please help, what should I do?

[smoochie]

Hi,I would be really grateful if anyone has any ideas that could help me.
I'm 25, now live in San Francisco and have (had) normal diet and never complained about any stomach problems. No family history of any cancers, either. I've got a really bad chronic diarrhea that has been torturing me for five months already. It all started as a bad food poisoning about half a year ago, I had acute diarrhea and upper stomach ache that lasted for hours, and then became constant. It never resolved itself, and since then even got worse-I cannot eat anything at all, except rice and steamed vegetables, anything else brings nagging stomach pain and diarrhea, and for the last month I've been having gray and even white stools that contain undigested food. For the past month I even have chills and light fever at night, and I've lost 20 pounds. Normally diarrhea doesn't wake me at night, but often it doesn't let me sleep.I've been to two doctors already, and neither one of them believes I have something serious because the tests don't show any abnormalities.
The testing that have been done to me includes:
Blood count
Upper endoscopy
Abdominal ultrasound
Colonoscopy (they did not take biopsies because they said everything looked normal)
Stool cultures for parasites
pancreatic enzymes test (amylase, lipase)
I'm not sure of the names of the tests, but possibilities of hepatitis and gallbladder problems were also excluded.
The only thing they found was H.Pylori and mild gastritis, and i was treated for it three months ago. They killed the bacteria but my condition only got worse.
All the tests above returned normal results. Both of the doctors I went to are completely sure I have IBS, and are not willing to do any further testing. I was treated for IBS with Dicyclomine and Amytriptyline, but they don't help either. The last tests my doctor agreed to is D-xylose and thyroid tests, I have to do that next week. Beyond that, I will have to look for another specialist and I'm terribly depressed, I really don't know how to persuade any doctor that I think my problem is something else. I had to drop all my college classes and cannot go anywhere, because of constant diarrhea and inability to digest anything at all. If you have any idea, what other tests could be done and is it true that these symtoms could be IBS, please respond.

[Kevin Pho, MD]

Hello - thanks for asking your question.

You are having chronic diarrhea and a battery of normal tests.  Here are some tests to consider that you haven't done:
- quatitative stool fat to look for malabsorption
- tests for neuroendocrine tumors (i.e. VIPoma can cause watery diarrhea, gastrinoma can also be considered)
- tests for celiac disease

If the diagnosis is indeed irritable bowel syndrome, then here are several other medications that may help.  
- Tricyclic agents can slow intestinal transit time and may therefore be beneficial in diarrhea-predominant IBS.  You have already tried amytriptyline - you may want to consider paxil, zoloft or prozac which have been studied in small trials.
- Loperamide has been shown to improve the symptoms of diarrhea-prominent IBS
- Ondansetron and granisetron have been shown to be of some utility in diarrhea-predominant IBS.

You may want to discuss these medication 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.

Thanks,
Kevin, M.D.

[dowdsm]

Just wanted to let you know that I do know how you feel. This time last year I was just like you. Couldn't do anything because of my chronic diarrhea.  After months of screaming and yelling and crying at doctors, I was diagnosed with Zollinger Ellison. Was put on Prevacid, had unsuccessful surgery, but the diarrhea is gone and I'm back to feeling good, living my life and being myself.  Have faith that someone will find out what is wrong with you. IF you don't like what your dr is telling you or if he/she isn't telling you anything, go elsewhere.  You only live once.

[smoochie]

Thank you so much, at least I will know that there are still options and things to look for. I will try to follow your advice and if I finally get diagnosed I will tell you what it was. I hope all the other people out there also get help from their doctors and get well.:-)This illness is really a big deal for me, cause if I don't get better I will have to go home, back to Russia, and get in the hospital-this would be the end of my college degree here and may affect my husband's job here, as well. But at least there they put you in the hospital with symptoms like this and don't let you out until you're diagnosed and treated:-)))serious.
Thank you all so much for your support.

[tessa0825]

Hi, you hit on a very important topic and one that has concerned me for several yrs...I have often (lately) wondered why people arent hospitalized anymore to get quicker diagnosis and treatment instead of spending months running around to various Drs. and specialtist...I was a little different case in the fact that I really had no BIG significant symptoms(I had a little heartburn and some swallowing problems that initially was disconted as being no big deal) my Dr. got concerned over some routine blood test results...So I was diagnosed kind of in reverse....They knew something was wrong but didnt know what or where it was (because of my lack of symptoms) every Dr. I saw I was hoping would say "well, you are feeling good, so , it must not be anything important" but what they said was "something is wrong and we have to find it" ...You cant imagine all the tests and things I went through...It lasted months and all the time I was now convinced I must be dying...I spent every  one of my days off of work, for months, having some kind of scheduled test..It affected my work and my life in general...I often wondered why I wasnt just hospitalized and had all the tests and saw all the Dr.s at once and be done with it...I remember when it use to be that way,I think it has to do with the rules govering insurance...I bet it is also frustrating to the Drs. The insurance companies seem to be in control in this area.....Best of luck to you.....Tessa

[dowdsm]

Please let us know what you find out.  I know it's a long, hard period until you get a diagnosis.  I went 8 months.  Was out of my mind by the time they found out what was wrong. Looking back, I can't believe how poorly I was feeling and it seemed like no one cared nor wanted to help me.  The medical set up sucks, but they will find something and you'll feel better.  

Again, good luck and try to be as positive as possible.

[cheyfly]

I found Librax to be helpful for diarrhea-prone IBS.  I've had IBS for many years, since I was a small child, and Librax has been the most helpful med I've used.  My mother also found this to be the case.  Good luck.