Dr. Babu Lal Meena
Medical Gastroenterology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My friend had diarrhea every morning after having breakfast. A couple of years ago, this condition stopped suddenly, with no medication and instead, she began having bloating and constipation all day. She feels bloated even after drinking water. Hair loss was also noted more recently. She has been taking Movicol to help with constipation but sometimes it takes one to two days of three to four daily sachets to have any effect. On testing of thyroid function and antibodies, the results came back with an extremely high level of anti-Tg (807.21 IU/mL), ANA negative (0.5), anti-ds DNA positive (30.1 IU/ml), and all other thyroid-related tests being within the normal range. Today, stool tests came back with slightly raised Calprotectin (69.7 ug/g). She was prescribed probiotics, vitamin D, and liquid selenium and was also told to follow a low-FODMAP diet. She was given a two-week course of Rifaximin approximately one month ago, and 50 % improvement was noted. She has a medical history of TMJ disorder and currently undergoing splint treatment. She had a removal of a large benign ovarian cyst approximately 12 years ago.
Kindly help.
Thank you.
Hello,
Welcome to icliniq.com.
I read your query and understand your concern.
This is IBS (irritable bowel syndrome), where the patient has intermittent diarrhea and constipation with bloating sensation. Actually, this disorder needs laxatives and lifestyle changes with dietary modification. I would suggest you take a few investigations that are pending.
I hope this helps you.
Thank you for consulting me.
You can always come back and reach me at icliniq.com.
The Probable causes
Investigations to be done
Treatment plan
Regarding follow up
Patient's Query
Hello doctor,
Thank you.
I have attached the requested results. As for the X-ray and the urine routine examination, we will make sure to do those. We are very worried this might be IBD instead of IBS, particularly because of the high Calprotectin (69.7 ug/g).
Hello,
Welcome to icliniq.com.
Glad to have you back.
I am here to help you get the best medical advice.
I am also concerned about the same issue. It could be IBD (inflammatory bowel disease) as well. But she does not have symptoms of IBD at this point of time. There is no fever, weight loss, or abdominal pain. That is why I asked for ESR (erythrocyte sedimentation rate), but ESR is also normal. So apparently it does not fit into IBD. Here there are three issues with the reports, first is fecal calprotectin, the second more important issue is stool occult blood, and the third one is ds DNA positivity. Although clinical features are not suggestive, we should investigate after repeating p-fecal calprotectin and occult blood. If it is positive again and if she does not get relief, then we need to do upper and lower gastrointestinal endoscopy. A biopsy can confirm the diagnosis. It is better to do an endoscopy earlier because if there is evidence of IBD, then it can be controlled better in the early stage and complications will be less.
I hope this helps you.
Thank you for consulting me.
You can always come back and reach me at icliniq.com.
Investigations to be done
Treatment plan
Regarding follow up
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Medical Gastroenterology
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