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Lower abdominal bloating, celiac, upper and lower GI tests, Bentyl, gluten, workout

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Internal Medicine Specialist
Practicing since : 1998
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I am a 19 year old male who is having severe lower stomach/abdominal bloating and discomfort. I have been treated for about everything out there. I was treated for celiac, and that came back negative, though I have discovered that avoiding gluten helps the situation, however bloating still occurs after every meal. I had a lower and upper GI and the tests came back negative for Crohne's. I am currently taking Bentyll for IBS, but that isn't making any difference. I workout everyday and get very discouraged when I see results everywhere but my stomach. Any ideas?
Tue, 22 May 2012 in IBS(Irritable Bowel Syndrome)
Answered by Dr. Jasvinder Singh 2 hours later

Thanks for posting your query. I can understand your concern for these symptoms. You have mentioned that you had lower and upper GI tests but did these tests include a biopsy of the duodenum as well? Also did you get the blood tests done for celiac disease?

From the symptoms that you have mentioned a few possibilities are coming to my mind which need to be ruled out. These include:

1)     The possibility of severe abdominal pain, discomfort, bloating and alteration of bowel habits like alternate constipation and loose stools. For ruling out the possibility of irritable bowel syndrome, you have to consult a gastroenterologist as it can be a very difficult diagnosis to make. IBS is called a diagnosis of exclusion, which means that your doctor has to rule out other possibilities first.

2)     Second possibility is of gluten enteropathy. It is an autoimmune inflammatory disease of the small intestine that is precipitated by the ingestion of gluten and bloating occurs after eavery meal. Serologic tests for antibodies against endomysium, transglutaminase, and gliadin identify most patients with the disease. IgA antiendomysial antibody has been quite sensitive in diagnosing this condition. Distal duodenal biopsy is the gold standard for the diagnosis. Hence please get these tests done if they have not been done before.

Regarding gluten intolerance, there are no direct investigations as such but often many investigations are done which help in pinpointing the diagnosis. These include:

1)     Stool Fat test, to determine malabsorption level and presence of steatorrhea in stools
2)     Complete blood count to find out any anemia ( this you must have got done in the blood tests).
3)     Erythrocyte Sedimentation Rate (ESR) and C reactive protein to look for inflammation.
4)     Vitamin levels especially B12, D, and E to check for vitamin deficiency.
5)     Comprehensive metabolic profile (CMP) to analyze protein, calcium and electrolyte levels and liver and kidney functions. These may include albumin, Ca, K, and Na and alkaline phosphatase and PT
6)     Setrological markers like anti-tissue transglutaminase antibody (AGA) and anti-endomysial antibody
7)     A small-bowel biopsy from the second portion of the duodenum

Please discuss with your doctor if all these investigations have been done because from the symptoms it looks like either of these possibilities.

Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries.

Wishing you good health.
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