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Gastroenterology (Expert Forum)
Second opinion of IBS diagnosis? Other diag test needed?
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Second opinion of IBS diagnosis? Other diag test needed?
by outsideopinionneededmom, Jan 04, 2005 12:00AM
Daughter (12) recently been diagnosed with IBS. Need to understand if we should get second opinion on diagnosis and/or run additional tests. Diagnosis made by a GI specialist after referral from pediatrician.
Child has been having stomach pain at least 2X/week more than 1 year. Frequent sinus infections had been thought to contribute to nausea/pain, but sinus symptoms relieved through antrostomy late 1/04. Bloodwork normal. Lactose tolerance test 10/04; 27PPM H2 baseline, then lowering counts resulted in SBBO diagnosis (no lactose tolerance issue). Pain frequency and duration increased and consistently described as stomach area...upper left, above waistline, not lower quadrant...virtually daily, starting early AM and often not significantly relieved until 2-3PM. No complaints of diarrhea, but was constipated. GI consult 11/04...abdominal xray confirmed stool throughout colon. I believe dietary changes during kitchen remodelling contributed, plus family trend to large stools/constipation. Miralax used to BM (about 10 days), plus 2 Tbsp Benefiber daily. Initial BM NOT hard or diarrhea-like; normal looking stool. Parasitology negative. Pain frequency and duration reduced but not eliminated. Miralax stopped and generally 1 Tbsp Benefiber per day, plus lower fat diet...seems good correlation between high fat intake and pain.
Levbid prescribed...generic fulfilled...initially sublingual/low dose, now higher dose supposed to be taken daily. Medication provides no apparent relief of pain, lower or higher dosage. Told anecdotally that some anti-spasmodics must be taken regularly over time before effective, but no doctor has advised this is true of Levbid; can't find Web confirmation either. So we concluded drug is ineffective and are not using. Opinion on continued use? Is there a reason to believe drug will eventually be effective?
Child has general difficulty with insomnia, dating from prior to stomach issues, but stomach issues seem to increase restlessness at night and ability to fall asleep (night owl tendencies anyway). Child also has periodic dizziness which appears to correlate to congestion, but want to report all symptoms.
Stress also seems adds to pain esp. duration but also onset.
Areas of concern/question:
- Is SBBO associated with IBS? Is this commonly seen in IBS patients? Were told SBBO indicated bacteria higher in the digestive tract...in stomach itself where bacteria don't belong. Does this happen in IBS patients or is this unusual?
- Is child's difficulty in sleeping/staying asleep consistent with IBS? Does this need more investigation?
- Does lack of responsiveness to anti-spasmodics indicate something other than IBS? Or is this common?
We have stopped regular visits with GI specialist, but we are still dealing with pain. Have we quit too soon? Should more testing be done? Second opinion needed?
Child has been having stomach pain at least 2X/week more than 1 year. Frequent sinus infections had been thought to contribute to nausea/pain, but sinus symptoms relieved through antrostomy late 1/04. Bloodwork normal. Lactose tolerance test 10/04; 27PPM H2 baseline, then lowering counts resulted in SBBO diagnosis (no lactose tolerance issue). Pain frequency and duration increased and consistently described as stomach area...upper left, above waistline, not lower quadrant...virtually daily, starting early AM and often not significantly relieved until 2-3PM. No complaints of diarrhea, but was constipated. GI consult 11/04...abdominal xray confirmed stool throughout colon. I believe dietary changes during kitchen remodelling contributed, plus family trend to large stools/constipation. Miralax used to BM (about 10 days), plus 2 Tbsp Benefiber daily. Initial BM NOT hard or diarrhea-like; normal looking stool. Parasitology negative. Pain frequency and duration reduced but not eliminated. Miralax stopped and generally 1 Tbsp Benefiber per day, plus lower fat diet...seems good correlation between high fat intake and pain.
Levbid prescribed...generic fulfilled...initially sublingual/low dose, now higher dose supposed to be taken daily. Medication provides no apparent relief of pain, lower or higher dosage. Told anecdotally that some anti-spasmodics must be taken regularly over time before effective, but no doctor has advised this is true of Levbid; can't find Web confirmation either. So we concluded drug is ineffective and are not using. Opinion on continued use? Is there a reason to believe drug will eventually be effective?
Child has general difficulty with insomnia, dating from prior to stomach issues, but stomach issues seem to increase restlessness at night and ability to fall asleep (night owl tendencies anyway). Child also has periodic dizziness which appears to correlate to congestion, but want to report all symptoms.
Stress also seems adds to pain esp. duration but also onset.
Areas of concern/question:
- Is SBBO associated with IBS? Is this commonly seen in IBS patients? Were told SBBO indicated bacteria higher in the digestive tract...in stomach itself where bacteria don't belong. Does this happen in IBS patients or is this unusual?
- Is child's difficulty in sleeping/staying asleep consistent with IBS? Does this need more investigation?
- Does lack of responsiveness to anti-spasmodics indicate something other than IBS? Or is this common?
We have stopped regular visits with GI specialist, but we are still dealing with pain. Have we quit too soon? Should more testing be done? Second opinion needed?
Doctor's Answer
by Kevin Pho, MD, Jan 06, 2005 12:00AM
, Jan 06, 2005 12:00AM
To answer your questions:
1) I am not aware of a connection between bacterial overgrowth and IBS. Normally, most of the more serious disorders should be ruled out before settling on the diagnosis of IBS.
2) IBS can certainly lead to difficulty sleeping.
3) Anti-spasmodics are not 100% effective in the treatment of IBS. Normally, increasing the fiber in the diet can help as well. Unfortunately, there is no "magic" treatment that can give a complete cure. There are some smaller studies that suggest the use of antidepressant therapy that may help.
You may want to discuss these options 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.
Medical Weblog:
kevinmd_b
1) I am not aware of a connection between bacterial overgrowth and IBS. Normally, most of the more serious disorders should be ruled out before settling on the diagnosis of IBS.
2) IBS can certainly lead to difficulty sleeping.
3) Anti-spasmodics are not 100% effective in the treatment of IBS. Normally, increasing the fiber in the diet can help as well. Unfortunately, there is no "magic" treatment that can give a complete cure. There are some smaller studies that suggest the use of antidepressant therapy that may help.
You may want to discuss these options 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.
Medical Weblog:
kevinmd_b
Member Comments
by newlydiagnosedibs30, Feb 18, 2009 09:57PM
A related discussion, IBS second opinion was started.
