How to manage my mother's anemia and GI dysfunction?

Question

Hello doctor,

My mother is 65 years old and diabetic. She has hypertension, hypothyroidism, and thalassemia minor. She is anemic, too. For 10 days, she has been having alternating bloated stomach, diarrhea, constipation, and lower back pain. What could these be symptoms of?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand that you must be very upset about your mother for her troubling symptoms.

You know diabetes, hypertension are chronic ailments that can affect every system of the body. Some of these effects, particularly of diabetes, are related to the gastrointestinal tract (GIT). The possible cause is diabetic gastropathy (involving the stomach), and diabetic enteropathy (when involving the small bowel) can cause bloating, alternating diarrhea with constipation, such as in her case.

It is highly likely that she has one of the above-mentioned conditions, but to be on the safe side, I will suggest some tests, as we can rule out anything other than this.

I would suggest the following measures:

Complete blood count (CBC).
HbA1c (glycated hemoglobin).
TSH (thyroid-stimulating hormone), FT4, FT3.
Vitamin B12 and RBC folate.
Serum albumin, BUN, creatinine, electrolytes, calcium, phosphorus, magnesium, and serum CRP.
Stool for ova and parasites.
Stool for fat globules, and reducing substance.
Stool for C difficle.
Stool for fecal calprotectin.
Stool for H pylori antigen.

Meanwhile, start her on tablet Digestine (Metoclopramide) 40 mg once daily, half an hour before meals. Start her on tablet Rifaximin 200 mg thrice daily for three weeks. This is a safe antibiotic that will correct her abnormal bacteria within the small and large bowel. This will help her control her production in the long term. Use Fibrocol or any other fiber that is available, two tablespoons full with water, once daily with water.

And the most important of all, tight control of her sugars. Since the problem is secondary to diabetes, once diabetes is controlled fairly well, her symptoms improve.

Regarding the follow-up after one week of use of the above medication, to see how she responds. Meanwhile, get above mentioned investigation. Please do not get frightened seeing a list of investigations; they are just a thorough overall assessment of her condition. If she already had some of these tests before, then please do not get those.

I hope this helps.

Thank you.