ostomy and diarreha

[thomas-wright]

  Hello. I have had an ostomy for twenty years with little problems. eight months ago, I started having diarreha with no
  explanation for it. I had drunk some well water, and thought it might be parasitical in nature. I then went to the VA and had an
  upper G.I., 72 hour fat absorption test, endoscopy, blood tests, parasite tests, and all other sort of tests all of which proved negative.
  I lost ten pounds which is a lot for me, and since then have been drinking Ensure Plus, and so have put all my normal weight back on. All the doctors
  say to me `you're sick? you don't look sick.' I have no symptoms except the diarreha now. In the beginning I was initially tired all the time for
  about two weeks, or more, I had to sleep all the time, and now I am not so tired, but still don't have the energy I used to. My bowel movements were like toothpaste after the ostomy
  for twenty years and then all in one day they changed. At first they were quite smelly and black, very liquid, and now they don't smell so much, but the
  diarreha is still there. What more tests should I do and what could be causing this? Other than this one single symptom I feel great most of the time.
  Thank you very much for your time. Tom Wright. (ostomy/complete colectomy)
Dear Thomas Wright,
You did not mention the reason you have an ostomy. I assume the ostomy that you have is an ileostomy. There are a variety of reasons to have diarrhea.An abrupt change in your ileostomy output suggests a change in diet or medication or an infection as a cause. Many prescription and non-prescription medications can induce diarrhea. Sorbitol and fructose in elixir medications and in a number of foods can cause diarrhea. Antibiotics and laxatives can also cause diarrhea. Lactose intolerance can do so as well. It is also important to note if you have had contact with small children in diapers or have travelled. Weight loss suggests malabsorption, inflammation or the presence of a tumor. It may help to note whether or not your diarrhea persists after a fasting period. This can help to distinguish between a secretory or an osmotic diarrhea. Since you have had some of the terminal ileum (last portion of the small intestine) removed, you may have a bile acid diarrhea. Another possibility is that you have small bowel bacterial overgrowth. If you have a history of Crohn's disease, recurrent inflammation or a stricture (narrowing) may be present.
Initial tests should be directed toward identifying an inflammatory or infectious cause. Stool for culture and sensitivity, ova and parasites, Giardia antigen, Clostridium difficile toxin, leukocytes (white blood cells) and fat should be performed. A complete blood count and thyroid hormone test should also be performed. You mentioned that you had an endoscopy but did not mention whether or not a biopsy was performed. Did you have an endoscopy through the ostomy (ileoscopy) with biopsy? Another alternative is to image the small intestine is to perform a small bowel x-ray. If there is suspicion for bile acid diarrhea, a trial of a bile acid binding drug may be appropriate. Antibiotics may improve small bowel bacterial overgrowth. If small intestinal malabsorption is suspected a D-xylose test or tests to check for vitamin B12 absorption may be indicated.
You also did not mention whether or not you've tried medications to control diarrhea. Over the counter anti-diarrheal agents may provide some relief. It is extremely important to prevent dehydration by replenishing fluid and electrolytes that are lost. I hope you find this information helpful.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you wish to be seen at our institution, please call 1-800-653-6568, our Referring Physicians' Office and  make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
HFHSM.D.-ym
*Keywords: diarrhea