Could this be malabsorption? Desperate for information....

[Anna50]

Current symptoms:
Diarrhea in the AM only.  Stools are either greasy or pale in color and float.  I recently took Citrucel and the stools were on the pale/floaty side.  I have some reoccuring hip/groin pain but it may be from some other activity.  I have a good appetite but have lost weight the last few months.  My digestive system is very loud, growly in the AM prior to a bowel movement.  Sometimes I have the same sounds late at night before bed.  The sounds are loud enough for others to hear.

I am 5ft 6in and weigh 118 and weighed 128 2 months ago.  I'm 38 years old.

I have had an abdominal CT scan which was normal and several blood tests.  My CA125 was 18.5 which I've read is the higher end of normal for a healthy individual.

My lymph nodes in the groin area appear slightly swollen (not painful) but I have been assured they are normal by two physicians and the CT scan results.

I'm going crazy because I know something is not right.  Could this be malabsorption?  I am not anemic and my pancreas appeared normal on the CT scan.  I have had other times where I have lost significant amounts of weight without any change in diet or excercise but this seems worse.  Can malabsorption be reoccuring?  I have had 3 normal pregnancies.  During the pregnancies I was very constipated.

MY Gastro physician has ordered an ESR test, an endoscopic procedure and stool fat tests.  I will get the ESR test and stool fat tests back tomorrow.  I feel the DR thinks this is more of a psychological problem.  Any insight would be very helpful.

[Nanny]

Your symptoms sound like malabsorption to me.  I have had this in the past.  In my case it was due to my undiagnosed chronic pancreatitis.  I am not suggesting that this is what you have, as malabsorption can have many different causes.  Here is a copy of some symptoms and causes:

Malabsorption
Malabsorption Syndromes

Malabsorption syndromes are disorders due to a deficiency in the absorption of nutrients from the small intestine into the bloodstream. Normally, food is digested and the nutrients necessary for the proper functioning of the body are absorbed into the bloodstream from the small intestine. Malabsorption can occur due to either a disorder which interferes with normal food digestion or due to a disorder that directly effects the mechanism of absorption.

* Disorders that interfere with digestion.
Disorders that result in too much or too little stomach acid to digest food or disorders which result in inadequate amounts of enzymes necessary for breaking down ingested foods (e.g. Pancreatitis, Cystic fibrosis, Lactase deficiency, Obstruction of the bile duct) are the most common types of disorder that interfere with digestion, resulting in malabsorption.

* Disorders that effect the mechanisms of absorption.
Infections, drugs (e.g. Neomycin, alcohol), Celiac disease and Crohn's disease all injure the sensitive stomach lining and thus decrease the area available for adequate absorption of nutrients. Lymphoma and an inadequate blood supply to the intestine are examples of disorders that prevent substances from being passed into the bloodstream.

Symptoms of malabsorption include weight loss, malnutrition (due to a lack of essential minerals and vitaines), diarrhea, abdominal bloating, flatulence, jaundice and steatorrhea (light-coloured, foul-smelling stool that may float and stick to the side of the toilet bowel). These symptoms, of course, vary according to the precise disorder in question.

Treatment may include avoidance of certain substances (e.g. Lactose in lactose intolerance), antibiotics (where the cause is an infection) or a simple change in diet.

[Anna50]

When you had chronic pancreitis (SP?) did you have any pain?  I haven't had any real abdominal pain which I find puzzling.  Did you have an abdominal CT Scan?  How did they diagnose your condition?  I think that I have had this condition on and off for years (9+).

Does anyone else have any comments?

[Wilson]

Hi...your weight loss and stool description do sound like malabsorption to me. I think your doctor is ordering the appropriate testing given your symptoms. The stool fat test is the main one they use to determine IF there's malabsorption, and if you are malabsorbing the next question will obviously be WHY. I've been through the whole battery of tests for malabsorption - some more than once - so if you have any more questions after you get your test results I'd be glad to try to answer them.

[Nanny]

Initially I had some abdominal pain, also nausea and vomiting, then I had an acute attack.  It showed up on an ultrasound and then a CT-scan, there was calicification and psueodocysts in the pancreas.  It's unlikely that this is your problem, I can't see someone going 9+ years without it being detected and without having some serious pain with it.

Wilson's right, that stool test should be the one that determines malabsorption.  It could be caused by many different things, and your doctor will need to keep testing you until he finds the cause.  Good luck.

[Anna50]

I received the results of my fecal fat test, stool blood test and ESR.  All were negative.  They are proceeding with the endoscopic procedure and colonoscopy later this month.

I still think I have a malabsorption problem.  You mentioned having the tests several times.  Did your test initially come back negative?  I did not have the 72 hour test - they simply tested one stool.

Because I have had so many blood tests and the abdominal ultrasound, I don't think I have a malignancy.  I realize the other tests will test more specifically for that but given the fact I have had this problem (to some degree) for years, it doesn't seem likely.  In addition I had a colonoscopy 4 years ago that was negative.

I just don't think I can tolerate them telling me nothing is wrong.  Can biopsies from the endoscopic procedure determine a malabsorption problem?  What else could I request?

[Anna50]

I just got a call from my DR and the fecal fat test results had NOT come back in yet.  When they called yesterday the nurse did not realize we were still waiting for this test.  She just said, "All the test are normal".  She caught her error today and called to let me know they are still waiting.

[Wilson]

The tests I had several times were stool fat and a variety of scope procedures. The initial stool fat was positive, the scopes were inconclusive, and subsequent stool tests see-sawed between o.k. and slightly to moderately positive. The weight loss and other symptoms that initially brought me to seek medical attention eventually improved and no definitive diagnosis was ever made. It was chalked up to possible food allergies, which is something you might want to consider. Can you think of ANY other possible reason for your weight loss? (stress, lack of sleep, etc.)

Biopsies of your small intestine definitely can and SHOULD pick up almost any cause of significant malabsorption other than something pancreas-related. I agree with Nanny that your problem does not sound pancreatic ... 9 years with no diagnosis sounds more like celiac disease, if you do in fact have a malabsorption problem. If the scope is negative I would ask for the blood antigen test for celiac disease, although usually those tests are in the reverse order. The only other thing I can think of would be that camera pill that they recently came out with. You can find out about it at the company's website - I think they're called 'Given Technologies' or something.

I hope this is helpful, but I think you're on the right track with what you're doing.

[karie]

I am 5 7" 108 and have lost over 20 lbs. For 10 months I have had stomach aches, light colored stools , very soft. heartburn , gerd, indigestion with meals.
Have posted alot here. Very bland diet and healthy lifestyle always.
My stool test and h.pylori, endoscopy and upper g.i. 7 months ago looked fine.
Dgl in a low dosage now for 9 plus weeks brings some relief.
Tried many things.But still discomfort. Told now maybe gastritis and it takes time.
Keep us posted and on what tests exactly so others can learn here too please.......

[Anna50]

My tests (fecal fat), ESR, stool blood test and a protein test all came back normal.  The Dr called last night and although I couldn't talk directly with him he seemed to have the tone that "I didn't need to worry".  We still have the endoscopic and colonoscopy procedure scheduled.

He has asked me to take Citrucel (or another fiber supplement daily) for the next few weeks and let him know how it affects my diarrhea.  I have been doing this for two days and have noticed a difference.  Stools are slightly more solid and bowel sounds have lessened.  He also gave me a prescription for Bentyl but I hesitate to take it.  Does anyone have info regarding this drug?

For others that have posted regarding their own similar symptoms:  Please don't hesitate to push for CT scans or similar diagnostic tests.  My mother died at age 60 from gastric cancer.  She was very healthy and never smoked and rarely drank alcohol.  She had gastric reflux for years and was constantly told to take Tagamet or Pepcid.  Unfortunately, by the time she saw a GI Dr and they did a CT scan her cancer was Stage IV.  She had no other relatives with these symptoms or cancer.  

I do not believe my issues are gastric related but it has certainly made me more proactive.