Can Low-FODMAP diet and Rifaximin treat IBS symptoms?

Question

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 is currently undergoing splint treatment. She had a removal of a large benign ovarian cyst approximately 12 years ago.

Kindly help.

Thank you.

Answer 1

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 a bloating sensation. Actually, this disorder needs laxatives and lifestyle changes with dietary modification. I would suggest you take a few investigations that are pending.

The probable cause is IBS (irritable bowel syndrome), to rule out celiac disease.

Investigations to be done include complete blood count with peripheral smear examination, ESR, and tTg-IgA (tissue transglutaminase), X-ray abdomen, urine routine examination, and repeat thyroid-stimulating hormone levels (TSH).

Continue Movicol (Macrogol 3350) three sachets daily at night. Take a Polyethylene glycol 130 gm packet in 2-liter water over two hours. Repeat it on the same or another day only if a water-like, clear stool does not appear. Consume a high-fiber diet, incorporating curd and plenty of water. Sit in the toilet three times a day for at least 15 minutes. without any straining. Avoid coffee, tea, and cold beverages.

I hope this helps you.

Thank you for consulting me.

You can always come back and reach me at icliniq.com.

Answer 2

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 in 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 of stool occult blood, and the third 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.

Do the advised investigations. Send the pic of the X-ray (not the report). An X-ray should be taken before the medicine I advised. Other investigations to be done include tTg-IgA, TSH (thyroid-stimulating hormone), Calprotectin, stool, and occult blood.

Give the advised medicine in the form of 130 g of Polyethylene glycol and continue with Movicol (Macrogol) on a daily basis. There is no role for probiotics. Continue vitamin D, maximum of 6 lakh units.

I hope this helps you.

Thank you for consulting me.

You can always come back and reach me at icliniq.com.