Suggest treatment for diarrhea, gas, bloating, stomach discomfort and pain

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Posted on Thu, 11 Jun 2015 in Digestion and Bowels
Question: I am suffering from loose stools less than three times a day for seven days mainly in mornings,also gas,bloating and mild belly discomfort,pain.what to do?I have done several tests on stool,reports are uploaded.please go through them.
I have also gone through fecal calprotectin tests twice results are 32.88 mg/kg and 6.25 mg/kg,negative result below 25 mg/kg,borderline between 25-50 and positive above 50 mg/kg,had normal colonoscopy.my question is,do I have IBD like ulcerative colitis or chrons disease.

also I am having lightheadness for several weeks,two brain mris were done both came normal,I also have anxiety and worryness.
I have also done several blood tests,reports are uploaded.please go through them.I want to know if I am iron deficient and vitamin b12 deficient.
I have attached two different blood tests report.
abdomen ultrasound,upper gi endiscopy, colonoscopy and small bowel follow thorough were done previously all are normal.
I have significant belly problems like pain,discomfort,gas,nausea,acidity for several months in past.
I have a question for you I have gone through a test called endomysial antibody test iga,report I have attached.
I am requesting you sir kindly interpret my endomysial antibody iga test result.do I have positive or negative result?do I have celiac disease or not.
my result are endomysial antibody iga is negative,but titer was 1:10.
I searched google and found that titer equal or more than 1:10 is positive,but in report it was written it is negative.
kindly tell me what is exactly the situation.
doctor
Answered by Dr. Prasad 13 hours later
Brief Answer:
How are you currently treating this problem?

Detailed Answer:
Dear XXXXXXX

I went through your post and reports with diligence. I noted that you are suffering with loose stools associated with bloating and belly discomfort for a week or so. You had multiple investigations over the week. Apparently you have not had loose stool or cramping problems in the past. With this background, I shall answer your individual questions.

1. Well, your complaints are too short to consider chronic condition such as inflammatory bowel disease (IBD) as a possibility. Instead I would think of an acute inflammation as the close probable diagnosis. Moreover the blood parameters, inflammatory markers as well as endoscopic results are not consistent with IBD.

2. The initial marginally elevated fecal calprotectin report suggested an inflammatory process. However just like the marginal bilirubin rise as well as low platelet count, the fecal calprotectin value has also settled down. This goes in lines with acute inflammation and it seems you are in process of recovery.

3. The rest of reports including vitamin b12 and iron values were not significant. Therefore no vitamin b12 or iron deficiency noted.

4. Standard reference range for some specific lab tests varies among laboratories. Therefore the results of individual tests will matter more than your google search result. I will still consider endomysial results as negative in this case.

5. Lightheadedness may or may not be related to your other symptoms. With normal MRI results, atleast serious brain conditions are ruled out. If the lightheadedness is troubling you, you can consider further evaluation in consultation with a physician and ENT surgeon.

In all the summary is, the symptoms seems to be secondary to an acute inflammatory process probably infection. Your reports suggest the progress is towards recovery. In such cases I would treat you with just probiotics and high fibre diet and no specific medications. If the problem persists, you should be referred to a gastroenterologist where the stool test could be repeated.

Hope this answered your questions.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Prasad 7 hours later
so sir although titer is 1:10,as report say negative, I am definitely negative for endomysial antibody test and do not have celiac disease?also sir kindly tell me the meaning of titer 1:10 in the context of endomysial antibody test.
kindly recommend appropriate treatment and any further investigation.

my loose stool improved today.as sir I have normal colonoscopy,small bowel follow through and fecal calprotectin level below 6.25 mg/kg,so I definitely do not have IBD like chrons disease?
I have lost 2.5 kg of weight from april,what is the reason sir for my loss of weight.I have poor sleep and anxiety,worryness.
also sir I have mild intermittent upper mid chest pain over 2 months,normal chest x-ray and pft test,deficient in vitamin d.what is causing this?no cough and no other symptoms.
doctor
Answered by Dr. Prasad 39 minutes later
Brief Answer:
Antibodies cross react....

Detailed Answer:
Hi,

All antibody tests are not absolutely specific and sensitive. Let me explain this in simple terms. Imagine a box with a million differently colored balls. You are given a task to remove all orange color balls with limited time. Since it is an absolutely impossible task, you design a computerized robot that is programmed to differentiate orange shade and pick them up. Now this robot will do the job for you. However since orange shade may resemble yellow and red shade to certain extent, it is definitely possible your robot will pick up some yellow as well as red color balls.

All antibody tests are similar to this programmed robot. Each have some amount of sensitivity and specificity to pick up the true balls, which in this case is the true antibodies. However at times when the lot is huge, they do pick up some falls ones. Hence we consider the test to be true positive only when titres are higher than standard reference range. In this case, the laboratory has assured that the titre range is low and is considered negative. So don't be worried about celiac disease.

I am glad your symptoms are resolving. I expect you to improve very soon. Please add probiotics as discussed earlier. I am confident it is not IBD.

Weight loss is not significant in your case. You need to stop worrying and start good protein rich food.

The chest pain in this context may be secondary to acid reflux. I am not considering any other possibilities here since you have a very typical background history. However chest pains are extremely difficult to predict. If you feel the pain troubling a lot, check a physician nearby.

Hope I have answered all your questions.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Prasad

General & Family Physician

Practicing since :2005

Answered : 3355 Questions

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