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Dr Basu
Dr Basu, Experienced Specialist
Category: Medical
Satisfied Customers: 29244
Experience:  MD
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If you had a patient present with pretty consistent diahrea

Customer Question

If you had a patient present with pretty consistent diahrea (light brown in color, no blood apparent) and heavy, odorous flatulence for about three weeks with no apparent dietary changes outstanding, what would your first diagnostic thoughts be? Also no history of GI issues before. Last medical intervention was 2 months of antibiotocs for a sinus infection 4 months ago.
Thanks!
Submitted: 2 years ago.
Category: Medical
Expert:  Dr Basu replied 2 years ago.
Hi there,
This is Dr Basu, Experienced Specialist.
I am here to address your concerns and provide great service.
C difficile infection is the first thing that comes to mind.
Recent antibiotic use, and persistent chronic diarrhea and flatulence go along with C difficile infection.
This is an opportnusitic infection and occurs with weakened gut immunity.
Please get your stool tested for C difficile toxins.
There can be other possibilities as well.
These symptoms can also be due to the gallbladder problem.
Excess bile acid will cause intestinal irritation.
When the gallbladder is not functioning well, the bile flow to the intestine may increase causing these symptoms.
This will result in bloating, belching and also diarrhea especially after meals.
These symptoms can be treated with a medication called Cholestyramine 4 gram twice daily will meals.
Inflammatory bowel disorders like Crohn's disease, microscopic colitis, eosinophilic gastroenteritis are other possibilities.
This requires colonoscopy to establish the diagnosis.
Malabsorption syndrome is another strong possibility.
Malabsorption syndrome includes the follow possibilities:
1. Excess bacterial overgrowth in the small intestine known as SIBO syndrome.
This is not usually diagnosed by the colonoscopy.
Small intestinal aspirate can be sent for bacterial count.
Carbohydrate breath test ( D xylose) is a simple test to diagnose this condition.
But, the treatment is much easier.
A 14 day course of Rifaximine improves the symptoms dramatically/
2. Lactose intolerance--- regular milk, dairy products.
3.gluten senisitivity or celiac disease--- Wheat based products.
4. Chronic pancreatitis --- deficiency of the digestive enzymes produced by the pancreas.
You should consider following low fermentable sugar diet ( FODMAP diet) to reduce your symptoms.
Please go to this link for detailed information:
http://stanfordhealthcare.org/content/dam/SHC/for-patients-component/programs-services/clinical-nutrition-services/docs/pdf-lowfodmapdiet.pdf
Thank you for sharing your concerns with us today. If you have any additional questions or need further clarifications, please do not hesitate to ask. I am here to answer them. I wish you good health. Regards, ***** *****