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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Chronic Diarrhea and soft voluminous stools since last 6 months.

Answered by
Dr.
Dr. Ratnakar Kini

Gastroenterologist

Practicing since :1996

Answered : 1957 Questions

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Posted on Tue, 2 Apr 2019 in Digestion and Bowels
Question: Chronic Diarrhea and soft voluminous stools since last 6 months. MRI & Ultrasound Abdomen shows fatty liver and pancrea.

had H pylori positive and took 1 week course of it.

Endoscopy, Colonoscopy, TTG IGA, TB test all are normal.

doctor
Answered by Dr. Ratnakar Kini 27 hours later
Brief Answer:
Need more information

Detailed Answer:
Hi,
Thanks for posting your query.
I am Dr.R.K and I am pleased to assist you.

I would like to have some more information before I can give my opinion.

1. Any blood or mucus in stools?
2. Small or large volume diarrhea?
3. Night time loose stools that wake you up from sleep?
4. Do you have abdominal pain?
5. Is there weight loss?
6. Any relief after taking Rifaximin?
7. Are you on any other medications?

Regards,
Dr.R.K.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Ratnakar Kini 2 hours later
Sir,

1. No blood or mucus in stool. Done 4 times fecal occult blood test (negative).
2. Large volume diarrhea Stools
3. No night time loose stools.
4. Yes some times but tenderness always
5. Weight loss about 5 kg but then recovered around 4 kgs.
6. After taking rifaximin no feeling of urgent motion.
7. NO other medication

Kindly suggest accordingly.

Thank you
Bharat XXXXXXX
doctor
Answered by Dr. Ratnakar Kini 8 minutes later
Brief Answer:
Small bowel biopsy?

Detailed Answer:
Hi,
Was small bowel biopsy done?
Was the weight loss intentional or unintentional?
Regards,
Dr.R.K.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ratnakar Kini 2 minutes later
no small bowel biopsy taken place.
Weight loss was totally unintentional.

Thank you
Bharat XXXXXXX
doctor
Answered by Dr. Ratnakar Kini 4 minutes later
Brief Answer:
MRI report

Detailed Answer:
Hi,
Kindly upload the MRI report.
Also I would like to know whether you have oily stools/floating , difficult to flush stools?
Is your blood sugar high?
Regards,
Dr.R.K.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ratnakar Kini 23 minutes later
yes stools are floating and difficult to flush. yes my blood sugar after meals some time on high side.

doctor
Answered by Dr. Ratnakar Kini 10 minutes later
Brief Answer:
Answer given below

Detailed Answer:
Hi,
Thanks for the details.

There are two possibilities -
1. Malabsorption syndrome - Points favoring are large volume diarrhea, unintentional weight loss. Endoscopy and a small bowel biopsy will help to know whether you have any malabsorption issue

2. Irritable Bowel syndrome - Though most of the symptoms point towards IBS, weight loss is one point against it. You can avoid milk and milk products and take low FODMAP diet and see whether there is any improvement. You can also take T.Librax 1-0-1 and C.VSL#3 1-0-0 and look for improvement.

Though floating and difficult to flush stools with high blood sugar and weight loss point towards chronic pancreatitis as a possible cause of chronic diarrhea, a relatively normal pancreas in MRI scan makes this diagnosis less likely.

Regards,
Dr.R.K.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ratnakar Kini 6 days later
Sir
Can it be EPI since whatever symptoms are there it also suggest that one as pancreas is bulky. Is it possible.

If yes what test should I go for to get it confirm and what medication should be used for that.

Thank you
Bharat XXXXXXX
doctor
Answered by Dr. Ratnakar Kini 10 hours later
Brief Answer:
No

Detailed Answer:
Hi,
A bulky pancreas with other relevant features indicate acute pancreatitis which is not associated with EPI.
Only chronic pancreatitis is associated with EPI.
Stool fat analysis and fecal elastase test may be done for confirmation.
Pancreatitis enzyme supplements have to be taken for relief from EPI.
Regards,
Dr.R.K.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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