IBS, Absorption Problem or ??

[Steph__0__0]

  I'm a 32 year-old healthy female who began experiencing diarrhea
  about two months ago.  I lost 7 lbs in 2 months, despite trying to
  eat enough to maintain my weight.  After numerous tests, including
  stool tests for bacteria and parasites, blood tests for thyroid,
  celiac sprue, and HIV, and a colonoscopy -- which all came back
  negative--my doctor said that I probably had a parasite that didn't
  show up on the tests and put me on Flagyl for 10 days.  It's now
  one month since I stopped the Flagyl, and while the diarrhea
  subsided, I am still having unusual bowel movements:  they are
  more frequent than usual for me (2-3x day), and I usually have
  a bm right when I wake up in the morning.  In addition, they are
  soft, and disintegrate in the toilet.  I often notice bits
  of undigested material in them.  I have no abdominal pain and
  the only other symptoms that have continued are a bit more burping
  and flatulence than normal and ongoing anxiety.  Immodium seems
  to help firm my bm somewhat.  The only dairy I eat is yogurt and
  I was not even eating that when the diarrhea began.  I've added
  quite a bit of fat back into my diet, but I don't seem to be
  gaining weight.  Does this sound like Irritable Bowel or an
  Absorption problem?  Would you suggest any more tests?  Thanks
  for any suggestions.
____________
Dear Steph,
Most people with acute infectious diarrhea get better within a short time.  Your physician was correct, in my opinion, by treating you empirically for Giardia infection.  There are several possible explanations for the persistence of your symptoms.
1) The antibiotic treatment did not eradicate (cure) the Giardia infection.
2) You have another infection that was suppressed but not eliminated.
3) You have a small intestine or pancreatic problem that is causing an impairment of digestion leading to your inability to regain weight etc.
4) The infection and subsequent treatment altered your intestinal flora and it has not yet returned to normal.
I suggest that you contact your physician and discuss the following
a) repeat stool studies looking for parasites as well as organisms such as Cryptosporidium which can affect immunocompetent people
b) an upper endoscopy with small intestine biopsy
You should also continue to take the yogurt but yake brands that contain lactobacillus which will return your flora to normal.
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 investigate your symptoms. Dr. Fogel of the Division of Gastroenterology would be able to see you and to quickly evaluate your symptoms.  He can be reached by calling the Henry Ford Physician Referral Line at [phone].
HFHSM.D.-rf
*keywords: diarrhea, Giardia infection
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