I get persistent diarrhea for 3-4 times a week. Please help.

Hello,

Welcome to icliniq.com.

I can understand that you must be very upset about your symptoms that have been running for almost over two months.

There are few possibilities like peptic ulcer disease (ulcers within the stomach and duodenum a part of the small bowel), and the pain due to pancreatic inflammation called pancreatitis. Since you mentioned the pain has been there for a month and was more like a steady mild pain, and pain worse after meals favor more to the former diagnosis than later.

But I want you to give me more information about this before I can really make a clear cut difference in between the above possibilities. Could you tell me the total number of stool you pass in a week's time? How much is the approximate amount of the stools in each episode of diarrhea, such as 50 ml, 100 ml, 200 ml, or even larger than this? Do stools contain fat particles? Are they excessively smelly? Does this diarrhea ever awaken you from sleep at midnight? I understand you mention that diarrhea usually follows 30-60 minutes after meals. Did you notice any blood in the stools?

The pain you had radiate to back? Did you have a fever in the last one month? You mentioned that you had blood tests done. Do you have blood tests like serum amylase, serum lipase for pancreatic inflammation? Did they test for H.pylori infection? This is a bug that is commonly responsible for ulcers within the stomach and duodenum.

Any history of passing worms in the stools? History of foreign travel? Exposure to dogs or other pets? Any family history (parents, or siblings) having pain or diarrhea in their young age? Lastly, would you mind telling me the duration of alcohol intake? And are you a regular drinker? How much alcohol on that single episode? Plus also let me know do you smoke?

Kindly if possible, then upload all blood tests that you have done recently, as I can interpret those in light of symptoms you mentioned. I will wait for further information.

Hello,

Welcome back to icliniq.com.

Well the blood report and urine analysis you uploaded are within normal limits (attachment removed to protect patient identity).

But I would suggest you some more investigations that will help us further to exclude other possibilities as a potential reason for your symptoms. The particular set of investigations are stool related, I will write down below that you can do in a week time (not urgent) and share with me the reports once available. As for as I understand the overall scenario there are still a few possibilities.

1. Peptic ulcer disease: The characteristic pain you had seem secondary to peptic ulcer disease which are ulcers, erosion formations within the stomach and small intestine. I would investigate this with a stool testings for H.pylori infection, if found positive, would give you some antibiotic course to treat it.

2. Functional dyspepsia or hypersensitive stomach. Given your family history of this condition, plus given a mild (not significant pain at moment) pain and now change in the bowel habits make me this a possibility. I will given you acid suppressant medications which would correct this problem.

3. The pain and diarrhea are just secondary to bacterial overgrowth or abnormal accumulation of the bacteria within the small bowel. The condition is called as small intestinal bacterial overgrowth SIBO and dysbiosis. This basically produces excessive gases, particularly after foods like milk, salads, beans, certain cereals, grains collectively called as FODMAPs diet. Alcohol is one of them to produce excessive gases after fermentation in the small bowel when combine with these abnormal bacteria.

So I must say, it is completely possible that your symptoms are a result of all these conditions which are in to play. Diagnosing individual condition would cost time, money and labor rather I usually give medications, and usually see person improving and making diagnosis retrospectively without that much exhaustive testing. So the treatment plan is some preliminary testing only, and I would suggest you some treatment and some precautions related to foods. You can find it below. I would like to hear from you in a week time, preferably after testing.