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What causes mild diarrhea with apetite loss?

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General & Family Physician
Practicing since : 2012
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After 4 years of specialists investigations and trials in my gut finding no Crohns or TB So what you suspect with my symptom: ileum ulceration ,mild diarrhea,noblood ,no fever,lost weight low appetite and eating a little specific food ? I made all food allergy ,blood, stool test (by traditional method not PCR) ,tissue finding nothing my upload report fail because it is WORD format so I copy and paste the report: ‎ ‎ At 2007 my Iraqi son 28 years old stayed at XXXXXXX camps and then Greece Camps for 6 months through his ‎refugee struggle to reach Netherland . At beginning of 2008 he reached Netherland as refugee . After 2 ‎days he had mild diarrhea two time daily but didn’t care and not affected his health or appetite . ‎ Through ‎his staying at Netherland he worked in the XXXXXXX (Hens)farm for 5 months . Through this time he had ‎symptom of a cute diarrhea . At 2009 return to Iraq with no change and still diarrhea in spite of taking ‎antibiotics and others without making any testing procedure to diagnosis his disease .At middle of 2009 ‎came to Egypt to join us (we came to Egypt and stayed from 2006 to 2010 due to bad situation In Iraq). He ‎made endoscopy in the Egypt clinics and diagnosed as CROHNS (some ulcers at Ileum) so he taking ‎PENTASA tablets and PREDNISONE for six months but without any change and still severe diarrhea. At May ‎‎2010 he came to USA Colorado state as a legal refugee due to threatened at his original country Iraq . He ‎visited a first Gastroenterology specialists at Denver, he diagnosed his disease as CROHNS by using a ‎CAPSULE CAMERA. and gave him PREDNISONE for two months followed by AZATHIOPRINE one month but still ‎diarrhea and his weight decrease more than 20 lb and his appetite decrease sharply.‎ ‎1-‎ We change the Doctor at Dec.2010 so he made upper scopy and endoscopy and many biopsies are taken ‎throughout digestive tract. The ulcers still in the ILEUM and additional ulcers appeared in esophagus ‎‎,Stomach and duodenal ,the test of biopsies show negative results so he diagnosed also a CROHNS and ‎gave him ENTOCART EC 6MG daily for two months but his situation got worse. We took him to the third GI ‎specialist who study his case through the past time and his history and symptoms and told him it is NOT ‎crohns .So he made ENOSCOPY and UPPERSCOPY and taking many biopsies .After testing these biopsies ‎he found a BACILLA at one of them and due to pathologist report proved that is infectious disease and not ‎immune disease as diagnosed before ,but he didn’t know the type of this RARE ACID FAST BACILLA . So he ‎suspected that is a INTESTINAL TB so he referred to TB specialist and took the required medication for ‎two months but without any improvements or stopping his diarrhea ,and his health got worse ,He ‎transferred to the hospital and gave him TB medication through vain for 10 days in addition of ‎AMIKACIN 250ML and LEVOFLOXACIN and PREDNISONE . He had some improvement and stop ‎diarrhea and gains some weight .Then the TB specialist switch on oral TB medicine again for two ‎months. The result is no improvement so the specialist stop medication due to causing irritation in ‎his gut . At Mar-7-2012 made LAPAROSCOPY and taking a portion from his ileum for test but they ‎proved normal cross sectional tissues (No suspicious diseases like Crohns or Behchet or TB). ‎Currently stopping any medicine since Nov-2011 : he have no fever , no nausea no vomiting no blood in the ‎stool but abdominal pain (sometimes) but he still mild diarrhea 1-2 time daily, loss appetite , unspecified ‎infection ulcers at ileum and infection at small intestine without any ulcers.‎ ‎2-‎ His daily food is: 100gm Potatoes ,500gm bread, 30gm lettuce 30gm rice and 4 cups black tea. ‎ ‎ Best Regard ‎ Majeed Aldamah XXXX
Posted Sat, 1 Mar 2014 in General Health
Answered by Dr. Shafi Ullah Khan 2 hours later
Brief Answer: TPN/EEN and if still a trouble surgery Detailed Answer: Assalam o Alaekum XXXX! Thank you for asking. I am dr S XXXXXXX and i would like to try my best to help you know what this complex presentation is. The presentation of the patient is multidimensional and the three gastroenterologists suspecting IBD/ crohn's were right in their way. But the patient's exposure to TB susceptible zones also make the presentation of Gastrointestinal tuberculosis which involves ileum in the very same way. Or there is also a possibility of both the disease involvement together as TB drugs start responding in a few weeks. Now irrespective of the etiology or what it is the focus should be on diet and nutritional therapies and weight loss that severe and diarrhoea that promprt it needs to be Par enteral Nutrition for some time as Gut needs some rest here. Ulcers need to be healed and that would required sparing them of any effort of food peristalsis and digestion. Or gut would end up in fistulaes and that would be an other pandora's box. If its TB 9 months medicines will fix. if its crohns DMARDs, Biologictherapies, NSAIDs and other medicines will help with diet and lifestyle modification. But the main focus should be health and electrolytes. So diet and nutrition should be a focus now after working up for 4 years. Get a nutritionist and devise a plan for total parenteral nutrition TPN or EEN for the patient. Calcium needs to be supplemented, Steroids need to be stopped as they are worsening the ulcers. Dairy products need to be avoided. Bone osteoporosis needs to be monitored. Nutritional and diet management is our last conservative optin. If the problem persists then the next step would be surgical resection of the gut after it meets the guidelines for American Society of Colon and Rectal Surgeons (ASCRS). The patient needs a team of gastroenterologists, psychologists, nutritionists, social workers, and nurses and team to handle complications like surgeons, dermatologists, rheumatologists, endocrinologists, and obstetricians( In women case to manage fistulas) Hope XXXX it helps. I wish you very good luck and take some very good care of your patient. Don't forget to close the discussion please.I would be here if you need me. My email is YYYY@YYYY cell number is +0000. Assalam o alaekum.
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