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Hello doctor,
For the past one year, I am having diarrhea. I went to the doctor. He wrote me some tests. My blood, urine, and feces are normal and negative for parasites. My stomach ultrasound, colonoscopy are normal.
Six months later, I went to the dentist. She asked me to take Flagyl 500 mg (Metronidazole). On the next day, my feces was normal and tight. I asked another gastroenterologist and he said to continue the Flagyl for 14 days. After 10 days I had diarrhea again. The doctors are telling me that I have very sensitive intestines and advise me to take probiotics and Ibutin gelsectan. I still have diarrhea. What is your idea about my problem?
Hello,
Welcome to icliniq.com.
As you described this condition to be lasting for almost more than a year, it can be IBS (irritable bowel syndrome), but IBS usually starts at an early age than this, although it can happen at any age. That is why it is important to rule out all organic causes before labeling it as a sensitive bowel (IBS). Please answer the following questions to rule out organic causes.
Do you have any weight loss with it? How many episodes of loose stools do you have in 24 hours? Do you get up in the night for stools? Do you have any crampy abdominal pain with it? Is there any blood in stools or mucus? Is your sleep disturbed? Any stress? Any travel history to tropics? Any biopsy was taken during the colonoscopy to rule out microscopic colitis?
Meanwhile, do a few of these lab tests and start this treatment in addition to probiotics but the tablet should be taken four hours apart from probiotics.
1.TSH (thyroid-stimulating hormone).
2.CRP (C-reactive protein).
IBS?
Treatment plan:Tablet Rifixamine 550 mg 1+0+1 for 21 days.
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|Thank you doctor,
Yes, I lose 4 to 5 kilograms due to the diahrrea period but if I take Flagyl I take the kilograms back. One stool every day when I wake up. Sometimes I may have two or three loose stools. No, I do not wake up in the night for stool. I wake up only for urine if I drink a lot of water. I would not describe it as pain but as pressure combined with some gas. No blood at all. My sleep is not disturbed.
I may have some stress because I got married and my wife is expecting a baby and I work on shifts for 14 years. I have been to the tropics, not recently. Yes, during the colonoscopy the doctor took biopsies along the colon and a little bit of the thin intestine. They were clear. The lab said that they found traces of a substance that causes the bowel to empty but that was the substance that the doctor gave me the previous day to empty the bowel for the exam. So should I do the tests, TSH and CRP?
Hello,
Welcome back to icliniq.com. The answers to all the questions are very satisfactory to me. All these answers almost rule out something serious such as inflammation in the bowel. The normal biopsies also rule out microscopic colitis which is one of the most important diagnoses at this age. The stress and your office job duty hours are also contributing to your problem.
Please do the advised tests as it will assure me and you as well. Once we lock our diagnosis of IBS then we will manage it easily with medications. I will request you to take the following treatment and do the advised lab test and I am hoping that it will sort out your problem.
TSH. CRP.
Probable diagnosis:IBS.
Treatment plan:Tablet Rifixamin 550 mg 1+0+1 for 21 days but it should be four hours apart from Probiotics, Amitriptyline 25 mg half tablet at night time for one week and then one tablet at night time for three to six months. This is a tricyclic antidepressant, at high doses it is used for depression but at such low dose of 25 mg it is recommended in IBS-D and it will help you a lot.
Preventive measures:Avoid milk but can use yogurt.
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|Thank you doctor,
My TSH was 3.29 μIU/mL and my CRP is 0.02 mg/dL.
Hello,
Welcome back to icliniq.com.
I am happy to see these reports which you already did and these are normal. Especially a normal CRP results rule out almost all inflammatory processes going on. This is good and satisfactory news for me and you. Now we can concentrate on your symptoms which are disturbing your day to day life a lot.
Start the medications which I prescribed and I am hoping to hear good news from you after three weeks of treatment.
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|Thank you doctor,
What do you mean by 1+0+1 for 21 days? In Greece, we have tablets for 200 mg. Is one tablet every eight hours for 21 days the right dosage?
Hi,
Welcome back to icliniq.com.
1+0+1 means every 12 hourly. Take 550 mg every 12 hours for 21 days but if it is not available and only 200 mg is available then take 200 mg one tablet every eight hours for 21 days.
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|Thank you doctor,
I will send treatment feedback in 15-20 days.
Hi,
Welcome back to icliniq.com.
Try to have one hour excercise regularly.
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