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Suggest treatment for celiac disease and lactose intolerance

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Posted on Mon, 5 Dec 2016
Question: Hi Please tell me tests name to diagnose Celiac disease, and also lactose intolerance.

Please provide me proper name of these tests and where it can be done, whether it can be done in normal path labs like Lal path labs.

If this include multiple tests, please write all the names of the tests.

Thanks!
doctor
Answered by Dr. Dr. Happykumar Kagathara (3 hours later)
Brief Answer:
Symptoms based approach is required

Detailed Answer:
Hello,
1) I would like to know why you want to do these tests. What are symptoms?
2) If you are thinking on Irritable bowel disease then it is last diagnosis to come because it is rare in XXXXXXX population.
3) You must do evaluation based on symptoms not based on suspicion. Most of times symptoms provide half of diagnosis and also provide clue for which investigation to be done.
Therefore I suggest you to start with symptoms so we can proceed on investigations and then treatment later on
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Dr. Happykumar Kagathara (6 hours later)
Hi, I have provided some attachments. Please review them.

Hi Dr. Happykumar

Good to hear from you!

Please find attached my all reports including USG.

The problem I am facing is of bowel movements, I need to go for stools throughout the day. I find some smell coming out of my bottom part and feel my ass watery but in actual when I touch I find no water and no smell on fingers, that smell I think must be coming from inside ass.

I need to go for stools many times, the first stool of the day is quite normal, and good in quantity, but after every stool it changes it become more and more watery (when I am including Papaya in my Diet), and becomes more and more harder when I am not including Papaya in my diet or any other fruit. At last comes some sticky substance (raal) in the stools.

When i am not including papaya in my diet, the stools after the first one gets harder and harder but are in small- small quantity and many times I need to use my finger to adjust my ass to remove them. I think they makes me uncomfortable while sitting as they get stuck in my ass at the very tip.

One major problem is I feel incomplete stools. I am also taking IsabGhol at night.

I have consulted many Gastroenterologist till now, and right now I am prescribed medicines for Stomach gas and nerve relaxing pills also a gel to apply on ass -Anno Bliss

What I personally experienced the problem is that stool and gas inside my stomach gets interlocked- I will explain you clearly what in actual happens.
If I go 6-7 times for stool daily.
After my 1st stool when I feel that I can't do more shit (but in actual I have feeling of incomplete stool), I can after making some movements of body do the 2nd stool right after that in just other few minutes and so on the 3rd one but this process is very tiring..... What I feel is when I moves my body in such a way that my Spleen get pushed or stretch first a gas comes out and after that the stool comes out, Again stretching, moving or shaking, again gas comes out and after that some other stool so this process continue whole day, When I will have a feeling of gas my stool will next to it at the tip of my ass....

I feel I also stopped farting since that comes with stools. But sometimes When I fart uninterrupted (That may happen after I workout or brisk walk), I feel very good inside.

I was asking for those tests since few months back the smell problem was almost in control. But right now after doctor suggested me to increase diet and eat everything, I increased my Chapattis from 2 to 3 twice a day and also started drinking lot of milk. But my condition has worsen from that time in terms of smell from the ass......

Please study my case. I don't feel meeting people these days because of that dirty smell, even I ran from my home members.

Thank You!
doctor
Answered by Dr. Dr. Happykumar Kagathara (42 hours later)
Brief Answer:
Definitely no IBS, but suspecting inflammatory bowel disease

Detailed Answer:
Hello,
I apologize for late reply.
1) Your symptoms are not consistent with IBD. I do not think that you have IBD
2) In brief, your symptoms are incomplete defecation + mucus discharge along with stool + increased frequency of stool + hard stool.
3) Lets talk about first simple possibility; In case of constipation from long time, hard stool get impact somewhere at lower end of intestine and it block further passage of remaining stool. So sometimes only mucus discharge passes with smell but when you strain more or do finger maneuver then hard impacted stool pass and after that you got regular bowel movement with near-normal consistency. But generally increased frequency (>4-5, daily) does not occur in this condition. Isabghul is for constipation and as possibility of this condition is less you should stop it for temporary period.
4) Now second possibility; Mucus discharge along with stool + increased frequency of stool + liquid consistency of stool suggest possibility of inflammatory bowel disease (Ulcerative colitis or Crohn's disease). In this, inner wall of part of intestine become inflamed (redness + swelling) and this develop symptoms.
5) In IBD, you have intolerance (allergy) to particular type of food and develop diarrhea after ingesting that food. In XXXXXXX population, IBD with alternate diarrhea and constipation is very rare and also mucus discharge does not present in IBD.
6) You have consulted my gastroenterologist but none suggested to do Colonoscopy, why? Your symptoms are typical indication for undergo colonoscopy and this is must. I suggest you to do colonoscopy because I am suspecting inflammatory bowel disease based on your symptoms. Doctor will take few millimeter biopsy also for confirmation. Also control of symptoms with papaya suggest possibility of inflammatory bowel disease.
(If you have done colonoscopy in last 3-4 months then please upload it)
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Dr. Happykumar Kagathara (44 hours later)
Hi Dr. HappyKumar
Thanks for your reply.

I am not sure whether you are able to see my all reports PDF, as it is not showing in my XXXXXXX (please confirm).

Please tell me which is the best place in XXXXXXX where can I get colonscopy done. Also what will be the cost approx for this.
Is there any cutting or stitching done in this process or it is just done by putting camera inside anus.

Also will I be Able to know after the test whether it is IBS or IBD..... I mean to say whether will there be any progress in my case as I don't have much time, I have taken enough time offs from my office, and also I am very tired and disturbed with this now mentally as its been around 1 year and I am not able to detect the real problem for this smell.....

I have followed a strictly healthy diet (not a single junk food) for the last 8 months, but I didn't got any relief. I just got relief once few months back when I was eating papaya. But now no permutation and combination is working....
doctor
Answered by Dr. Dr. Happykumar Kagathara (24 minutes later)
Brief Answer:
Colonoscopy is 100% safe procedure

Detailed Answer:
Hello,
1) Yes I have seen all your uploaded files.
2) Choosing consultant for consultation or investitgation or treatment is patient's free right in XXXXXXX I not believe it should be suggested neither by any third-person nor by any other doctor. But I would recommend to go any multispeciality hospital where gastroenterologist with degree of MD, DM (gastroenterology) is available.
3) Yes this procedure is completely safe, there will be no stitching on body for this procedure. Just passing of colonoscope through anus.
4) With colonoscopy you get 100% confirmation about IBD as it affect large intestine first. But it is difficult to confirm IBS by any test because it is physiologic disease which not affect structure of intestine and also it affect small intestine not large intestine. There is no any procedure in world which can visualize inside of small intestine. But colonoscopy is gold standard test for symptoms related to large intestine (like you)
Above answer was peer-reviewed by : Dr. Yogesh D
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Dr. Dr. Happykumar Kagathara

Gastrointestinal Surgeon

Practicing since :2006

Answered : 434 Questions

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Suggest treatment for celiac disease and lactose intolerance

Brief Answer: Symptoms based approach is required Detailed Answer: Hello, 1) I would like to know why you want to do these tests. What are symptoms? 2) If you are thinking on Irritable bowel disease then it is last diagnosis to come because it is rare in XXXXXXX population. 3) You must do evaluation based on symptoms not based on suspicion. Most of times symptoms provide half of diagnosis and also provide clue for which investigation to be done. Therefore I suggest you to start with symptoms so we can proceed on investigations and then treatment later on