HomeAnswersMedical Gastroenterologyirritable bowel syndromeWhat should I do to help my IBS-D?

I have IBS-D with bowel changes and weight loss. Please help.

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Ajeet Kumar

Medically reviewed by

Dr. Vinodhini J.

Published At November 25, 2020
Reviewed AtJanuary 12, 2024

Patient's Query

Hello doctor,

I am a 34-year-old female suffering from bowel changes for the past four years. My physician then said that the symptoms are probably like IBS-D passage of loose or unformed stool that used to happen twice or thrice in a year for around one to three weeks every time. Nowadays, this bowel change happens four to five days in 15 days for six months or so. I lost more than 22 lbs of weight. Presently I am using Darolac probiotics and homeopathic medicine but of no improvement. Please help. Can I use Kefir? Do I need to get any tests done?

Answered by Dr. Ajeet Kumar

Hello,

Welcome to icliniq.com.

I can understand you must be very upset about your problem. I want to explain to you what it could be and how to approach it.

For diagnosis of IBS-D (irritable bowel syndrome-diarrhea predominant), the patient will have abdominal pain, which changes in intensity with physiologic activities of the body such as defecation, farting, belching, or menstruation. I see you did not mention any pain in your history. So possibly it is not IBS.

Another entity called functional diarrhea can present in almost the same way as IBS, but abdominal pain is not usually present in this.

The other thing which is very crucial in your history is weight loss. Ideally, no patient with IBS-D or functional diarrhea should lose weight. If it is nonintentional, then it is a concern for me. I recommend that you should have tested before jumping on to give you some treatment for it.

I urge you to get the following tests and come back to me with reports. Then I may be in a good position to tell you what to do now.

Lastly, the Rifaximin you took in the past and probiotics that you are on now partially help patients with functional diarrhea or IBS-D but never treat core problem, which I think is very important to diagnose before embarking on its treatment.

I hope this helps.

The Probable causes

Functional diarrhea. Celiac disease.

Investigations to be done

Complete blood count. Bun Cr lytes. Liver function test. TSH (thyroid-stimulating hormone), FT4, FT3. Serum ferritin. Anti TTG (tissue transglutaminase) IgA and IgG. Serum amylase and lipase. Total protein and AG ratio. Stool for H.pylori. Stool detail report, for ova parasites and giardiasis. Stool for fat globules, reducing substance. Stool for spot Na, spot K, and stool osmolarity. Stool for fecal calprotectin and fecal elastase.

Differential diagnosis

Small intestinal bacterial overgrowth (SIBO). Malabsorption syndrome.

Probable diagnosis

Functional diarrhea.

Treatment plan

Tablet Librax (Chlordiazepoxide and Clidinium bromide) 5 mg twice daily for diarrhea.

Regarding follow up

Follow up after investigation.

Patient's Query

Thank you doctor,

Yes, I do have somewhat sharp pain, mainly on the left lower lateral part of the abdomen.

Answered by Dr. Ajeet Kumar

Hello,

Welcome back to icliniq.com.

I have received your reports (attachment removed to protect patient identity), and they say

1. Mild elevated TSH, which is a thyroid hormone. This level suggests that you have subclinical hypothyroidism. It does not need treatment at the moment. We will just follow this.

2. You have significantly raised fecal calprotectin of 603, which is abnormal. At least I can say that you do have some pathology, causing weight loss and persistent symptoms. This test tells us that you have ongoing inflammation within the bowel, including small or large bowel.

3. The course of action from now is two-fold. The one is to do a colonoscopy and a gastroscopy and take biopsies from the large bowel, small bowel (terminal ileum), and stomach. Both procedures are performed by a gastroenterologist or endoscopist. It is performed under sensation (no anesthesia). You will be in a semiconscious state while the procedures are going on.

Once you are sedated in gastroscopy, an endoscopist passes a scope from the mouth and sees inside your stomach. Similarly, in colonoscopy, a scope is passed from the anus to see the large bowel and a part of the small bowel called terminal ileum. Both procedures are performed in the same sitting after a day long preparation with some laxative medications. Both procedures can take 15 to 20 minutes in experienced hands.

The other way is to get a magnetic resonance enterography (MRE). In this 45 minutes procedure, you will be asked to lie in a tube, and the radiologist will take photos of your belly. This procedure also requires a day-long preparation.

I can understand you must be very nervous hearing all this. But unfortunately, these are the only way to diagnose and solve your problem, which has been occurring to you for the last four years.

As soon as we reach a diagnosis, then treatment can be started.

The possibilities are Crohn's disease, ulcerative colitis, microscopic colitis of the colon, Whipple disease, celiac disease. You also missed one test, which I have recommended to you, Anti TTG IgA and IgG. Please get it done as well.

The Probable causes

Crohn's or ulcerative colitis.

Investigations to be done

Magnetic resonance enterography and gastroscopy plus colonscopy.

Differential diagnosis

Microscopic colitis. Food allergies. Whipple disease. Celiac small intestinal infection such MAC and histoplasmosis.

Probable diagnosis

Small bowel Crohn's disease.

Treatment plan

Investigation and then treatment.

Patient's Query

Hi doctor,

Thank you for your help.

Answered by Dr. Ajeet Kumar

Hi,

Welcome back to icliniq.com.

You are welcome. Keep in touch for further doubts.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Ajeet Kumar
Dr. Ajeet Kumar

Medical Gastroenterology

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