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Diagnosed with IBS. Taking spectrum digestive enzyme supplement but gas is still present. Can gastroenterologist be wrong?

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Gastroenterologist, Surgical
Practicing since : 1984
Answered : 922 Questions

My doctor has diagnosed me with Irritable Bowel Syndrome.
I am just looking for a second opinion on it.

I went to a gastroenterologist a little over 2 years ago, because of frequent stomach and lower abdominal aches. They were mostly severe but varied day-to-day.

He ran many different tests. He did a full blood panel. I had an Esophagogastroduodenoscopy done to check for peptic ulcers. They did a biopsy to test for H. Pylori and Celiac. I did a lactose-free diet for 2 weeks to check if it is lactose intolerance. And I have had a CT scan done on my abdomen with contrast.
Everything has come back normal.
He never ordered a stool sample, or a colonoscopy.
He says that this is because I have no blood in my stool, and I do not have the main risk factors that would order for a colonoscopy (age, blood in stool)

So because of this, my GI doctor believes it is IBS.
He put me on Amitriptyline and slowly increased the dose up to 100mg, which is what I am on now and have been for a few months.
I am also taking Omeprazole more recently, as I started having bad heartburn pains.
I take Dicyclomine or Hyoscyamine, as needed for pain.

The medicine has been working to lessen everything. The Omeprazole stopped the acid reflux, which is a more recent (within the past few months) condition.
The pain is mostly lower abdominal. It is severe prior to bowel movements. But all day I have a large amount of gas, in both my stomach and lower abdomen.
I have been taking a full spectrum digestive enzyme supplement prior to meals, and probiotics in the morning.
But the gas is still there, and still painful. I feel like I am burping all day, every day. And flatulating a lot when using the bathroom. Sometimes I feel like I need to make a bowel movement, but instead it is a lot of gas.
I know that IBS is worsened by stress and anxiety. And lately I have been under severe stress. I do get nervous stomach aches throughout the day.
But this is even when I am not stressed out.

Do you have any advice or ideas?
Is the gastroenterologist correct in diagnosing IBS?
If he is, is there anything that would better treat it?
Is there anything I should ask him on my next visit?

Thank you!
Posted Sun, 15 Apr 2012 in Digestion and Bowels
Answered by Dr. Ajit Naniksingh Kukreja 38 minutes later


Thanks for posting your query.

From your detailed history it does appear you are suffering from IBS (Inflammatory Bowel Syndrome).

Replying to your queries:

1] Yes, there are few suggestions that you will need to follow.

2] Yes, your gastroenterologist has a correct diagnosis.

3] It is you yourself who can manage it with proper advice and treatment from your doctor.

As you have mentioned that you are aware of IBS being worsened by stress and considering the fact that you are under lot of stress, it is better you manage your stress levels first and this cycle of stress-symptoms-stress will worsen the situation.

The symptoms of burping and flatulence are at times added with infection in GI (GastroIntestinal) tract if you have had contaminated meals or drinks

There is a role of GI antiseptics like Rifaximin in IBS that has come up in recent research

4] You may request him a simple stool examination to rule out any infection

Now had I been your doctor I would have advised you:

A] Management of stress as a primary objective, either by meditation, yoga or if need be anxiolytics.

b] After a stool report I would consider giving you a seven day course of GI Antibiotics.

I will prefer continuing probiotcs, digestive enzymes and amitriptyline
Omeprazole - you can take as and when needed

c] I would also consider trying Rifaximin for at least six weeks

But the best is management of stress and change in attitude towards life and disease

Hope I have replied to your satisfaction

Am available for follow-up queries

Do accept our response if there are no additional concerns

Wishing you a Speedy recovery
Above answer was peer-reviewed by
Follow-up: Diagnosed with IBS. Taking spectrum digestive enzyme supplement but gas is still present. Can gastroenterologist be wrong? 2 days later

Thank you.

I emailed some of what you said over to my gastroenterologist and he said that these antibiotics arent very helpful for the symptoms that I am having. And that they are very expensive at $700+. He says I can get them if I would like to try, but chances are it wouldn't help me.
Answered by Dr. Ajit Naniksingh Kukreja 3 hours later

Thanks for posting your followup

I can understand your concern

Very obviously one to one consultation is preferred over online consultation

Though the role of medicines vary from case to case, there is adequate literature mentioning advantage of this molecule over others

The choice is yours and as far as the cost factor is concerned it comes to 2 usd per day in our country you may inquire in yours

Hope all clear

Any further concern revert back

Get well soon
Above answer was peer-reviewed by
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