Diarrhea and inablity to eat

[Annie May]

Early last year I was diagnosed with hyperparatyroidism and started losing a lot of weight (I was overweight anyway) but for the last 3 months I can't eat any solids other than jello and small pieces of fruit.  I had to go to emergency room 2 days ago and I was dyhydrated.  I've been to so many specialists and have now lost 75 pounds and am very weak I just don't want to go on like this can you possibly give me some idea of whats going on?  Since all tests have come back normal do ya think I may be mental?  I'm starting to feel like I am.  Thanks for any info you can provide.

[Kevin Pho, MD]

Hello - thanks for asking your question.

Please understand my limitations over the internet as I have neither met nor examined you. This information is for patient education only. Please see your personal physician for further evaluation.

Chronic diarrhea is a frustrating problem.  There are many causes for this and I will outline suggested tests you may want to discuss with your personal physician.

Chronic bacterial, mycobacterial, and parasitic infections, functional disorders, malabsorption, and inflammatory bowel disease, irritable bowel syndrome (IBS), inflammatory bowel disease, malabsorption syndromes (such as lactose intolerance and celiac disease), and chronic infections (particularly in patients who are immunocompromised) are all causes that need to be evaluated.

The minimum laboratory evaluation in most patients should include a complete blood count and differential, thyroid function tests, serum electrolytes, total protein and albumin, and stool occult blood. In addition, most patients require some form of endoscopic evaluation (either sigmoidoscopy, colonoscopy, and sometimes upper endoscopy).

If all the above tests are negative, here are some specialized tests you may want to discuss with your personal physician:
- 72-hour fecal fat collection can establish the diagnosis of fat malabsorption
- cultures to exclude chronic infection
- imaging of the small and large bowel
- selective testing for secretagogues, such as gastrin or vasoactive intestinal polypeptide, to evaluate for neuroendocrine tumors causing chronic diarrhea

It would be impossible for me to guess what is going on - there are too many causes.  You may want to discuss the extensive tests above with your personal physician to ensure a comprehensive evaluation.  

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.

[J512]

Here is what I experience:  urgent extrememly painful need to have a bowel movement.  During this, I am gagging and puking and my body overheats extrememly (sweat drips off my face)
This will happen probably 3 times in a row.  When it is done, my anus is burning and i am extrememly exhausted.  I will need to pass out immediately.

On the days when that doesn't happen... I have normal diarrhea that does not go away (in the bathroom all day) and i feel nauseous all the time.  Sometimes my stomach burns.  Sometimes i puke up bright yellow fluid.  

Everything makes my feel sick and I never want to eat or drink.  I have had the barium swallow and the barium enema but they have found only a slightly inflammed duodenum.  

What do you guys think?  (some of the doctors have told me this could be stress related so i am going to see a shrink as my job will pay for it)

Please help me!!!