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

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.

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.

Hi,

Welcome back to icliniq.com.

You are welcome. Keep in touch for further doubts.