mid abd pain w/diarrhea and solid food intolerance

[docauer]

I'm a 40 yr old female who began having mid abd cramping followed by bright yellow watery stools starting approx 2 yrs ago. At the time I was diagnosed with biliary dyskinesia by HIDA scan. My ejection fraction was 11%. I had a lap chole, but the symptoms continued intermitantly. It was then thought that I had Celiac sprue, but lab work and biopsy did not confirm this diagnosis. In Sept. the cramps and diarrhea became more severe with eating solid food.  If I did not eat solid food the cramping and diarrhea would go away.  In the first part of Nov. I noticed that I had no appetite and felt very full after "eating" (drinking) small amts of soup or broth.  I had a gastric emptying study that showed NO emptying after 90 min. I underwent an EGD w/botox on Jan 5.  The symptoms have not abated, and now have gotten worse. I now have cramping and diarrhea with liquids as well.  This cramping I noticed is also accompanied by a sensation of falling. As if I am on a roller coaster. I have NO nausea or vomitting. I have lost about 50 lbs and continue to lose wt. It has been suggested by my GI specialist that I have sphincter of Oddi dysfunction type 3.  Does this sound reasonable to you? I'm at my witts end. I'm having trouble working due to fatigue.  Please help.

[Kevin Pho, MD]

It is unlikely that SOD causes diarrhea.  If this needs to be evaluated, the best way would be Sphincter of Oddi manometry that is done during an ERCP.

I would first consider malabsorption syndromes.  This can include fat malabsorption - which is tested via a fecal fat test.  

Another consideration is bacterial overgrowth - which can also cause the symptoms of malabsorption.  The gold standard for diagnosing this would be via a jejunal aspirate during endoscopy.  

I would also consider a colonoscopy to evaluate for colitis or inflammatory bowel disease which can cause some of the symptoms you are describing.  

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.

[krisg]

Sorry to hear your troubles.  But speaking from first hand experience with SOD, it does not cause diarrhea.  It causes SEVERE upper abdominal pain that is extremely painful.  Comes on suddenly and disappears suddenly too, only hours later unfortunately.  There is a test that specialists perform to check out the biliary tree, ERCP.  They can look at the bile duct and pancreatic duct and check pressure in the sphincter of oddi muscle.  Rule of thumb:  Make sure the specialist has performed lots and lots of ERCP's, so they are very experienced.
Good Luck.