IBS-D or something else?

[IbsD]

I have a long history but I will give the short version (yes, this is the short version believe it or not):

I was diagnosed with milk protein allergy (anaphylaxis reaction) when I was 2. I was also diagnosed with tree nut allergy (anaphylaxis reaction) when I was 7.

When I was 11 I had a horrible sickness after eating at a Taco Bell on vacation. The stomach pain paralyzed me. I couldn't speak or move until morning when it subsided. When it did, I threw up hard taco shell that hadn't digested from 15 hours prior.

After this illness, i developed ongoing stomach issues (diarrhea, extremely severe cramping, nausea, etc) to the point where I had to be homeschooled. I visited the Mayo Clinic and had every test done. They diagnosed me with IBS-D and sent me on my way. They prescribed low dose anti depressants and anti-cramp medicines. Neither of these helped.

From age 12-15 I struggled with the symptoms mentioned above, on a slow decline. I lost significant weight and ended up not being able to eat anything at one point. At this point, I was admitted to the ICU. The short version is that they performed a huge battery of tests and found out that I lacked an ezyme to digest ibuprofen and other anti-inflammatory medicines which caused gastritis and a massive amount of stomach acid on my stomach. I had been taking a lot of ibuprofen for headaches.

After the hospital they prescribed protonix, low dose anti depressants, and anxiety medicine. None of these helped.

I continued on those medicines until I was 23 and started getting worsening of symptoms, particularly nausea and acid reflux. Then diarrhea started as well. After seeing many doctors who had no idea what was going on and kept saying it was "IBS" I eventually went to see my allergist. I was tested and told that I was allergic (to varying degrees, but not anaphylaxis) to about 20+ different common food items that I normally ate.

At this point I stopped eating all of those foods completely and I saw a huge improvement in my symptoms. I almost felt normal. I was able to get off ALL medication completely. The biggest problem was having a very restricted diet, but it was a small price to pay compared to the pain.

After 1 year of improvement, I started having the symptoms again. So I went back to my allergist. I was tested and they said (some) of my allergies went away, and I had gained about 15-20 new allergies again. So, once again, I cut all of those foods out of my diet.

All I ate for the next 1-2 years after that was rice and chicken basically for every meal.

Now, fast forward to today. I am 27 years old, turning 28 soon. Male. One year ago I started getting acid reflux, diarrhea every day, etc. I was retested for allergies and they said all allergies were gone besides milk and tree nuts.

I ended up at a gastroenterologist who diagnosed me (again) with IBS-D and prescribed XIFAXAN. I did a two week course of it, and it helped give me regular bowel movements. However as soon as I stopped taking it my symptoms returned. I took a second 2-week course and the same thing happened. I am currently on a one-month dose and I have experienced improvement but not as big as the first two times I took XIFAXAN.

I will wrap this up by saying this: it seems like everything I eat, my body rejects. I cannot eat rice anymore without major heartburn that lasts for 24-48 hours. My stomach will feel like an acid pit. I switched to oatmeal and at first my bowels improved, however i am having issues again. It seems that if I eat something for an extended period of time eventually my body treats it as poison.

What conclusion can be made from this? I am running out of options for food to eat.

[Red_Star]

You might be interested in this article by Sophie Lee - "Do You Have IBS-D, or Is It Habba Syndrome?". Out of the 303 people suffering so called "IBS-D" they had various other conditions as listed below.

"Do you have IBS-D, or do you have Habba Syndrome? That’s what Dr. Saad F Habba, MD,(1) would like to know.

He’s coined the term Habba Syndrome to describe a condition that causes chronic diarrhea and is caused by a faulty gallbladder, and he believes that millions of IBS-D patients have been misdiagnosed and actually have Habba Syndrome.

This is the theory:

• When the gallbladder goes haywire, you end up with too much bile in the intestines, and the bile causes diarrhea. [A healthy gallbladder collects fat-digesting bile acids from the liver and delivers bile as needed through a tiny bile duct to the top of the small intestine.]

• This, of course, is the same thing that happens to some patients who have had their gallbladders removed.

• The treatment is the same too, with drugs such as Questran used to bind the bile.
One particular feature of Habba Syndrome is diarrhea straight after a meal, which is called post-prandial diarrhea, and occurs because bile acids are naturally released directly after meals. This is something that many patients with diarrhea-predominant IBS experience.

Sound interesting?

For me, one of the best things about this theory is that there’s a specific test that can be used to see whether your gallbladder’s gone bad. It’s called a HIDA or DSIDA scan with CCK injection, which in layman’s terms means that you get injected with some mildly radioactive stuff to highlight the bile, lie in one of those big white scanning machines, and wait while the docs study the flow of bile through your body.

This is a fairly new theory, so who knows whether we will all be having HIDA scans in the future. Theories like this tend to take years to really gain traction.

Lately, though, Dr Habba has taken his theory even further. In  an article published in 2010, he suggested that IBS-D doesn’t exist at all. He studied 303 patients and concluded that 98% of them were suffering from a ‘true clinical entity’ rather than the ‘vague entity’ that is IBS.(2)

Of the 303 patients, he concluded that:

• 41% had Habba Syndrome,

• 23% had diarrhea caused by gallbladder removal,

• 8% lactose intolerance,

• 7% microscopic colitis [Inflammation of the colon visible only using a microsocpe, involving build-up of white blood cells in the bowel lining, and caused, many think, by an abnormal immune response triggered by stressors such as bacteria, medication, or food],

• 4% celiac disease or gluten sensitivity,

• And then a handful of patients had multiple diagnoses, drug-induced bowel problems, infectious colitis or other problems.

In follow-ups, 98% of patients improved significantly when their specific problems were treated appropriately.

In other words – IBS-D, to all intents and purposes, is fictional. Wow.

Now, this was only one study, and I’m sure there are many doctors who are busy refuting the theory, because that’s how medicine works.

But I have to say that this is a fascinating idea, and it addresses what is, to me, one of the stupidest aspects of the IBS diagnosis, and that is the fact that people who have their gallbladders out and subsequently suffer from bile-related diarrhea get told they have IBS. How can that possibly be called IBS? [See “Gallbladder removal and IBS.”]

You might as well diagnose someone with IBS if they’re taking 20 laxatives every morning, as if the mere presence of severe diarrhea automatically means IBS.

It seems obvious to me that post-gallbladder removal diarrhea is not IBS-D, just as diarrhea when you’ve had half your colon cut out isn’t IBS-D, so why doctors insist on calling it IBS I have no idea.

But maybe the problem isn’t just that doctors call gallbladder-related diarrhea IBS. Maybe the problem is that they call anything IBS…and none of us have irritable bowels at all."