Q. I get recurrent diarrhea and doctor suggested sensitive intestine. What is my problem?
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.
Investigations to be done:
1.TSH (thyroid-stimulating hormone).
2.CRP (C-reactive protein).
IBS?
Treatment plan:Tablet Rifixamine 550 mg 1+0+1 for 21 days.
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.
Investigations to be done:
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.
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.
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.
Thank you doctor,
I will send treatment feedback in 15-20 days.
Hello doctor,
No improvement so far. Last day I ate boiled chicken, with potatoes, carrots, and plain rice. I felt good. I increased the dosage to 400 mg every 8 hours for the last nine months. Today I woke up and drank some green tea. After 30 minutes, I had watery diarrhea.
Hello,
Welcome back to icliniq.com.
I am sorry to hear that you do not have any improvement with treatment. There was no difference in stools this whole week? Have you started Amitriptyline 25 mg at night as well?
Hello doctor,
No difference. I did not start Amitriptyllin. The pharmacist suggested me another with one more substance (a sleeping pill), but I refused. I have no problems with sleep. Why does taking Metronidazole (Flagyl 500mg) fix the problem the next day? Should I do a fecal culture again at a laboratory?
Hello,
Welcome back to icliniq.com.
This combination was part of this regimen, and improvement was expected. So, yes, you do not need any sleeping pills. I do not have an answer to this question about improvement with Metronidazole as the literature has no such things. Still, some of our patients feel improvement with the Metronidazole course and often use intermittent courses of it.
As far as culture is concerned, you can have stool examination for cyst and ova with culture, but I expect it to be normal. Therefore, I would like you to use the following medication with this Rifaximin. Take tablet Lomotil (Diphenoxylate 2.5 mg and Atropine) 1 tablet two times daily for two weeks and then slowly down titrate it with an improvement of your diarrhea.
Hello doctor,
These are photos from the colonoscopy. I want to inform you and help you with my case. The doctor who performed it found it clear. So I will follow your advice.
Hello,
Welcome back to icliniq.com.
Thank you very much for sending these pictures. Yes, these are completely normal-looking. I am very much concerned with all the problems you are facing, and I want to help out with this. The good news in all this workup is that we are not dealing with something serious about mortality, although it is bothering you a lot. Therefore, we can slowly try all our options available for treatment. Rifixamine and Amitriptyline are a very good 1st option, and most of my patients respond to this combination. Still, unfortunately, we could not get it over there, so I advised my second option and if there is no improvement we can offer many more step-by-step. But I am hopeful that we will tackle this issue soon.
Hello doctor,
This is feedback for the whole treatment period. Begun by taking the Rifaximin 200 mg daily for the first four days. No effect. Increased dosage at 400 mg per day. For four days, I had tremendous improvement and drank tea. I lost four days because I cooked spaghetti with pesto (lots of basil) which caused diarrhea. Also, I used one tablet of probiotics daily. So until today, I have two ways to fix the problem of IBS. The first is Metronidazole, and the second is Rifaximin. Should I ask a nutritionist to tell me what to eat?
Hello,
Welcome back to icliniq.com.
Have you used Lomotil with it? The second medicine I prescribed? You can take opinions from a nutritionist, but even without a nutritionist, you can avoid the things causing problems. Another option is a low FODMAP diet.
Thank you.
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