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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
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Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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Thank you for looking into my gastroenterology question. I

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Thank you for looking into my gastroenterology question.
I am a 31 year old female from Canada. I have seen my family physician and yesterday a gastroenterologist for a change in bowel habits that started 6 months ago.
The present complaints started acutely after having been out for dinner with my husband. I was woken up at night by nausea and stomach pain. I had an episode of watery diarrhea, no blood. A couple of days of acute diarrhea followed, with 2-4 bowel movements per day. Afterwards the symptoms improved but a few weeks later I realized that my bowel movements were not as they had been in the past: they continued to be loose.
In the couple of months that followed I realized that on top of the loose bowel movements I am also passing a lot of gas, this often being the first thing that happens when I sit on the toilet. There is bloating, some days more than on others. I also have some lower abdominal pain, again, of variable intensity. Sometimes there are also sharp pains, often accompanied by an urgency to go to the washroom. The pain is often either relieved or improved my having a bowel movement.
Currently, 6 months after the onset of these symptoms I continue to have looser stools, with variable abdominal pain, flatulence and bloating. The stools are sometimes well formed, but still not as thick as they used to be, and sometimes looser. On most days I have 1 or 2 bowel movements.
That would be the history.
I have seen my family doctor in July, after 3 months of symptoms.
He performed routine blood work as well as a Stool culture + Ova and Parasites. Everything came back negative, blood work normal.
We decided to book an appointment with a gastroenterologist, as I said I would feel best to have a colonoscopy done as well.
I saw the gastroenterologist yesterday, but it was a very short encounter. I think we spent about 7-8 minutes together.
I described the above history. She asked whether I have a family history of GI problems. My grandfather was diagnosed with Crohn's disease when he was in his 80s. There is some ambiguity about my grandmother. She had very advanced Alzheimer's disease when she had an episode of urinary retention, and it was seen on ultrasound that she has a lower abdominal tumor, but it was not established whether it was coming from the bladder or colon. Further tests were not done as she passed away a few days later.
The gastroenterologist just said that it is worth looking into the matter further and that we should book both an EGD and a colonoscopy.
I have 2 very important exams in November and I wasn't sure whether I shouldn't wait until after my exams to have further investigations done. I have been studying for them since January and a lot is at stake. I wouldn't want anything to interfere with my final stretch of studying, but then again good health would come first. I wanted to know how urgent it would be to investigate the matter further and therefore asked the doctor what she thinks of my condition.
She just said that it's hard to say.
I decided to proceed with the endoscopies as soon as possible then, and I am having both done in a little over a week.
I just wanted to ask another opinion until then though, as I see I can't concentrate at all on my studies yesterday and today, and if it's nothing that will keep me from going to my first exam in 5 weeks, 1 week of studying is extremely important.
I am the first person who wanted a colonoscopy done, because functional diseases are a diagnosis of exclusion, and one must rule out other more serious diseases.
Still, I was hoping the gastroenterologist would share her thoughts a little, as to her primary diagnosis and the main differentials. I found it unsettling that it was so hard to say what the most likely diagnosis is.
I guess this is why I'm here.
I am perfectly aware there is no way of knowing for sure, and I guess she did not want to waste time hypothesizing what it could be, when she will have a look and know for sure soon.
Still, I would appreciate your thoughts. Sorry for the lengthy message.
Thank you,
Thank you for using JustAnswer.

The problem in this situation is that if you ask what is the most likely cause of these symptoms, a functional bowel problem, such as irritable bowel syndrome (IBS) is vastly the most likely cause. The prevalence of IBS in various studies is about 10-20% of people, as compared to inflammatory bowel diseases, with a prevalence well <1%. But, as you have noted, a functional bowel problem is a diagnosis of exclusion.

There are many other possible causes, including the inflammatory bowel diseases (Crohn disease and ulcerative colitis), parasitic infections (such a Giardia), bacterial overgrowth, and food intolerances, such as to gluten, lactose, fructose, or artificial sweeteners.

So, the issue is not whether it is important to quickly diagnose the most likely cause of these symptoms (it isn't), the issue is whether it is important to quickly diagnose the more serious of the potential causes of symptoms (the inflammatory bowel diseases), and it would generally be better to diagnose inflammatory bowel diseases sooner.

From the perspective of studying for your exams, the level of interference from simply having the tests done is relatively minor - the prep and then the day of the procedure and then returning to normal activity the following day. If a more serious condition is found, then there may be other interference, but this would be in the people in whom it would be most important to make a quick diagnosis.

If you have any further questions, please let me know.
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