September 2013

I aim to provide thorough yet efficient care to individuals with the most intractable conditions and/or complaints. I focus on Irritable Bowel Syndrome and other functional bowel disorders because these are the hardest disorders to treat, often requiring multiple modalities to be successful.

 

September 9, 2013

Q:

My husband has diarrhea from having his gallbladder taken out five years ago. Is there anything he can do so he doesn’t have to take the diarrhea meds?

A:

This sounds like post-cholecystectomy diarrhea, which I addressed in an earlier post. If the medications work, and stopping them causes the diarrhea to recur, then unfortunately he will continue to need to take the medications.

September 9, 2013

Q:

I have days that put me to bed with pain and diarrhea. I was given a list of foods to eat and not eat. It is just not working for me. What should I do?

A:

There are more nerves in the GI tract than in the spinal cord. It constitutes the “3rd nervous system,” after the central nervous system (i.e., brain) and peripheral nervous system (i.e., those in your skin). It is no exaggeration to say that the gut nervous system has a mind of its own. I like to use anti-depressants from the tricyclic class to address the malfunctioning of the gut enteric nervous system. Identifying the correct one can address both of your symptoms.

September 9, 2013

Q:

I am 43 years old, exercise regularly and eat a lot of fiber and Irritable Bowel Syndrome is still a constant problem. Every four or five days I have diarrhea and then my stomach is flat again. I hate to eat afterwards because the bloating and discomfort cycle continues. I have had a colonoscopy because my mother passed away from colorectal cancer three years ago. I had no polyps and doctors said everything was fine. Probiotics helped for a while.

A:

The differential diagnosis of bloating is quite extensive and includes: aerophagia (swallowing air); gastroparesis (poor stomach emptying); dietary intolerance (ranging from lactose to gluten); altered colonic microflora (composition of the bacteria normally residing in the large intestine); small intestinal bacterial overgrowth, which can be due to a variety of diseases such as scleroderma or it could be idiopathic (no identifiable cause); and diverticulosis, just to list a few. To identify the best treatment for you depends on determining the root cause of your bloating. You should make an appointment for follow-up.

September 9, 2013

Q:

Can celiac disease or Irritable Bowel Syndrome develop later in life and is anal itching a symptom? I am a 46-year-old male with constant diarrhea. I was prescribed clindamycin in April 2012 and that’s when my explosive diarrhea began, sometimes 20 or more times per day with a few accidents during sleep. Stool sample tested negative for C-diff. and Flagyl helped a little. I’m trying only gluten-free foods. Depressed.

A:

Both celiac and IBS can develop at any time in life. However, what you are describing makes me wonder if it isn’t C. difficile diarrhea, especially since it developed after taking clindamycin, an antibiotic notorious for causing this to occur. When you say that your stool sample tested negative, it is important to know which test was employed since many tests can provide what are called “false negative” results. The best way to test the stool is with a PCR-based assay. And in rare cases a flexible sigmoidoscopy might be needed to make the diagnosis. You need to go back to your health-care provider.

September 9, 2013

Q:

What are some of the preventive things I could do to limit or stop flare-ups of Irritable Bowel Syndrome?

A:

Since IBS can be due to so many factors the key to treatment and preventing flare-ups depends on identifying the cause of the IBS. That said, a FODMAPs diet can help (listed on a Sept. 5 question), as can peppermint oil, probiotics, fiber and anti-depressants of the tricyclic category. As to the latter, keep in mind that anti-depressants are not being prescribed because you’re depressed but rather to treat the extensive neural network that is present in your gut. And lastly, there is good evidence that cognitive behavioral therapy and hypnosis can also help.

September 9, 2013

Q:

How safe is the lap-band procedure for weight loss? Can it be temporary? How obese do you need to be to qualify?

A:

Bariatric surgery in general is very safe today. Operations like the gastric bypass, sleeve gastrectomy and adjustable gastric band are performed at Loyola through a “less-invasive” approach, or laparoscopic approach. This allows for less pain, faster recovery and fewer overall complications. The most common operation remains the laparoscopic gastric bypass followed by the laparoscopic sleeve gastrectomy. The adjustable gastric band is less commonly performed but remains one of the weight-loss operations we perform at Loyola.

None of the operations should be thought of as temporary. The effects should be lifelong.
Qualifications depend not only on the degree of obesity but also on whether the patient has obesity-related illnesses such as diabetes, heart disease, high blood pressure, etc.) Much of this information is readily available on our website at loyolamedicine.org/bariatrics

September 6, 2013

Q:

What is most effective for stomach gas bloating that defies treatment?

A:

You have linked two issues: gas and bloating. However, they’re not necessarily linked. The differential diagnosis of both is extensive, and effective treatment depends on identifying the root cause. Hence there is no single treatment.

September 6, 2013

Q:

I have been having diarrhea for about two weeks. Every time I eat I always have to use the bathroom about an hour later. My BM would be watery or on some occasions it would look black and sticky. What can be wrong or is there anything serious?

A:

Unfortunately, it’s Impossible to say from the information in your email. But if you are passing black sticky stool that could be digested blood in which case you should seek medical attention immediately.

September 6, 2013

Q:

My son had a Whipple procedure in 2011. He is missing his gallbladder, half of his pancreas, part of his small intestine and part of his stomach (along with a handful of lymph nodes that were malignant). He was 14 months old. He takes enzymes and Prevacid daily. What are the long-term side effects from these medications and is it possible he would ever be able to survive and thrive without them?

A:

It would be useful to know what type of malignancy your son had. I cannot address whether he needs these medications at present since I don’t have enough information to comment. However, there are no long-term consequences to taking pancreatic enzymes. In contrast, data indicate that decades of prolonged use of medications like Prevacid can result in decreased calcium absorption, leading to an increase in hip fractures, decreased vitamin B12 absorption and small intestinal bacterial overgrowth. These medications can also promote the growth of carcinoid tumors. Please keep in mind, though, that these are extremely uncommon problems. And the carcinoid tumors that occur are typically benign. Now to answer your question: Will he possibly be able to get off these medications? Maybe. It depends on whether he has absorption problems off the medications. And that is a question that can only be answered over time, in collaboration with your physician.

September 6, 2013

Q:

Do you have nutritional suggestions for celiac patients who are trying to heal their gut? I’ve been off of gluten for eight years and have been ill since I was a newborn with reactions to gluten and dairy. I had a benign growth removed during a colonoscopy three years ago and my motility has greatly improved overall. I am 50.

A:

The gut in celiac disease is injured by the gluten; hence the only treatment is complete avoidance of gluten. There are no shortcuts.

September 5, 2013

Q:

I would like to know if there’s anything natural that I can take to help with my IBS. I can’t avoid all foods and it’s sometimes hard to tell what will give me a reaction. I am so uncomfortable, feeling so bloated and it affects so much of my life.

A:

Maybe. Keep in mind that Irritable Bowel Syndrome is not due to one process, but is multifactorial. Indeed, it’s not even one disorder, but rather a constellation of diseases that share similar symptoms. Hence the key to treating IBS is a careful history and exam. That said, you shouldn’t have to avoid all foods. Rather you adopt the FODMAPs diet, a diet low in fermentable oligo-, di-, monosaccharides and phenols. Hence, avoid foods:

  • That have more fructose than glucose (apples, pears, watermelon)
  • With fructans (onions, leeks, asparagus, artichokes)
  • That are wheat-based (i.e., gluten contained in bread, cereal, pasta, cake, biscuits)
  • With sorbitol and lactose
  • With raffinose (legumes, lentils, cabbage, Brussels sprouts)

Probiotics have been shown in selected patients to improve the symptoms of IBS, most particularly VSL#3, a combination of live bacteria including Bifidobacterium (B. longum, B. infantis and B. breve); Lactobacillus (L. acidophilus, L. casei, L. delbrueckii ssp. bulgaricus and L. plantarum); and Streptococcus salivarius ssp. thermophilus, available over the counter at health supplement stores.

September 5, 2013

Q:

Why is my excrement almost always in liquid form?

A:

If it is entirely liquid, it is, by definition, diarrhea. The differential diagnosis of diarrhea is enormous, depending on the duration, volume, association with eating, occurrence during sleep, history of surgery (particularly of the pelvic floor), soiling oneself, presence of blood and/or mucus and medications, etc. Without additional information I cannot even hazard a guess. But I certainly would recommend that you seek medical evaluation.

September 5, 2013

Q:

My 16-year-old daughter has diarrhea after every meal she eats. This all started after she had her gallbladder removed two years ago. Is this normal? Her doctor told her to take two anti-diarrheal pills before each meal and she does, but it doesn’t help. We don’t know what the next step should be.

A:

The fact that this started after her gallbladder removal strongly suggests that that is the problem. Post-cholecystectomy diarrhea affects up to a third of individuals after gallbladder removal. For most patients the diarrhea resolves within a few months, but unfortunately it can last years for some. While the cause is not known, it is thought to be due to the effects of bile acids-normally stored in the gallbladder-passing into the intestines in an unregulated manner. The treatment is to slow the diarrhea using agents such as Lomotil, and to bind the bile acids. Bile acid binders include cholestyramine, which is practically unpalatable, and cholestipol, which is expensive. Also, avoid foods that trigger bile secretion, such as fats and milk.

September 1, 2013

Q:

Can you help me with the symptoms of Irritable Bowel Syndrome?

A:

Yes, but it is a complicated condition. For this reason, understand that this could be a long process involving several attempts to identify the root cause of your discomfort.