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Dr. Andrew Rynne

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Is stool test a gold standard test for diagnosing irritable bowel disease?

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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 1938 Questions

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Posted on Fri, 4 May 2018 in Digestion and Bowels
Question: I have hemhhroids and i had a rectal bleeding and i went to the doctor he told aftet diagnostic that i should consider colonscopy and stool test for ibd , i have mucus discharge on stool and bleeding , so i was refered to another doctor and i had to the ibd stool the results is normal (negative and not inflamed) now am waiting for the colonscopy ? Is stool test is enough for ibd ? And whats thr sloution for the hemmhroids ?
doctor
Answered by Dr. Ramesh Kumar 23 minutes later
Brief Answer:
Colonoscopy to be done its gold standard test to diagnose IBD.
As you are just 30 i would suggest you to go for conservative therapy for hemorrhoid.
Minimal invasive or surgical methods should not be used at age of 30.

Detailed Answer:
Hello,
Thank you for choosing HealthcareMagic for your query.
I've gone through your details.
I am Dr Kumar and would be addressing your concerns.

As per your queries answer is see Inflammatory bowel disease can present with symptoms you are having and stool test is not a gold standard test for its diagnosis. Ideally you should go for a colonoscopy. During colonoscopy biopsy samples would be taken by pathologist and would be studied for pathological changes specific for IBD.

Second test is fecal calprotectin-faecal calprotectin is a biochemical measurement of the protein calprotectin in the stool. Elevated fecal calprotectin indicates the migration of neutrophils to the intestinal mucosa, which is very specific for IBD. If this is the test you are talking about then also no this test is not enough. They are just screening tests and colonoscopy should be done(gold standard test) to rule out IBD.

Hemorrhoid treatment-

Initially we start with conservative management for at least 3 months-
Suggestion for conservative management are-
Start taking Syp. Lactulose(OTC) 10-15ml once daily before going to bed. It is one of the most frequently used laxatives, tolerated very well by patients in long terms with minimal side effects. Using laxative would prevent straining while defecating.
Secondly, start using Prepration H (OTC)(a combination containing contains Calcium Dobesilate, Hydrocortisone, Lignocaine, and Zinc.) locally over hemorrhoids.
Thirdly, request your gastroenterologist to prescribe you with oral Calcium Dobesilate-Doxium therapy for 3 months. Initially twice daily for 21 days followed by once daily for 10 weeks. Trials have shown that 3-month therapy can cause shrinkage of Hemorrhoids in almost 60% cases.It was demonstrated that calcium dobesilate decreased capillary permeability, inhibited platelet aggregation and improved blood viscosity; thus resulting in reduction of tissue edema.
Add Metamucil/Fybrogel to your regimen. It's a natural laxative containing husk. It absorbs water from the intestine and swells up making passage of stool easy and add bulk to stool.Take it 2 tsf twice daily with half cup of XXXXXXX warm milk.
Take Sitz bath daily.

If not relieved in three months minimal invasive therapy would be followed.
1)Sclerotherapy: This is currently recommended as a treatment option for first- and second-degree hemorrhoids. The rationale of injecting chemical agents is to create a fixation of mucosa to the underlying muscle by fibrosis.

2)Rubber band ligation: Rubber band ligation (RBL) is a simple, quick, and effective means of treating first- and second-degree hemorrhoids and selected patients with third-degree hemorrhoids. Ligation of the hemorrhoidal tissue with a rubber band causes ischemic necrosis and scarring, leading to fixation of the connective tissue to the rectal wall.

3)Cryotherapy: Cryotherapy ablates the hemorrhoidal tissue with a freezing cryoprobe. It has been claimed to cause less pain because sensory nerve endings are destroyed at very low temperature.

In case if this is not successful then we have invasive surgical procedures like-

1)Hemorrhoidectomy: Excisional hemorrhoidectomy is the most effective treatment for hemorrhoids with the lowest rate of recurrence compared to other modalities.Success rate is more then 90%.

2)Stapled hemorrhoidopexy-A circular stapling device is used to excise a ring of redundant rectal mucosa proximal to hemorrhoids and resuspend the hemorrhoids back within the anal canal. Apart from lifting the prolapsing hemorrhoids, blood supply to hemorrhoidal tissue is also interrupted.

Hope I provided you with the information you wanted.
In case you need further advice feel free to ask.

Regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Ramesh Kumar 26 minutes later
I had calprotectin test the result was less then 50 normal and eliminated crohn disease and ulcertic
doctor
Answered by Dr. Ramesh Kumar 1 minute later
Brief Answer:
Follow up answer.

Detailed Answer:
Hi again,
As told earlier just doing calprotectin can't rule out possibility of not having IBD.
Sensitivity of this test is some what around 80%.So in 80 out of 100 cases results are true while in rest 20 cases it misses the problem.
Sensitivity of colonoscopy is more then 99% and you should go for it.
Hope i was helpful.
Warm regards!

Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Ramesh Kumar 48 minutes later
Whats ibd treatment ?
doctor
Answered by Dr. Ramesh Kumar 2 hours later
Brief Answer:
Follow up.

Detailed Answer:
Hello again,
Nonsteroidal anti-Inflammatory drug, Anti-Inflammatory, Immunosuppressive drug, Steroid, Analgesic, and Dietary supplement are treatment of IBD.
Long term treatment is required.
Mesalamine is usually started initially.

Regards!
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Ramesh Kumar 2 hours later
And how long it will take to be 100% cured ?
doctor
Answered by Dr. Ramesh Kumar 3 hours later
Brief Answer:
follow up.

Detailed Answer:
Hello again,
Would take almost 1 year.
Thanks!
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Ramesh Kumar 4 hours later
Doctor i dont have symptoms and the calprotectin is negative is it highly likely ibs ?
doctor
Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
Yes very likely its not Inflammatory bowel.

Detailed Answer:
Hello again dear patient,
Yes off course its very likely that you don’t have inflammatory bowel disease as far as Irritable bowel syndrome is concerned its a diagnosis of exclusion which means that when despite of all possible tests patient has no finding but symptoms are there he/she is labelled as having IBS.
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 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.Every patient with IBS is different with varying symptoms.
In IBS there is some problem in the functional ability of the gut that leads to the symptoms of irritable bowel syndrome. The structure of the intestines is normal, only functional abnormality occurs in this condition.So frankly speaking (IBS) represents a functional disorder of gastrointestinal tract without the presence of an anatomic defect SO in lay mans language till date we are not sure whats the exact cause of this problem.So the million dollar question is how to repair a system when you don't know which part of it is faulty(Some says it can be brain other says it can be hormone anxiety age etc etc).
Again initially you have to go theough colonoscopy abd if its normal we could proceed with treatment of irritable bowel disease and hemorrhoid.

Hope i was helpful.
Thanks!
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Ramesh Kumar 46 minutes later
Doctor usually rectal bleeding comes when i feel pain passing a stool and there isnt mucus charge except if i eat a bad meal , but there is eczema near the anus but it happens i scrath too much my rectum and surrounding and when i dont scratch it and leave it nothing itchy (i developed it as a habbit) i scratch alot snd touch my bottom alot even if it isnt itchy, other then that i dont have a problem with the colon , i only feel gassy and bloating if i eat bad and drink carbonated drinks , caffeine and dairy
doctor
Answered by Dr. Ramesh Kumar 5 hours later
Brief Answer:
Follow up answer.

Detailed Answer:
Hi there again my dear patient,
See hemorrhoids ,IBS all are somehow related to our food habits and life style.You are just 30 and having these problems at such a tender age is definitely a premature event.
When digestion of food in a persons gut is not proper it is acted upon by a number of harmful bacterias and protozoans leading to production of large amount of gas resulting in bloating belching farting excessive acid gastric pain etc.When stools are hard to pass or a person is constipated mucosa layer is constantly damaged leading to formation of hemorrhoid.When a part of soft mucosal tissue is damaged large amount of mucous is secreted by nearby glands as a protective phenomenon.

So what you need to do is that you have to follow a proper life style with changed food habits and you would feel things getting better in few months.

Please pen down the medications you are on right now and your food habits so that i can guide you further.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
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