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Posts Tagged ‘Diarrhea’

Irritable bowel syndrome (IBS) is the most common diagnosis (25-50%) given to people referred to stomach and intestine specialists. It is reported to affect between 10-15% of people in the U.S. However, it cannot be diagnosed by any specific tests. It is diagnosed by criteria. The criteria are called the Rome II diagnostic criteria because a group of doctors meet periodically to establish rules for labeling intestinal conditions that have no diagnostic tests.

These conditions are called syndromes because they don’t meet the definition for a disease. They don’t have a specific known cause and/or diagnostic test(s). They are often referred to as “functional” problems. The cause of the functional problem in IBS is not known. By definition there is no abnormality that can be seen on a biopsy, x-ray, blood or stool test. The diagnosis is made by applying criteria after exclusion of other conditions or diseases of the intestine. There is not a universally agreed upon consensus for what constitutes an adequate evaluation to exclude other causes.

For IBS the criteria required to make the diagnosis is the presence of abdominal pain or discomfort that has been present for at least 3 months in the past year (not necessarily consecutively) and has at least two out of three of the following features:

1. The pain or discomfort is relieved with a bowel movement.

2. The beginning of pain or discomfort is associated with a change in frequency of bowel movements.

3. The beginning of pain or discomfort is associated with a change in the appearance or consistency (hardness or softness) or stools.

There are other symptoms that doctors use to support the diagnosis of IBS and to further divide it into three different categories. The three categories are determined by whether there is a predominant stool pattern of diarrhea or constipation or is the stool pattern alternating diarrhea and constipation. The supporting symptoms are as follows.

1. 3 bowel movements per day (diarrhea)

3. Hard or lumpy stools

4. Loose, mushy or watery stools

5. Straining during a bowel movement

6. Urgency, or the sense that you need to rush to the bathroom to have a bowel movement

7. Feeling of incomplete emptying after a bowel movement

8. Passage of mucus or whitish material during a bowel movement

9. Feeling of abdominal fullness, bloating or swelling

Therefore, the diagnosis is made by a report of the symptoms and the doctor excluding other causes. The extent to which other conditions are excluded is highly variable and doctor dependent. Self-diagnosis of IBS should be avoided because serious conditions can cause symptoms that mimic IBS.

Theories of the cause of IBS are not proven. Serotonin, a chemical present in both the brain and the gut, has been suspected. An imbalance in serotonin has been blamed for IBS. Serotonin increases the contractions of the intestine. Several medications that either increase or decrease serotonin have been developed to treat constipation or diarrhea predominant IBS.

More recently, research has been focusing on the common report of many people with IBS of a distinct time that their IBS symptoms began, often after some type of intestinal infection such as food poisoning, traveler’s diarrhea or gastroenteritis. This “post-infectious” theory has lead to theories of bowel injury and/or alterations in bacteria in the intestine. An imbalance of “good and bad” bacteria in the intestine is a theory. Some are treating people with antibiotics and/or probiotics. Antibiotics kill bacteria. Probiotics are live bacteria that are “good bacteria” like acidophilus and lactobacillus that can be taken as pill, capsule, powder or eaten or drank in yogurt or milk.

Food intolerances have been proposed as a cause of IBS by some, especially in Europe, but have not been accepted by most doctors in the U.S. Trials of elimination diets, with or without the use of food allergy or antibody tests have been reported in a few studies or a lot of testimonials to be helpful.

Lactose intolerance is a common condition that can cause symptoms that may be misdiagnosed as IBS and resolve with avoidance of lactose. Undiagnosed colitis or Crohn’s disease can be a cause of symptoms that can be diagnosed by colonoscopy with biopsy of the intestine. Blood tests for colitis and Crohn’s disease also now exist.

More recently, undiagnosed Celiac disease has emerged as a cause of what had been previously been diagnosed as IBS in as many of 20% of people. Those with a diagnosis of IBS should be screened for Celiac disease, as it is a common condition, affecting 1 in 100 people. The symptoms of abdominal pain, bloating, gas and diarrhea are common symptoms of Celiac disease and it is now known that untreated Celiacs can be constipated. Gluten free diet relieves these symptoms in people who are gluten sensitive. Further information about irritable bowel syndrome, food intolerance, colitis, Crohn’s disease, lactose intolerance and Celiac disease may be found at www.thefooddoc.com

If you have symptoms suggestive of IBS or have been diagnosed as having IBS it is important that you have an evaluation by a physician and other causes including colitis, Crohn’s disease, lactose intolerance, and Celiac disease are excluded. Food intolerance should also be considered. Minimum evaluation should include a blood count, stool tests for blood and pus cells, screening lab tests for Celiac disease, colitis, Crohn’s and a colonoscopy. Talk to your doctor about the diagnosis and how other causes can be or have been excluded before accepting the diagnosis of IBS.

The numerous medical details behind the ailment commonly known as “Crohn’s Disease” are rather complex; especially to those of us who don’t have dozens of years of clinical training in our professional past. In the simplest terms, Crohn’s Disease results from an inflammation often located in the small intestine (a.k.a. “the ileum”). There is some strong evidence that suggests that this inflammation is caused by a virus. Though generally localized in the small intestine, this inflammation has the potential to adversely affect any area of the entire digestive tract. As a result, the bowels are constantly agitated and often compelled to empty, leading to diarrhea, discomfort, and pain.

Indeed, this is a very simple way of grasping the essence of Crohn’s Disease, and to truly understand the details, a great deal of medical study and experience is necessary. Yet with this being said, there’s one thing that can be concluded without hesitation; something that doesn’t take years to study or grasp. For the millions of people who suffer from Crohn’s Disease, their life is unfairly filled with pain, often constant discomfort, and a looming fear of being unable to control their bowel movements.

It’s fair to say – in fact, it’s an understatement to say – that people who suffer from Crohn’s Disease are forced to dramatically change their entire lifestyle. Some people – and this is not dramatic at all – have been forced to quit their jobs, or cancel vacations simply because of the tremendous stress that the disease places on a sufferers physical and emotional health.

Treatment Options

The US National Institute of Health (NIH) outlines the treatment “options” that Crohn’s Disease sufferers are often forced to choose from: drugs or surgery. The NIH also points out, very clearly, that according to them there is no cure for Crohn’s Disease. As a result, pharmaceutical and surgical treatment methods focus on symptom management; they do not and cannot cure the disease. At the very most, they can mitigate some of the pain and discomfort; though, naturally, with the introduction of side effects that can adversely affect other biological systems, including emotional health. Some of the side effects include:

There are different symptoms of having an allergy. Some can be mild, some can be very annoying, but some can be dangerous and even life threatening. Below is a list of some common allergy symptoms:

1. Skin rashes – annoying and itchy and sometimes painful. Depends where they are on the body, they can make someone to look quite ugly.
2. Breathing problems – when allergy causes problems with breathing and lack of oxygen, it is very serious and requires attention.
3. Itchy notes, mouth, throat and skin – this is one of the most common and annoying allergy symptoms – an itch that can’t be smoothed.
4. Conjunctivitis – burning and itchy eyes, is also a common allergy problem.
5. Coughing – another common allergy problem for many people – constant cough that sometimes is also painful.
6. Hives – hives can be painful and they can cause attention of others in public.
7. Headache – distracting headache that makes difficult to do anything constructive or relax.
8. Diarrhea – long time diarrhea can be also life threatening.

When you have an allergy the next step is to find out what causes it. You should talk to your doctor who will after checking the symptoms, know what to do. You should have a physical examination. The next step is usually tests which can find out precisely what causes the allergy. There are three kinds of tests:

1. The Skin Test – it is the least expensive and is very accurate. To do the skin test, a small amount of allergen is put on the skin and then the spot is pricked or scratched with a needle. A bit of allergen is also injected into the outer part of the skin. If there is an allergy to the tested product, after about 15-20 minutes after the test, there will be redness, swelling and itching on the skin

2. The Patch Test – it is done to find a contact dermatitis. A small amount of allergen is put into skin and then covered with a bandage. A doctor then checks the spot within forty-eight hours to see if a rash develops.

3. The Blood Test – this test is done when there are skin conditions or medications taken that might interfere with a skin test. In the blood test, the blood is taken to a laboratory and allergens are added to the blood sample. The amount of antibodies that are going to be made will be measured in this test.

Irritable Bowel Syndrome (IBS) and Microscopic Colitis Symptoms Overlap

Symptoms of IBS and microscopic colitis overlap. In a group of biopsy proven microscopic colitis patients, there is noted that up to half have symptoms that meet diagnostic criteria for Irritable Bowel Syndrome (IBS). Microscopic colitis is diagnosed only by biopsies of the colon even when it appears normal. Symptom-based criteria for diagnosing IBS are not specific enough to rule out microscopic colitis. Some people with IBS have Mastocytic Enterocolitis, a newly recognized form of microscopic colitis characterized by increased numbers of mast cells in the intestinal lining. These cells can only be seen when special stains are applied to intestinal biopsies, a maneuver, not usually done by most pathologists or requested by most doctors performing intestinal biopsies.

PATIENTS WITH IBS SHOULD UNDERGO COLONOSCOPY WITH BIOPSIES OF NORMAL APPEARING INTESTINAL LINING

Patients suspected to have irritable bowel syndrome should undergo biopsies of the colon. This is absolutely necessary to exclude the possibility that they could have one of several forms of microscopic colitis. The diagnosis of microscopic colitis is made when biopsies of the colon have an increase in infection fighting or immune cells or deposits of excess collagen connective tissue in the lining of the digestive tract. In the most common form of microscopic colitis seen without special stains, excess lymphocyte white blood cells, or so called “intraepithelial lymphocytosis”, seen under the microscope. This microscopic finding is present when the colon looks normal on the surface. Many doctors don’t biopsy the colon when it looks normal despite obtaining a history of diarrhea from the patient. Microscopic colitis is a known treatable cause of diarrhea, bloating, gas and abdominal pain that can only be diagnosed by colon biopsies. In many patients who do get biopsies, special stains are not ordered when the standard stains fail to reveal an abnormality. However, under special stains, excess mast cells may be seen and a diagnosis of a treatable form of IBS known as mastocytic enterocolitis is missed.

BLOOD TESTS SHOULD ALSO BE DONE BEFORE ASSUMING A DIAGNOSIS OF IBS

Blood tests should be done to screen for Celiac disease, ulcerative colitis and Crohn’s disease. Without these blood tests and intestinal biopsies, Celiac disease, Crohn’s disease and various forms of colitis especially microscopic colitis are frequently missed.

MULTIPLE BIOPSIES SHOULD BE DONE TO AVOID MISSING PATCHY AREAS OF INVOLVEMENT

Microscopic irritation or inflammation of the intestine can be patchy. Therefore, anyone undergoing colonoscopy or upper endoscopy with symptoms, especially diarrhea, bloating, gas or abdominal pain, should have multiple intestinal biopsies. Inflammation that is the cause of these symptoms is often only seen microscopically and may be patchy. However, once a diagnosis is made treatment with medications and/or diet is often effective.

EARLY FINDINGS OF INTESTINAL INFLAMMATION OFTEN CONSISTS ONLY OF INCREASED CELLS, SOMETIMES ONLY SEEN WITH SPECIAL STAINS

The earliest intestinal biopsy findings of Celiac disease and microscopic colitis is increased number of lymphocytes per 100 epithelial (intestinal lining) cells. In the colon intraepithelial lymphocytosis is considered diagnostic for microscopic colitis if 20 or more lymphocytes per 100 epithelial cells are found. Interestingly the criteria for abnormal intraepithelial lymphocytosis in Celiac disease has more recently been reduced from 40 IELs per 100 utilized for nearly thirty years to 30 per 100. Even more recent studies have indicated that this should be reduced further to 20-25 per 100 because it is noted that early gluten injury occurs with lower levels of lymphocytes in the intestinal lining and is associated with a favorable response to gluten free diet. Microscopic colitis frequently responds favorably to a gluten-free diet.

DON’T HAVE YOUR DIAGNOSIS MISSED BY FAILURE TO GET AN INTESTINAL BIOPSY AND BLOOD TESTS BEFORE ACCEPTING IBS

Numerous patients have come to me with a diagnosis of IBS for years who I have confirmed to have Celiac disease, microscopic colitis or non-celiac gluten sensitivity. These patients typically respond dramatically to a gluten free diet even in the absence of a diagnosis of Celiac disease. Several of my patients have both Celiac disease and a form of microscopic colitis such as lymphocytic or collagenous colitis.

UNNECESSARY DELAYS IN DIAGNOSIS AND SUFFERING NOT NECESSARY IF YOU BECOME YOUR OWN ADVOCATE

People often experience years of unnecessary suffering due to delays in diagnosis of Celiac disease, microscopic colitis, Mastocytic Enterocolitis, Crohn’s disease, and food intolerance. Many developed preventable secondary complications such as osteoporosis, infertility, iron deficiency or autoimmune diseases. Most live for years with pain, stomach pains, and diarrhea under the false conclusion that they have IBS. Frustation occurs when you are told there is little to nothing that can be done besides taking anti-diarrhea and anti-spasm medications combined with a high fiber diet and fiber supplements. Yet, most note they are no better or even worse with increased fiber. If you have complained to your doctor that such agents seem to cause more severe bloating, gas, diarrhea and abdominal pain you are often scoffed at or told you are not being compliant. Little did you or your doctor know that increasing fiber intake can make you worse if you are gluten intolerant.

GLUTEN FREE DIET MAY HELP SYMPTOMS OF IBS AND SHOULD BE TRIED AFTER GETTING TESTED FOR CELIAC DISEASE FIRST

Don’t accept a diagnosis of IBS without adequate diagnostic testing or consideration of a trial of gluten free diet. Before accepting IBS learn more about the various forms of colitis, Celiac disease, non-celiac gluten sensitivity, Crohn’s disease and altered gut flora and be your own advocate when you visit your doctor.

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