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Pain in the lower abdomen and watery stools after eating, weight loss. Has diabetes. Gastric bypass done. Not responding to Flagyl

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Posted on Sat, 30 Jun 2012
Question: Hi, my mother is 58 years old and has been suffering with a GI issue for several years now (about 3). She finds that immediately after eating (no more than 15min), she has an intense pain in her lower left abdomen and then she must immediately run to the bathroom where her stools are watery and come out very harshly. She has suffered weight loss because of this, and the issue has worsened to the point that anything she eats causes this same reaction. She is diabetic (being managed), has had heart issues (under control), had a gastric bypass in 2005. She has had several endoscopies and colonoscopies performed. All came back normal, with the exception of some threads loose around her gastric bypass sight and a ulcer in the same area. She has seen several GI doctors and a Ob/GYN for this issue and nobody has been able to find a conclusion. She also sometimes gets a C-Diff infection at times. They have tried to treat the bacterial infection with Flagyl....to no response.
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Answered by Dr. Poorna Chandra K.S (2 hours later)
Hi and thanks for the query,

Rushing to toilet after meals is secondary to an exaggerated gastrocolic reflex. This can occur due to a variety of causes like-
1) Mucosal inflammation - secondary to mucosal diseases; unlikely as endoscopies have been normal. This can be associated with Vit B12 defeciency which may worsen the symptoms.
2) Intestinal dysmotility - which can develop secondary to diabetic affliction of nerves. This can secondarily lead to bacterial overgrowth.
3) Bacterial overgrowth - common in patients with Diabeties and gastric bypass. This can cause secondary mucosal irritation and malabsorption.
Hence get a stool examination (3 days), Fasting serum Vit B12, TSH(Thyroid stimulating hormone), CRP (C reactive protein Quantitative) and a glucose- lactulose H2 breath test. These may help you to localise the abnormalities and susequent management can be worked out

Hope I have answered your query. Please accept my answer in case you do not have further queries.
Regards
Dr XXXXXXX

Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Poorna Chandra K.S (24 hours later)
And the pain that comes before the rushing to the bathroom is also a symptom for the bacterial overgrowth? And what causes the pain to occur?
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Answered by Dr. Poorna Chandra K.S (1 hour later)
Hi and thanks for writing back
The pain prior to a bowel movement is because of spasms and these can be brought on by mucosal inflammation or the dysmotility associated with the bacterial overgrowth
Regards
Dr XXXXXXX
Above answer was peer-reviewed by : Dr. Yogesh D
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Answered by
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Dr. Poorna Chandra K.S

Gastroenterologist

Practicing since :2000

Answered : 339 Questions

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Pain in the lower abdomen and watery stools after eating, weight loss. Has diabetes. Gastric bypass done. Not responding to Flagyl

Hi and thanks for the query,

Rushing to toilet after meals is secondary to an exaggerated gastrocolic reflex. This can occur due to a variety of causes like-
1) Mucosal inflammation - secondary to mucosal diseases; unlikely as endoscopies have been normal. This can be associated with Vit B12 defeciency which may worsen the symptoms.
2) Intestinal dysmotility - which can develop secondary to diabetic affliction of nerves. This can secondarily lead to bacterial overgrowth.
3) Bacterial overgrowth - common in patients with Diabeties and gastric bypass. This can cause secondary mucosal irritation and malabsorption.
Hence get a stool examination (3 days), Fasting serum Vit B12, TSH(Thyroid stimulating hormone), CRP (C reactive protein Quantitative) and a glucose- lactulose H2 breath test. These may help you to localise the abnormalities and susequent management can be worked out

Hope I have answered your query. Please accept my answer in case you do not have further queries.
Regards
Dr XXXXXXX