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Q. I get recurrent diarrhea with IBS. Kindly suggest medication.

Answered by
Dr. Shubadeep Debabrata Sinha
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Sep 21, 2020 and last reviewed on: Sep 26, 2020

Hello doctor,

I am a 41-year-old female. For the past year, I am often getting loose bowel movement (like diarrhea) two to three times in a short period, and after that, I feel very dizzy and tired. Initially, I thought it was because of food poisoning or some food issues, but it is not. This issue has been for a year now. I used to get these two to three times a week. Because of this, I am unable to go to work or anywhere. I had to go to the hospital a few times to get glucose drips as I was drained out and did not have the energy to walk. Doctors have diagnosed as IBS (irritable bowel syndrome) and provided medicines. I have noted all the medication that I took. I have visited many doctors for the past one year and went through treatments, but did not help. I am uploading all my tests results taken. Can you please provide your opinion on what could be causing this?

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#

Hello,

Welcome to icliniq.com.

You seem to have given too many medicines and incomplete diagnosis.

Anemia- based only on Hb value of 9.9 g/dl. This value can be managed by having an effective diet planned by a qualified nutritionist with the diet planned for both anemia (high iron) and the irritable bowel syndrome. Iron supplements are not necessary at this stage. Please let me know if you have history of worm infestations or abnormal bleeding during your menstrual periods or whether they are too frequent and irregular.

Gastritis has many causes including stress, adverse effects of medicines such as pain killers (non-steroidal anti-inflammatory drugs), iron, H.pylori infection. From your upper GI (gastrointestinal) endoscopy report, there is no indication of H. Pylori testing.

Regarding irritable bowel syndrome, there is no evidence based on investigations uploaded by you. There is no report of the lower gastrointestinal (GI) endoscopy to diagnose IBS and rule out organic disorders.

Based on the above, my recommendations are to take the following measures:

1. Nutritionist consultation.

2. Lower gastrointestinal endoscopy (sigmoido-colonoscopy).

3. Repeat hematology blood test.

4. Stool culture.

5. H. Pylori test results from upper GI center.

6. Take capsule Econorm (Saccharomyces Boulardi) 250 mg one capsule twice daily (after lunch, after dinner) for seven days, Limcee (Vitamin C) 500 mg one tablet (after lunch) once daily for 15 days, Morease-L sachets (Mebeverine 135 mg plus Isapghula) one sachet twice daily for seven days, Emfol (Folic acid) 5 mg once daily (after lunch) for 15 days, Cintapro one tablet twice daily (before lunch and dinner) for seven days, and Rabeprazole 20 mg one tablet once daily for seven days.

Please revert after completing the above. You can use any brand of the above medicines that is locally available.


Investigations to be done:

Given in the main box text

Thank you doctor,

I do not have a worm infestation history but had Bendex 400 mg a month back. My periods are regular and slightly heavy on the second day. Otherwise normal. I will have these tablets and then decide on colonoscopy and stool tests. I hope it is fine. Considering gastritis, can my diet include milk, nonvegetarian foods? Should I avoid citrus fruits like orange etc.? Are there any specific restrictions in diet?

#

Hello,

Welcome to icliniq.com.

It is good to know that we can rule out worm infestation related anemia now that you have taken antiworm medicines. Heavy periods could cause loss of blood and mild anemia. Maybe you could reduce a bit of blood loss by taking tablet Drotin M (Drotaverine 80 plus Mefenamic acid) once or twice a day during the heavy period days.

For gastritis, Rabeprazole should take care unless you have H.pylori infection, which is why I have advised you to take a H.Pylori test in the next upper GI endoscopy or take the result from the earlier hospital where you did the test.

For mild anemia, please consume iron containing foods such as figs, peanuts, almonds, walnuts, cashews, pine nuts, hazelnuts. Pumpkin seeds are rich in iron, non-vegetarian foods like mutton liver, chicken breast, seafood, and eggs can highly boost iron levels and folate containing foods like legumes, asparagus, citrus fruits, beetroot, banana, broccoli, meat liver, eggs etc.

Additionally, please add tablet Claribid (Clarithromycin) 250 mg, Tiniba (Tinidazole) 500 mg to the above and change tablet Rabeprazole 20 mg one tablet twice daily for seven days (instead of one tablet per day prescribed above).

We shall do the tests after the above medicines including lower gastrointestinal endoscopy, blood investigations like hematology and serum folate levels and decide on further treatment, if necessary.

Hence the current prescription is as follows -Capsule Econorm (Saccharomyces Boulardi) 250 mg one capsule twice daily (after lunch, after dinner) for seven days, Limcee (Vitamin C) 500 mg one tablet (after lunch) once daily for 15 days, Morease-I sachets (Mebeverine 135mg plus Isapghula) one sachet twice daily for seven days, Emfol (Folic acid) 5 mg once daily (after lunch) for 15 days, Cintapro one tablet twice daily (before lunch, before dinner) for seven days, Claribid (Clarithromycin) 250 mg one tablet twice daily for seven days, Tiniba (Tinidazole) 500 mg twice daily for seven days, and Prazohext (Rabeprazole) 20 mg twice daily for seven days.


The Probable causes:

1. Irritable bowel syndrome. 2. Gastritis due to probable H. Pylori. 3. Mild anemia due to a mix of nutritional, blood loss on menses.

Investigations to be done:

After the above treatment.

Preventive measures:

Do not eat spicy food. Drink plenty of fluids three to four litres per day. Sleep well. Eat iron rich and folate rich foods suggested above.

Regarding follow up:

After seven days or earlier if patient feels necessary or any questions.


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