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Dr. Andrew Rynne

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Hi there - I have been experiencing GI issues for

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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 2041 Questions

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Posted on Mon, 7 Jan 2019 in Digestion and Bowels
Question: Hi there -
I have been experiencing GI issues for the past almost three months. It started out with feeling I had a slightly upset stomach. I thought I had a flu. The upset stomach got better, but then I noticed I was consistently constipated for about a month. Then things evolved. I started noticing more stomach issues and stool on the softer side. So for the past 6 weeks, here is what I've experienced very specifically:
- My bowels (and perhaps stomach too) make hyperactive sounds as soon as I put food in there (no matter what food). Within 10 minutes, my stomach starts 'working' - a great deal of gurgling and churning.
- I frequently experience nausea - it seems to be random. Some days I might have it half the day (queasiness), and other days I might only experience it for an hour in total.
- Sometimes I have that 'gnawing feeling' in my stomach that feels like hunger but which I know is not hunger. Again, it seems random. It could hit me one hour after eating, or lying in bed at night.
- Bloating happens frequently, but again is unpredictable in terms of when it will happen. It's always associated with having eaten, but it might hit after one meal, and then not hit for the next two.
- A great deal of gas
- No acid reflux, and doesn't feel like it's upper abdominal
- I have a bowel movement once a day. The consistency of the stool ranges from softer than normal but still with form, or veers more towards diarrhea (more liquidy). The colour seems normal, there is no foul smell, I don't see fat droplets or mucous, but I don't have a trained eye. I will go like this for several days, then one day I might experience constipation where I don't go.
- I've had chills that go along with this whole thing. I should note that chills have arisen for me many times in the past with other things too.
- No fever
- Appetite is normal, but I am driven away from eating much because of how my stomach reacts with the bloating, gas, gurgling, nausea, etc.
- No burning feeling ever (i.e. the trademark ulcer sign) and very few instances of cramping (maybe 5 times in total over three months)


I have met with my GP to discuss and she doesn't seem concerned. She did put in a referral to see a Gastroenterologist, but I won't see anything happen for 2 months. I've called in to a Toronto clinic and may book a colonscopy there within a month's time.

I was diagnosed with breast cancer 2.5 years ago and am on an Aromatase Inhibitor - Letrozole. I have had a couple clusters of very bizarre symptoms in the past which I could never figure out. These bouts led to scans which revealed nothing. Perhaps the Letrozole was leading to those symptoms.

Finally, I should say that except for one episode of GI upset (mostly constipation related) 6 years ago (along with some very strange symptoms that felt autoimmune and which I now link to changing hormones as I went into perimenopause just around that time), I've never been a person who has had strange GI symptoms. Eating has become a bit of an adversary for me, since it leads to the stomach reacting.

I would appreciate your reply. I have tried another site about 2 weeks ago, asking a specialist. I felt his reply to be very brief and not very insightful. I felt he was leaning in a direction that didn't make sense for me...but maybe I'm wrong.

I'm obviously concerned about GI related cancers given my history (even though breast cancer doesn't usually spread to GI organs other than liver, I am very sensitive to experiencing symptoms I cannot explain). I did have an abdominal ultrasound a few days ago, but won't know more for several days.

Thanks for any feedback you can offer based on my details above...
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Follow up: Dr. Ramesh Kumar 0 minute later
Hi there -
I have been experiencing GI issues for the past almost three months. It started out with feeling I had a slightly upset stomach. I thought I had a flu. The upset stomach got better, but then I noticed I was consistently constipated for about a month. Then things evolved. I started noticing more stomach issues and stool on the softer side. So for the past 6 weeks, here is what I've experienced very specifically:
- My bowels (and perhaps stomach too) make hyperactive sounds as soon as I put food in there (no matter what food). Within 10 minutes, my stomach starts 'working' - a great deal of gurgling and churning.
- I frequently experience nausea - it seems to be random. Some days I might have it half the day (queasiness), and other days I might only experience it for an hour in total.
- Sometimes I have that 'gnawing feeling' in my stomach that feels like hunger but which I know is not hunger. Again, it seems random. It could hit me one hour after eating, or lying in bed at night.
- Bloating happens frequently, but again is unpredictable in terms of when it will happen. It's always associated with having eaten, but it might hit after one meal, and then not hit for the next two.
- A great deal of gas
- No acid reflux, and doesn't feel like it's upper abdominal
- I have a bowel movement once a day. The consistency of the stool ranges from softer than normal but still with form, or veers more towards diarrhea (more liquidy). The colour seems normal, there is no foul smell, I don't see fat droplets or mucous, but I don't have a trained eye. I will go like this for several days, then one day I might experience constipation where I don't go.
- I've had chills that go along with this whole thing. I should note that chills have arisen for me many times in the past with other things too.
- No fever
- Appetite is normal, but I am driven away from eating much because of how my stomach reacts with the bloating, gas, gurgling, nausea, etc.
- No burning feeling ever (i.e. the trademark ulcer sign) and very few instances of cramping (maybe 5 times in total over three months)


I have met with my GP to discuss and she doesn't seem concerned. She did put in a referral to see a Gastroenterologist, but I won't see anything happen for 2 months. I've called in to a Toronto clinic and may book a colonscopy there within a month's time.

I was diagnosed with breast cancer 2.5 years ago and am on an Aromatase Inhibitor - Letrozole. I have had a couple clusters of very bizarre symptoms in the past which I could never figure out. These bouts led to scans which revealed nothing. Perhaps the Letrozole was leading to those symptoms.

Finally, I should say that except for one episode of GI upset (mostly constipation related) 6 years ago (along with some very strange symptoms that felt autoimmune and which I now link to changing hormones as I went into perimenopause just around that time), I've never been a person who has had strange GI symptoms. Eating has become a bit of an adversary for me, since it leads to the stomach reacting.

I would appreciate your reply. I have tried another site about 2 weeks ago, asking a specialist. I felt his reply to be very brief and not very insightful. I felt he was leaning in a direction that didn't make sense for me...but maybe I'm wrong.

I'm obviously concerned about GI related cancers given my history (even though breast cancer doesn't usually spread to GI organs other than liver, I am very sensitive to experiencing symptoms I cannot explain). I did have an abdominal ultrasound a few days ago, but won't know more for several days.

Thanks for any feedback you can offer based on my details above...
doctor
Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:
Very likely irritable bowel syndrome.

Detailed Answer:
Hello and Welcome to 'Ask A Doctor' service.
I have reviewed your query and here is my advice.

The symptoms you are describing are mostly suggestive of a functional disorder called irritable bowel syndrome.All your symptoms as well as duration of illness is suggestive of Irritable bowel syndrome.However IBS is a diagnosis of exclusion as there is no test to confirm you have IBS,It means that when you have nothing or all your investigations are normal you are labelled as having IBS.
what exactly is IBS?
A common disorder affecting the large intestine is the Irritable Bowel Syndrome. Abdominal pain, bloating, gas constipation and diarrhoea are some of the signs and symptoms of IBS. Foods, stress and other diseases can trigger the problem.
However the exact cause of irritable bowel syndrome is not yet known but studies suggest that a lot of factors play a major role. The intestinal walls are lined with a layer of muscle which contracts and relaxes in a rhythm when they move to your rectum through your intestinal tract. If you acquire irritable bowel syndrome, the contractions can get stronger and last much longer than usual. This causes diarrhea, bloating and gas. In some cases, the opposite can also occur, this can be characterized by weak intestinal contractions, which slows food passage resulting to dry and hard stools.Some patients presents with constipation while other have loose stools while some have both on alternation.Every patient with IBS is different with varying symptoms.
Initially i would suggest you to go for colonoscopy a CT abdomen and stool microscopy test.If both these tests are normal you would be treated on guide lines of IBS.In case of cancer or any such thing it would be reflected in these tests.

Till time tests are done-
For bloating and gas take Tab Nexium 40mg twice daily can increase it to 80 mg twice daily.Take a probiotic daily with food as proper digestion of food will prevent excess gas formation.When food is not properly digested large amount of gases are produced inside due to incomplete fermentation of food.Hence if digestion improves overall symptoms will also improve.
Food pattern recommended is-
Eat simple and natural home cooked food.
If possible try detox diet (Raw vegans) for at least 3 month. Take normal food in lunch while in supper take uncooked raw (low fiber) natural form of food. This can play wonders.
Avoid taking excessive fibres. A total fiber intake of about 20-25 gram per day would be good for you.
No pizza,Burger, Red meat, and dairies for few weeks.
No alcohol or smoking.

As to take natural food rich in probiotics like Yoghurt, Kimchi,etc.This doesn't mean that you have to take them as much as you can.Follow your body increase their uptake gradually.
Drink lots of juices and fresh water daily. Drink cleaner water, it will help a lot.
Avoid over spicy and heavy food.

Follow up with reports.
Hope I was elaborate and helpful,
Follow ups are welcome!
Please post the reply of other doctor with follow up want to go through it.


Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Ramesh Kumar 0 minute later
Brief Answer:
Very likely irritable bowel syndrome.

Detailed Answer:
Hello and Welcome to 'Ask A Doctor' service.
I have reviewed your query and here is my advice.

The symptoms you are describing are mostly suggestive of a functional disorder called irritable bowel syndrome.All your symptoms as well as duration of illness is suggestive of Irritable bowel syndrome.However IBS is a diagnosis of exclusion as there is no test to confirm you have IBS,It means that when you have nothing or all your investigations are normal you are labelled as having IBS.
what exactly is IBS?
A common disorder affecting the large intestine is the Irritable Bowel Syndrome. Abdominal pain, bloating, gas constipation and diarrhoea are some of the signs and symptoms of IBS. Foods, stress and other diseases can trigger the problem.
However the exact cause of irritable bowel syndrome is not yet known but studies suggest that a lot of factors play a major role. The intestinal walls are lined with a layer of muscle which contracts and relaxes in a rhythm when they move to your rectum through your intestinal tract. If you acquire irritable bowel syndrome, the contractions can get stronger and last much longer than usual. This causes diarrhea, bloating and gas. In some cases, the opposite can also occur, this can be characterized by weak intestinal contractions, which slows food passage resulting to dry and hard stools.Some patients presents with constipation while other have loose stools while some have both on alternation.Every patient with IBS is different with varying symptoms.
Initially i would suggest you to go for colonoscopy a CT abdomen and stool microscopy test.If both these tests are normal you would be treated on guide lines of IBS.In case of cancer or any such thing it would be reflected in these tests.

Till time tests are done-
For bloating and gas take Tab Nexium 40mg twice daily can increase it to 80 mg twice daily.Take a probiotic daily with food as proper digestion of food will prevent excess gas formation.When food is not properly digested large amount of gases are produced inside due to incomplete fermentation of food.Hence if digestion improves overall symptoms will also improve.
Food pattern recommended is-
Eat simple and natural home cooked food.
If possible try detox diet (Raw vegans) for at least 3 month. Take normal food in lunch while in supper take uncooked raw (low fiber) natural form of food. This can play wonders.
Avoid taking excessive fibres. A total fiber intake of about 20-25 gram per day would be good for you.
No pizza,Burger, Red meat, and dairies for few weeks.
No alcohol or smoking.

As to take natural food rich in probiotics like Yoghurt, Kimchi,etc.This doesn't mean that you have to take them as much as you can.Follow your body increase their uptake gradually.
Drink lots of juices and fresh water daily. Drink cleaner water, it will help a lot.
Avoid over spicy and heavy food.

Follow up with reports.
Hope I was elaborate and helpful,
Follow ups are welcome!
Please post the reply of other doctor with follow up want to go through it.


Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Ramesh Kumar 49 minutes later
Hi Dr. XXXXXXX
Thank you for all this information. I will follow your advice regarding the diet.
I have a couple questions for you regarding IBS:
- So, are you suggesting it's fairly normal for someone with IBS to have symptoms ongoing for a fair length of time? I thought that with IBS, the symptoms 'flare up' for a week or less, go away and then come up again later? I've had this going on fairly consistently.
- The major gurgling of my stomach - can I ask why there is so much gurgling? Is that just a byproduct of the great deal of gas being produced due to improper digestion?
- I thought that people with IBS get lots of cramping which is often relieved by going to the bathroom? I've only had cramping a fair number of times.

My GP thought I was exhibiting some features of IBS too.

So, from what I've told you, do my symptoms sound suspect for cancer to you? In other words, do people with bowel or other gastric cancers exhibit the exact same symptoms as I've detailed?

I appreciate your reply,
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Follow up: Dr. Ramesh Kumar 0 minute later
Hi Dr. XXXXXXX
Thank you for all this information. I will follow your advice regarding the diet.
I have a couple questions for you regarding IBS:
- So, are you suggesting it's fairly normal for someone with IBS to have symptoms ongoing for a fair length of time? I thought that with IBS, the symptoms 'flare up' for a week or less, go away and then come up again later? I've had this going on fairly consistently.
- The major gurgling of my stomach - can I ask why there is so much gurgling? Is that just a byproduct of the great deal of gas being produced due to improper digestion?
- I thought that people with IBS get lots of cramping which is often relieved by going to the bathroom? I've only had cramping a fair number of times.

My GP thought I was exhibiting some features of IBS too.

So, from what I've told you, do my symptoms sound suspect for cancer to you? In other words, do people with bowel or other gastric cancers exhibit the exact same symptoms as I've detailed?

I appreciate your reply,
doctor
Answered by Dr. Ramesh Kumar 19 minutes later
Brief Answer:
In gastroenterology almost all major disease present with same symptoms.

Detailed Answer:
Hi again dear patient


1)IBS is a functional disease.As told earlier in some patients it may be peroidic with relapses while in other it's continuous.Infact some patient responds very well to medication while other don't respond at all to any medication.In easy language sir you are repairing a car but you don't know where the problem is.IBS is a grey zone disease and treatment is on hit and trial basis.
2)Our intestine is a closed space.When a person is constipated or digestion is not proper fermentation and putrification of food takes place this gas produces voice when intestines moves(peristalysis) heard by you as gurgles.
3)No many patients presents only with loose motions without any pain which does not respond to any medication.Some presents only with constipation.Its not necessary that every patient has all symptoms.
4)Usually bowel cancer is associated with bleeding also.Secondly the basic problem with gastroenterology frankly speaking is that almost every disease from enteritis to cancer present with same four five symptoms.
Primi facia sir I don't think it's cancer unless proved otherwise in CT or Colonoscopy.
However after an age of 45 colonoscopy should be done once every five years.
just go for the tests and follow up with reports.
Regards and God bless you!
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
doctor
Answered by Dr. Ramesh Kumar 0 minute later
Brief Answer:
In gastroenterology almost all major disease present with same symptoms.

Detailed Answer:
Hi again dear patient


1)IBS is a functional disease.As told earlier in some patients it may be peroidic with relapses while in other it's continuous.Infact some patient responds very well to medication while other don't respond at all to any medication.In easy language sir you are repairing a car but you don't know where the problem is.IBS is a grey zone disease and treatment is on hit and trial basis.
2)Our intestine is a closed space.When a person is constipated or digestion is not proper fermentation and putrification of food takes place this gas produces voice when intestines moves(peristalysis) heard by you as gurgles.
3)No many patients presents only with loose motions without any pain which does not respond to any medication.Some presents only with constipation.Its not necessary that every patient has all symptoms.
4)Usually bowel cancer is associated with bleeding also.Secondly the basic problem with gastroenterology frankly speaking is that almost every disease from enteritis to cancer present with same four five symptoms.
Primi facia sir I don't think it's cancer unless proved otherwise in CT or Colonoscopy.
However after an age of 45 colonoscopy should be done once every five years.
just go for the tests and follow up with reports.
Regards and God bless you!
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Ramesh Kumar 1 hour later
Thank you very much for the further detail. I just have another 4 questions before we end our conversation?

1. The nausea I get here and there (mild)...does that happen because the food isn't being properly digested and the trapped gasses cause it?
2. I only go to the bathroom once per day, very rarely twice. I know you said that with IBS, people can have very individual symptoms, but does this still make sense? I go in the morning and that is it for the day (but it is usually more on the side of diarrhea).
3. The 'gnawing' or hunger like feeling I get in my stomach happens when I know I'm not hungry. But it makes me feel like I need to put something in my stomach. Is this something that still fits the possibility of IBS? What would make this happen if IBS is the cause? I thought the gnawing thing was/is related to stomach acid issues?
4. As I mentioned in my intro, I've only ever had GI related issues once before in any consistent/ongoing way. I had similar symptoms (but they seemed less pronounced and went away after 8 weeks) 6-7 years ago. At that time I started into perimenopause. My periods changed. I feel - looking back - that these symptoms, which were on the heels of other strange symptoms, might have been hormone change related. Since that time, I once in a blue moon may have a big bloat and nauseated feeling (maybe 3 times in all those years). Do you have any idea what would trigger IBS if that is what this is? Can cancer be there for years and years?

Thank you for your excellent responses; I've only used this type of service three times ever and those three times I felt that the replies were not very thorough based on the background I gave.

p.s. I'm a woman, not a sir :). But thank you very much!
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Follow up: Dr. Ramesh Kumar 0 minute later
Thank you very much for the further detail. I just have another 4 questions before we end our conversation?

1. The nausea I get here and there (mild)...does that happen because the food isn't being properly digested and the trapped gasses cause it?
2. I only go to the bathroom once per day, very rarely twice. I know you said that with IBS, people can have very individual symptoms, but does this still make sense? I go in the morning and that is it for the day (but it is usually more on the side of diarrhea).
3. The 'gnawing' or hunger like feeling I get in my stomach happens when I know I'm not hungry. But it makes me feel like I need to put something in my stomach. Is this something that still fits the possibility of IBS? What would make this happen if IBS is the cause? I thought the gnawing thing was/is related to stomach acid issues?
4. As I mentioned in my intro, I've only ever had GI related issues once before in any consistent/ongoing way. I had similar symptoms (but they seemed less pronounced and went away after 8 weeks) 6-7 years ago. At that time I started into perimenopause. My periods changed. I feel - looking back - that these symptoms, which were on the heels of other strange symptoms, might have been hormone change related. Since that time, I once in a blue moon may have a big bloat and nauseated feeling (maybe 3 times in all those years). Do you have any idea what would trigger IBS if that is what this is? Can cancer be there for years and years?

Thank you for your excellent responses; I've only used this type of service three times ever and those three times I felt that the replies were not very thorough based on the background I gave.

p.s. I'm a woman, not a sir :). But thank you very much!
doctor
Answered by Dr. Ramesh Kumar 14 hours later
Brief Answer:
follow up.

Detailed Answer:
Hello there and thanks for follow up,
You are free to ask as many queries you have i would be happy to answer them,

As of now,

1)Though there are a number of causes of nausea yet very likely in your case the gas formed compresses the intestines. This provokes the feeling of nausea.

2)There has to be a cause of diarrhea. If colonoscopy and stool test (to find any bug) are normal then only IBS can explain why you have diarrhea. My explanation is an assumption my dear patient for conclusion tests are required.

3)In IBS motility of intestine increases. In laymans language a hollow pipe starts to contract and relax at faster speed this would likely create more resonance and sounds.

4)Cancer usually spreads at a fast rate and symptoms are usually aggressive.It would hardly take you 3 to 5 months to move to a gastroenterologist because symptoms in case of cancer are usually aggressive. But rate of colon carcinoma is fairly high in European and XXXXXXX population therefore a colonoscopy has to be done. As far as IBS is concerned we still don't know if its IBS or not.

So what i would recommend you to go for tests initially and follow back with reports.
Looking forward to hear from you dear,

Do rate the answer.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Ramesh Kumar 0 minute later
Brief Answer:
follow up.

Detailed Answer:
Hello there and thanks for follow up,
You are free to ask as many queries you have i would be happy to answer them,

As of now,

1)Though there are a number of causes of nausea yet very likely in your case the gas formed compresses the intestines. This provokes the feeling of nausea.

2)There has to be a cause of diarrhea. If colonoscopy and stool test (to find any bug) are normal then only IBS can explain why you have diarrhea. My explanation is an assumption my dear patient for conclusion tests are required.

3)In IBS motility of intestine increases. In laymans language a hollow pipe starts to contract and relax at faster speed this would likely create more resonance and sounds.

4)Cancer usually spreads at a fast rate and symptoms are usually aggressive.It would hardly take you 3 to 5 months to move to a gastroenterologist because symptoms in case of cancer are usually aggressive. But rate of colon carcinoma is fairly high in European and XXXXXXX population therefore a colonoscopy has to be done. As far as IBS is concerned we still don't know if its IBS or not.

So what i would recommend you to go for tests initially and follow back with reports.
Looking forward to hear from you dear,

Do rate the answer.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Ramesh Kumar 1 hour later
Thank you very much.
And the hunger pangs I repeatedly get? Last night I kept having the gnawing/hunger feeling even though I put something in my stomach.
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Follow up: Dr. Ramesh Kumar 0 minute later
Thank you very much.
And the hunger pangs I repeatedly get? Last night I kept having the gnawing/hunger feeling even though I put something in my stomach.
doctor
Answered by Dr. Ramesh Kumar 15 hours later
Brief Answer:
Strong intestinal peristalysis causes hunger pangs.

Detailed Answer:
Hello again dear patient XXXXXXX
Hunger pangs are nothing but contraction of gut.
Intestines are there in abdomen.Almost complete gut is packed with intestines.In case of patients with IBS or any motility disorder in which intestine moves fast these rapid contraction may be felt as hunger pangs.
Hope I was helpful.
Follow ups are welcome,
Thank you!
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Ramesh Kumar 0 minute later
Brief Answer:
Strong intestinal peristalysis causes hunger pangs.

Detailed Answer:
Hello again dear patient XXXXXXX
Hunger pangs are nothing but contraction of gut.
Intestines are there in abdomen.Almost complete gut is packed with intestines.In case of patients with IBS or any motility disorder in which intestine moves fast these rapid contraction may be felt as hunger pangs.
Hope I was helpful.
Follow ups are welcome,
Thank you!
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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