Long standing digestive problem

[Frankenbiker]

Here's the deal:

Short version:  I eat, I get immediate gassy diarrhea.

Long version:  For several years, I've had food allergy problems.  They started around the age of 16.  I had an allergy test done a year or so into college, and it showed the following food allergies (as I recall):

Onions, Potatoes, Soybeans
Tomatoes
Ham/Pork
Peanuts
Wheat

I have a family history of severe allergies, as well as thyroid problems.

Now, the only one that regularly gave me problems was soybeans.  Onions and potatoes gave me immediate and relatively severe problems, but not always long-lasting.  The others were only problems at random times.  Most of the foods would show a reaction in a couple of hours, or at worst, within 30 minutes of finishing a meal.

In the last two years, several foods have been added to the list:

Apples
Oranges
Corn
Carrots
Coffee
Some cheeses

All of these result in IMMEDIATE (as in, before I finish a serving) and protracted reactions.   So bad, in fact, that the effect is much the same as having a colon cleansing regimen before undergoing a colonoscopy.   I get cramps that feel like I’m being kicked by a horse, and frequently wind up screaming in pain.  After one of these episodes stabilizes, it’s often DAYS before I need to go to the bathroom.  Antihistamine therapy is all but useless, unless I get into triple-dosage levels.  

I discovered about three years ago is that smokeless tobacco virtually stopped most if not all of my symptoms, but obviously, this has problems of it’s own.  I have also noticed that the symptoms get worse if I try to decrease the size of my "chews."

For a short time, taking large quantities of “digestive enzymes” seemed to help, but getting these ultimately proved too problematic to continue the regimen.

Recently, the problem has taken a sudden turn for the worse.  After a Christmas party on the 10th of December, I started feeling unwell with symptoms much like a short-duration flu virus.  I could not eat anything, regardless of the antihistamines I took.  My bowel movements had large quantities of mucous.  The symptoms have gotten a little better over the last week or so, but not enough to get back to pre-10th levels.

My doctor has written it off to "Irritable Bowel Syndrome," and not gone any further with any kind of diagnostics.  He would not order any kind of digestive chemistry tests, perhaps because of the expense; I pay my doctor in cash.

I did work with a gastroenterologist about six years ago, and wound up paying a great deal of money to have him tell me “nothing seems to be wrong.”  Again, no chemistry tests were ordered.  I underwent an upper GI series, and a colonoscopy.

What kind of tests would be able to tell me more about this particular malady, and what kind of cost (ballpark) am I looking at?

-blaine

[Kevin Pho, MD]

You have had a pretty comprehensive evaluation, with an upper GI series and upper endoscopy.

At this time, you can consider various malabsorption syndromes.  This can include fecal fat tests looking for fat malabsorption, blood tests looking for celiac disease, or breath tests to look for bacterial overgrowth.  

I would also consider pancreatic enzymes or imaging tests to look for pancreatitis, which can also cause the symptoms you describe.  

The costs for these tests would vary depending on what part of the country you're in - and can be discussed with your personal physician.

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.
kevinmd_b

[jessestuckey]

In spite of the food allergies, it might be worth your time (and money) to go to a really top notch IBD doctor (someone who specializes in IBD, not just gastro).  Preferrably, you can find someone who had their gastro training at Mt. Sinai (IBD Mecca).  Unfortunately, run of the mill gastros don't do a good job diagnosing (or treating) IBD (Crohn's or Ulcerative Colitis).  I saw 23 gastroenterologists (over 4 years) before the debate over what I had was settled by the IBD expert in Dallas (where I live).  Since she was qualified to state unequivocally that I have Crohn's, the debate ended.

The difficulty is that most gastros don't realize that there's very little (if any) correlation between macroscopic inflammation and symptoms.  Further, even a hyper-aggressive colonoscopy will take only 64 biopsies, which covers only .05% of the surface area of the colon.  Of course, that's not to mention the complete inability to get to the dozens of feet of the small bowel.  So, a "negative" colonoscopy is certainly not proof that you don't have Crohn's disease.  It doesn't take much positive sign of Crohn's to make it highly likely that you have it--particularly a biopsy (even just one) positive for inflammation.  It also might be worthwhile to have a CT scan, as they can often detect wall thickening which is even difficult to detect in colonoscopies.  

I'm not saying you do have Crohn's, but it's a possibility.  It might be good to get an upper scope to rule out Celiac/Sprue.  If you're anywhere close to Dallas, you should certainly see Dr. Kimberly Persley.  If you're anywhere close to New York, you should see Dr. Present at Mt. Sinai.  Rheumatologists are also helpful for such problems--you might get an ANA test run.  The Prometheus IBD First Step might also be worthwhile.

Most gastros are nearly worthless at diagnosing the tougher diseases.  That's my 2 cents.