Question:
Hi there
I am 25. I have had ongoing health issues for over a year and no doctors
I have seen (and there have been many) seem to be interested in helping
me.
For the
entire time I have had loose bowel movements, sometimes diarrhea,
frequent stomach pains, flatulence and nausea- all of which have severely
impacted on my work and personal lives.
I am
always tired and often feel faint.
I also
often get numbness in my hands but that is probably unrelated.
There
were no changes to my diet and it is pretty balanced - I eat plenty
of red meat, I had a gastroscopy in August which came back ok but
I am not sure what exactly was being looked for.
I was
told in February that I had a b12 deficiency (158 pmol/L) which has
been treated with injections, though there does not seem to be a cause
and all three doctors I have discussed it with have done blood tests
for pernicious anemia and then shrugged about it.
I have
also noticed on print outs I have requested that my bilirubin level
has been above the range at 21 and 24 umol/L for the two tests I have
had done on it, though I am not sure if this is significant as none
of the aforementioned doctors said anything about it.
I have
been referred to a different gastroenterologist in February, I am
not sure exactly why or what they will be doing though. I would really
like any suggestions of what it could be or what I can do to feel
better.
Thank you
Anon
Answer:
Dear
Anon,
Irritable
bowel syndrome (IBS) tends to take one of three different types: diarrhea
predominant, constipation predominant and alternating diarrhea and
constipation.
Most
people diagnosed with IBS have diarrhea predominant form.
Trigger
foods are different for every person that has IBS, but red meat is
one of them.
While
red meat is a great source of vitamin B12 and other nutrients, it
is hard to digest.
The diagnosis
of IBS is performed using a diagnostic algorithm. Well-known algorithms
include the Manning Criteria, the obsolete Rome I and II criteria,
the Kruis Criteria, and studies have compared their reliability.The
more recent Rome III Process was published in 2006.
Physicians
may choose to use one of these guidelines, or may simply choose to
rely on their own anecdotal experience with past patients. The algorithm
may include additional tests to guard against mis-diagnosis of other
diseases as IBS. Such "red flag" symptoms may include weight
loss, GI bleeding, anemia, or nocturnal symptoms.
B12 deficiency
can cause anemia.
In the
condition called Gilbert's disease, which occurs in 5% of the population,
there is an isolated increase in bilirubin. The disease does not progress.
There
is a connection between Gilbert's Syndrome and Irritable Bowel Syndrome
most likely due to gastroparesis, which has been found to be connected
with GS.
Gilbert's
disease is a common disorder passed down through families. It affects
the way bilirubin is processed by the liver, and causes jaundice.
Fatigue is the first symptom and Jaundice typically appears during
times of exertion, stress, not eating, and infection.
IBS or
Irritable bowel syndrome can also cause fatigue
Anemia
may cause high bilirubin values.
Fainting
is one symptom of Irritable bowel syndrome in extreme cases.
