggests a possibility of an abnormality in the terminal ileum.  Crohn's disease can present this way - an upper GI series with small bowel follow-through can be performed to further evaluate this.  

2) There are a variety of autoimmune disorders that can cause alopecia as well as GI symptoms.  An evaluation by a rheumatologist can be considered.

3) Irritable bowel syndrome can cause a change in bowel habits.  Various neurological disorders or metabolic conditions (i.e. electrolyte abnormalities as well as thyroid disorders) can also cause this.  Make sure that they have been ruled out.  

4) If you have been diagnosed with polyps, you are at increased risk for future polyps.  

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.

Thanks,
Kevin, M.D.