Regarding diagnosis of digestive disorder

Digestive health
1

I am 27 years old male.

I have been suffering from digestion related issues since last 3 years.

Some key points that I would like to mention about my daily routine:

1.         I work on laptop from my home (highly inactive lifestyle).

2.         Have to take rest (sleep) 2-3 times in daytime as I feel tired, sluggish & lethargic till the sun sets. I feel quite fresh, active & energetic in evening & night.

I consulted with 3 doctors (Allopathic, Homeopathic & Ayurvedic) regarding the issue & all of them told me that it is IBS. But I suspect that it isn’t IBS & might be something more serious.

            So, I researched about digestive disorders/diseases, went through their symptoms & made a list of symptoms that I have, I don’t have & I have no idea about. One thing I have observed that most of these symptoms are short lived. They appear for few days or weeks, then disappear & some other symptoms appear in their place.

There are almost 50 digestive diseases/disorders, all have nearly same symptoms & I think that accurate diagnosis is must in order to get right treatment & that’s why I have made a detailed list of symptoms.

 

I HAVE FOLLOWING SYMPTOMS:

 

1.Usually I have to go to the loo 3-4 times in the morning. Mostly I don’t feel need to defecate after morning but sometimes have to go in afternoon, evening or night as well.

 

Stool types & consistency:-

 

First time in the morning:

The faeces are sausage shaped, smooth & soft. Mostly brownish-yellow in color. Since I drink lukewarm water before going to the loo, some mushy stool also appears.

 

Second time in the morning:

Mostly loose motions. Sometimes stools have some form & are not too loose but sometimes it is watery.

 

Third time in the morning:

Usually I have to sit for long as I don’t get pressure to empty the bowels. Sometimes I have to put pressure to get the stools passed or defecation happens on its own after sitting for long time. This time usually defecation happens in the form of blobs & sometimes mucus or candida (some white stuff) appears with stools. Sometimes when I feel that I have passed stools & when I look into the bowl only mucus appears over there.

 

After meal or in evening:

Brown colored sticky stools which doesn’t float on water

2          Feeling of incomplete evacuation after defecating in the morning. (Usually I have to go to the loo 2-3 times in the morning to get the bowels completely emptied. But sometimes even after passing stools for 3-4 times, I just can’t clear the bowels completely)

3          Difficult & painful bowel movements (sometimes I have to sit for long to empty the bowels & sometimes even after sitting for long time if I am unable to pass stools, I have to put pressure to empty the bowels forcefully & this causes pain while passing stools. This happens usually 3rd or 4th time I go to the loo in the morning)

4          Change in frequency (ranging from 2-7 times a day) & consistency (sometimes a little bit watery stools, sometimes solid etc.) of bowel movements

5          Sometimes stools are narrow (not pencil width though)

6          Bright red blood in the stools (sometimes; it is occult  or hidden blood sometimes)

7      Fat in stools (Sometimes I get to see faeces floating on water. Sometimes they seem to be greasy & sometimes drops of oil also are seen in the water inside the bowl. Though the faeces aren’t that pale or foul smelling.)

8          Some symptoms are alleviated by defecation

9          Dark urine (rarely). Its usually white when I drink enough of water

10        Abdominal pain (I feel some mild pain very rarely in the upper left abdomen at the place of spleen, usually for few seconds.

Had extremely severe abdominal pain one morning a few months back where I had eaten more than my capacity last night. I feel it happened because of trapped gas.)

11        Abdominal swelling/bloating (only if the bowels don’t get emptied completely.

A few months back used to suffer from bloating after sunset without eating anything or even after drinking small amounts of water. It doesn’t appear anymore.)

12        Used to feel full even after eating a fruit or drinking a glass of water at evening, a few months back. The situation has improved much now. But still at night I feel full earlier than I should be.

13        Sometimes I feel my abdomen to be stiff (not sensitive at all) on the left side of lower abdomen. I think this is what is called as abdominal rigidity or abdominal guarding

14        Growling stomach (very rarely; mostly at afternoon after lunch)

15        Very mild burning in stomach (very rarely)

16        Belching (used to belch a lot a few days back, now since I have reduced my meals, the situation has come under control, I belch but not that much)

17        Wind/gas. (Used to pass a lot of gas for a period of few days, a few weeks back. Now the situation has become normal.)

18        Mild pain in the rectum while passing gas (very rarely)

19        Poor appetite (might be because of my inactive lifestyle & sometimes incomplete evacuation)

20        Enlarged spleen (I feel so because of some symptoms)

21        Fatigue, Sluggishness & Lethargy (I don’t feel the same though when I am outing or at a function etc.). I feel completely fresh only when I take a lot of rest, say 4-5 hours in daytime.

22        I feel hungry & the food consumed gets digested properly when I am travelling or am outdoors. Inactive lifestyle worsens the symptoms.

23        Weight loss (I have lost weight but I think it is because I have reduced my diet.)

24        Presence of excess saliva or some bitter liquid in mouth (this might be acid reflux), usually at daytime (I think that is what causes bad breath)

25        Heartburn or acidity (only when sometimes I get up at mid night at around 2-3 AM)

26        Regurgitation of food (very rarely)

27        Headaches (very rarely; usually when I am not able to empty the bowels completely)

28        Joint pain (very rarely get pain in the wrist. I feel it happens because of trapped gas.

Used to have feeling of uneasiness in the ankle joints for a long period, don’t have any more.)

29        Neck & back pain (rarely; I feel it happens because of trapped gas)

30        Cramping (had experienced only for a period of a couple of days, a few weeks back & that too I felt was happening because of trapped gas in scrotum or area between anus & scrotum. I used to feel pain in the scrotum & it was little difficult for me to sit)

31        Mouth sores (mild)

32        Mild chills (sometimes)

33        Low-grade fever (very rarely)

34        Mimicking heart attack (had a couple of attacks like this which were not that severe. Might have happened because of gas)

35        Itchy, red hives on skin (occur rarely; it seems like they occur because of biting from insects.)

36        Lactose intolerance (experience symptoms sometimes after consuming milk based products)

37        Stress & worries to some extent

38        Stress causes aggravation of symptoms

39        Sensitivity to light and sound (to some extent)

 

I “DON’T” HAVE FOLLOWING SYMPTOMS:

 

1          Clay colored or tarry stools

2          Bloody diarrhoea

3          Bleeding during or after bowel movements 

4          Pus drainage near the anal opening

5          Urgent need to defecate

6          Itchiness in the anal area

7          Discomfort while sitting

8          Rectal spasm

9          Pain or discomfort near the anus or buttocks

10        Feeling a bulge after coughing, sneezing or lifting

11        Feeling pressure in the rectum

12        Rectal fullness

13        Rectal prolapse

14        Redness, soreness of the skin around the anal opening

15        Rectal tenderness

16        Swelling around anus

17        Lump or painful hardened tissue or mass protruding near the anus

18        Visible tear or cut in the anus area

19        Levator ani syndrome

20        Passing excessive amounts of gas 

(Used to suffer from this a few days back for a period of few days. The condition is normal now.)

21        Trouble passing gas

22        Incontinence

23        Inability to pass wind (Used to suffer from this a few weeks back, where the gas was moving from here & there inside body but wasn’t getting out. Not anymore.)

24        Abdominal tenderness

25        Abdominal cramps

26        Abdominal bleeding

27        Abdominal discomfort

28        Full, round abdomen

29        Increased abdominal size.

30        Lump or protrusion in the abdomen

31        Mass in the belly

32        Changes to the belly button

33        Difficulty belching

34        Less urine than normal

35        Inability to urinate

36        Urinary tract Infections

37        Kidney stones

38        Malaise

39        Swelling on any other body part than abdomen

40        Dizziness

41        Migraine

42        Fainting        

43        Light-headedness

44        Used to get itchy red small boils on hand fingers, every summer a few years back. No more have these symptoms.

45        Vomiting

46        Fever

47        Feeling sick

48        Jaundice

49        Muscle pain (pain used to be there in the lats muscles. But disappeared after getting massage & taking rest.)

50        Fibromyalgia

51        Arthritis

52        Chest or shoulder pain

53        Pelvic pain

54        Lump or protrusion in the groin or scrotum

55        Groin discomfort or pain

56        Pain while coughing, bending or lifting a heavy object

57        Sleep disturbance

58        Night sweats

59        Cough

60        Feeling that something is stuck in your throat or chest

61        Choking during swallowing

62        Pain in the throat or chest during swallowing

63        Coughing during or after the swallow

64        Difficulty swallowing (suffered from little bit difficulty while swallowing for a period of few of days, felt it happened because of swollen tonsils.)

65        Trouble forming food and liquid into a soft ball in the mouth

66        Trouble pushing food or liquid to the back of the mouth

67        Throat irritation

68        Sore throat

69        Throat clearing

70        Hoarseness

71        Nasal regurgitation

72        Runny nose

73        Hiccups

74        Swelling or puffiness of the tissue directly under skin, especially in legs or arms.

75        Bone pain

76        Dehydration

77        Dry mouth, nostrils or skin

78        Not urinating as often

79        Fast heart rate

80        Shortness of breath

81        Difficulty breathing

82        Anorexia

83        Spider-like blood vessels

84        Bruising

85        Pain aggravated or relieved by meals

86        Burning or gnawing feeling similar to hunger pains

87        Red, purple, dark or discolored bulge

88        Stretched skin (but do have some strechmarks on some parts of the body)

89        Shiny skin (Used to be oily at teenage but became normal after taking treatment)

90        Skin that retains a dimple (pits), after being pressed for several seconds.

91        Weight gain

92        Increased salivation

 

I DON'T HAVE IDEA ABOUT FOLLOWING SYMPTOMS:

 

1          Decrease in caliber of stool

2          Osteoporosis (I feel my bones to be weak though & my posture is usually little bit stooped.)

3          Bumps or lumps on bones of legs, arms, skull and jaw

4          Infertility

5          Colitic arthritis, an arthritis that migrates along the body and affects knees, ankles, hips, wrists and elbows

6          Low blood count (anaemia) that makes you feel tired

7          Low blood pressure

8          Pericholangitis, inflammation of the tissues around the bile ducts

9          Malnutrition

10        Severe air swallowing

11        An enlarged bubble of gas in the stomach following heavy meals

12        Water-electrolyte imbalance

13        Teeth changing color or losing their enamel (My teeth always seem to be a little bit yellowish, no matter how properly I brush them.)

I consulted with a doctor & he said that it could be IBS+Anal fissure/Hemorrhoid. He prescribed me a few blood tests like CBC, Vitamin D3 & B12, LFT, Creatinine etc. & Anal manometry. 

So, should I continue with his advise or seek for second opinion?

 

2

The only way to know if there is something wrong is to do diagnostic tests. No matter how extensive your catalog of symptoms is, no one can give you answers.

People can't accept that their GI symptoms are a matter of dysfunction and not structural disease. Though that is often the case.

You can ask for an ultrasound which looks at the abdominal organs and is cheap and easy. You can also do a stool test which is fairly easy.

If you truly feel you need it you can insist on endoscopy which will rule out virtually everything.

3

You just need to go see a doctor as this seems to go on and on to much to comprehend..To much in one article

4

It sounds exactly like IBS. I think you may be over analyzing your symptoms. Work with your doctor and try a diet for IBS. Maybe try some acid reflux medicine. If you’re still worried, get an endoscopy and colonoscopy to rule any other problems out. 

5

Thanks for replying buddy smile. I think you are right, diagnostic tests is the only way to get accurate diagnosis. 

BTW as far as I know Ultrasound, MRI & CT scan are all done to get the picture of the organs. So, can you tell me which one will be the most effective in my case?

I have got stool test done. Will get the reports today. Will post it here if something abnormal is there. 

I consulted a doctor online & she suggested me to get colonoscopy done. So, just wanted to know which one will be more helpful; endoscopy or colonoscopy?

One last question I would like to ask is that the gastroenterologist I went to see, suggested to get anal manometry done. So, would that be helpful in any sense?

Thanks in advance.

 

6

Thanks for replying buddy  [smile] . Yes, I have done a lot or research as there are almost 50 digestive disorders with nearly the same symptoms & each time I went to see a doctor, they straightaway claimed it to be IBS. I am not able to understand that if there are 50 digestive disorders with nearly same symptoms then how can these doctors claim it to be IBS with asking just a couple of questions. That's why I decided to do my own research as I wanted accurate diagnosis.

As  adam21393 & you have suggested, I think diagnostic tests is the only way to get accurate diagnosis. 

BTW can you tell me that out of endoscopy & colonoscopy which one would be more helpful in my case?

Thanks in advance.

7

Sounds very like IBS.  Stop googling your symptoms because this will stress and confuse you more. See your doctor again and ask if you need more tests.  A doctor’s diagnosis will help you much more.  If all your tests are negative, you will be lkely diagnosed with IBS.   If your doctor confirms IBS, accept and trust what you are told.

8

Thanks for your suggestion smile. The reason behind my googling too much is that in India, the doctors are not ready to spend much time with patient, ask a couple of questions & come to the conclusion of the disease (to be frank, most of them are there to business only). This has happened with me several times before. That's why I decided to take things in my hands. But after searching a lot & by the help of people like you, I came to know that its impossible to make accurate diagnosis with the help of symptoms. I have got done a few tests & am going to do a few. Mentioning all those in below post.

9

Hi guys! I have got following tests done:

CBC, LFT, Creatinine, Vitamin B12 & D3, TSH, Fasting glucose & stool r/m

There is a deficiency in Vitamin B12 & insufficiency in D3.

The stool r/m shows presence of mucus, occult blood & RBC (1-2). Though it shows absence of blood (non-occult) & fat, I have observed blood to be there & feces floating in the bowl several times.

The Gastroenterologist I consulted with, has prescribed anal manometry to get done but I am going to request him to prescribe colonoscopy first.

I will get the colonoscopy done & come back here with reports.

Thanks to all for your help. 

10

In the UK, doctors don’t spend much time with you either; 10-15 minutes if you go to an NHS doctor.  If you go private, they will spend more time with you because they are charging a fee for seeing you.  Hope you can get an accurate diagnosis after your tests.

11

Hi guys!

I got Colonoscopy done yesterday. Below are the verbatim findings & impression of the report:

Findings - "There were presence of multiple patchy areas of ulceration seen in the colonic mucosa from rectum to hepatic flexure. The ulcers size ranged from 3 to 7 mm with surrounding erythema. The ascending colon, caecum, IC valve and 10 cm of the terminal ileum were normal.

Impression - Infective colitis.

The doctor also did biopsy & sent the sample to histopathology department for further analysis. Will get the reports in 4-5 working days. Once I get it, will update.

Would like to know your opinion on the impression of the report as I don't think that it is infectious colitis because the symptoms just don't match to the symptoms I have.

12

Hi Aryan,

I am going through something similar to you and I really appreciate you updating this thread, I will be following it. I have yet to get a colonoscopy but it's on the horizon I think. Were you awake for it? And if so, how long did it last?

13

Thanks for your appreciation buddy! surprised

"Were you awake for it? And if so, how long did it last?" - Can you please elaborate on exactly what you are talking about? 

BTW I have done thorough research on this topic. So, if you need any help you can get in touch with me. Would be happy to help you.

14

The various ailments of the gastrointestinal (GI) tract affect food digestion and absorption. Diagnosing them is critical to effective treatment and prevention of complications. Here are 11 diagnostic tests that help diagnose various GI disorders.

1. Clinical examination

The symptoms present and a physical examination may help diagnose a few GI disorders like diarrhoea, constipation, acidity, etc. For diseases like haemorrhoids, physical rectal examination may be done wherein the doctor inserts a gloved finger into the rectum to feel for abnormalities.

2. Blood test 

Blood tests like blood count, liver function test, lactose tolerance test, antibodies to H. pylori, pancreatic enzyme test, etc. can help diagnose certain GI conditions like bacterial or parasitic infection, celiac disease, lactose intolerance, exact cause of diarrhoea, etc. They may also be recommended to rule out other serious diseases. The laboratory tests to determine liver efficiency include CBC (complete blood count), liver function tests (SGOT, bilirubin, alkaline phosphatise, etc.), blood albumin and prothrombin time.

3. Stool analysis

Stool analysis can help assess the overall health of GIT. It helps analyse digestion, absorption, microbial balance, etc.

This gastrointestinal test profile may be advised in conditions like indigestion, constipation, diarrhoea, IBS, malabsorption, infection, etc.

For the analysis, a stool sample collected in a clean container is sent to the laboratory for microscopic examination and other tests.

Changes in colour, consistency and pH, and the presence of mucus, blood, white blood cells, bile, fat, sugars, etc. help diagnose GI conditions. A stool culture can help diagnose bacterial infection. Increased fat levels in the stool may be seen in celiac disease, pancreatitis, etc. High pH of the stool could indicate inflammation, cancer, etc. Some enzyme immunoassays are used to detect viral and bacterial antigen in stool sample.

4. Renal function test

Gadolinium containing contrast agents, most commonly used in MRI and CT scans, are avoided in patients with reduced kidney function or kidney failure. Hence, kidney function tests are done prior to MRI or CT scans of GIT.

5. Endoscopy

Long-standing acidity, heartburn, unexplained weight loss and changes in bowel pattern may need a detailed investigation of the intestine. Endoscopy is a non-surgical procedure that involves examination of the stomach or digestive tract with the help of an instrument called endoscope. Biopsies (small tissue sample) may also be taken during endoscopy to be examined under microscope. They can help detect presence of cancerous cells.

During colonoscopy, a tube is inserted through the anus to visualise the colon. It aids in detection for areas of inflammation or small ulcers in the colon. Proctoscopy can help visualise the rectum.

In case of a tumour in the intestine, an ultrasound followed by endoscopy, imaging, scans, etc. of the upper intestine is done to study the nature of the growth. An endoscopy ultrasound (EUS) can help make an accurate diagnosis without having the need to undergo several tests.

In endoscopic retrograde cholangiopancreatography (ERCP), the inside of the stomach and duodenum is seen through an endoscope, and radiographic contrast which can be seen on X-rays is injected into the ducts and pancreas. The test helps confirm gall stones.

In video capsule endoscopy, a swallowed capsule containing a tiny video camera travels through the small intestine and sends video images of the lining of the small intestine that are downloaded and studied on a computer. This test is superior in identifying the early stages of Crohn’s disease.

Narrow band imaging is a novel endoscopic technique which can be incorporated during gastroscopy especially if there is a lesion suspected to be malignant or pre-malignant. It uses special filters and magnifying methods to diagnose early cancerous or pre-cancerous lesions.

6. Abdominal ultrasound, CT scan and MRI

An ultrasound is a diagnostic medical procedure that uses high frequency sound waves to produce dynamic (or real-time) images of internal organs, tissue and blood vessels. Abdominal ultrasound is used to examine organs and their blood vessels in the abdomen like liver, pancreas, gallbladder, etc.

Computerized topography (CT) scan is a computerised X-ray technique that combines a large number of X-ray images taken in succession. These images then result in a cross sectional view of the internal organs which helps analyse the internal structures of the body. It can be used to examine the GIT for diagnosing traumatic injuries, tumours or an infection.

In magnetic resonance imaging (MRI), a beam of radio waves and magnetic fields is sent through the body to detect a defect in the organ of interest. It gives an accurate image of the organ and structures within, thus helping in getting a clear idea of cancerous cells and the extent of the growth.

7. Barium X-ray

In barium X-ray, a chalky liquid called barium is used which is visible on an X-ray. When ingested, the barium can help view the stomach and the small intestines on an X-ray. When administered rectally as enema, the colon and terminal ileum can be viewed on X-ray. This test helps diagnose gut narrowing, fistulae, ulcerations, etc.

8. Manometry

Manometry uses a device called a manometer to measure muscle pressure and movement. Oesophageal manometry measures the symmetrical contraction and relaxation (peristalsis) of oesophagus and relaxation of lower oesophagal sphincter in the evaluation of achalasia. The lack of oesophagal peristalsis and failure of the LES to relax during swallowing is disclosed during this test. Anorectal manometry is used to measure contractility of the anal sphincter to evaluate anal incompetence and faecal incontinence.

9. pH Monitoring

Esophageal pH monitoring measures the amount of stomach acid that enters the oesophagus during a 24-hour period. It is used to diagnose GERD. It also helps determine the effectiveness of the prescribed medications. During the test, a thin tube with a sensor is passed through the nose and positioned in the oesophagus just above the lower oesophageal sphincter that is present at the junction of the oesophagus and stomach. The acid level in the oesophagus is recorded on a monitor. The data gathered in 24 hours is downloaded into a computer and analysed. A wireless capsule that is placed using an endoscope may be used instead of the tube. It sends recordings through wireless transmission.

10. Breath Test

The hydrogen breath test measures hydrogen in the breath to diagnose GI conditions like lactose intolerance, etc. When ingested sugars are not completely absorbed by the small intestine, bacteria within the colon produce hydrogen gas. Bacterial overgrowth in the small intestine can also produce large amounts of hydrogen. Hydrogen gas absorbed into the blood travels to the lungs. The test analyses the breath at regular intervals to detect this hydrogen gas that is breathed out. The patient will be asked to breath before drinking milk and then samples are taken after fixed intervals to determine hydrogen levels in your breath. If you are lactose intolerant, breath levels of hydrogen will be high as compared to normal levels.

Urea breath test helps diagnose peptic ulcer. The test looks for presence of Helicobacter pylori bacteria in the stomach. Normally, the body produces urea from excess nitrogen-containing chemicals and eliminates it in the urine. H. pylori bacteria breaks down urea into ammonia and carbon dioxide. Carbon dioxide thus produced is absorbed from the stomach and exhaled. During the urea breath test a urea tablet containing radioactive carbon is swallowed. Presence of radioactive carbon dioxide in the exhaled air indicates the presence of H. pylori bacteria.

11. Transient Elastography

Diseased livers are stiffer than healthy ones. Transient elastography is a non-invasive test that records the elastic properties of liver and helps quantify liver fibrosis. During the test, a small transducer passes 50-MHz wave into the liver through a probe. The velocity of the shear wave (in meters/second) as it passes through the liver is measured. The measurement is then converted into liver stiffness (in kilopascals).

15

I would accept what your colonoscopy report says and believe and trust your docror.  Google gives very general information that idoesn’t always match the individual because symptoms vary from person to person.

16

Thanks for the reply. smile I think I also should do the same. 

17

Good luck.

18

Thanks for such a detailed reply. smile Got to learn a lot from this. 

19

Hi guys! Received the biopsy report a few hours back. Have an appointment with Gastroenterologist after two days. Was eager to get to know what is mentioned in the report. I could not understand the meaning of "GROSS" & "MICROSCOPY" section of the report. If anybody understands it, please comment. Here is the report:

DIAGNOSIS :

Moderate colitis; likely infective origin.

 

CLINICAL DETAILS :

Increased stool frequency with fecal red blood cells.

Colonoscopy - Multiple patchy ulcers from rectum to hepatic flexure.

Impression : Infective colitis.

 

GROSS :

Received multiple grey-white mucosal tissue bits aggregating to 1.0 x 0.7 x 0.2 cm; Colonic ulcer biopsy.

Sections : A to D.

 

MICROSCOPY :

Sections show ulcerated colonic mucosa with presence of neutrophils in the lining epithelium. Lamina propria shows

moderate mixed inflammatory infiltrate consisting of neutrophils, lymphocytes, plasma cells, and a few eosinophils.

There is no cryptitis, crypt abscess or crypt distortion seen. There is no evidence of granulomas or dysplasia seen. No

parasites evident.

20

Hi guys! I consulted with the gastroenterologist yesterday. After reading the report he said that infection is most likely the reason for ulcerations seen in the colonic mucosa. He said that he can't tell how long will it take to get cured. He also thought depression or my too much of thinking might be the reason behind my stomach not getting emptied properly or the reason might be a component of IBS & prescribed me an anti-depressant. He told me to not even think about the issue I am suffering from. He advised me to continue with normal diet and also advised to do some Yoga & exercise. He told me not to have protein powder as well as mass gainer as of now.

I am thinking of taking second opinion. I request you to guide me whether I should continue with his advise or go for second opinion.