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Forum Name: Gastroenterology Topics

Question: quick to diagnose


 LI2Boca - Sun Jan 23, 2005 4:15 pm

My husband has been having difficulty for the last 3 months. Pain is on the lower left side of the stomach. His bowels are fine....he has indigestion and heartburn occassionally and has been losing weight because he is afraid to eat. The doctor immediately said it was IBS. Then took a colonoscopy which was fine. We asked him to take a barrium an the results will be in this week, although I'm sure if anything was found they would have contacted us already.

Everything I've read about IBS says there is usually bowel involvement, which there isn't, and to only diagnose IBS after you rule out everything else. I don't beleive we've done that. Pepsid did not help. Today he was having the pain while sitting, got up and felt better. This pain is not constant and comes and goes throughout the day. The pain often wakes him up at night. It has no relation to what he eats that we can determine.

Please give us your opinion....we are thinking of going to the Cleveland Clinic if he doesn't get some answers.
 Dr. Tamer Fouad - Mon Jan 24, 2005 3:04 am

User avatar Hello LI2Boca,
Has an abdominal ultrasound been done? It would certainly help exclude alot of other causes. If the barium results and colonoscopy are negative then that safely excludes IBS.
I would recommend an abdominal ultrasonography (or even CT, depending on the clinical examination). If you intend to go to the Cleveland Clinic then you there is no reason for delay.
Best regards,
 LI2Boca - Mon Jan 24, 2005 9:09 am

Thanks so much for your reply. Yes a barium was done last week. I haven't gotten the results yet but assume if there was something wrong they would have gotten in touch with us already.

What confuses me, however, is " If the barium results and colonoscopy are negative then that safely excludes IBS". I was under the impression, perhaps wrongly, that if tests show nothing, that the doctor would assume it WAS IBS....that the diagnosis for IBM is strictly that of ruling out everything else.

I wonder if you would clarify this for me.

Thanks so much for your help.
 Dr. Tamer Fouad - Mon Jan 24, 2005 10:18 am

User avatar Yes, absolutely. I apologize for my hasty spelling mistake. I was referring to IBD (inflammatory bowel disease, as in chron's or ulcerative colitis). Inflammatory bowel disease would be one of the things his doctor was trying to exclude with the colonoscopy and barium. IBS (irritable bowel sydrome) on the other hand is indeed a diagnosis of exclusion.
 LI2Boca - Mon Jan 24, 2005 12:57 pm

Thanks for clarifying. I've been researching IBS and came across the Rome II Criteria among other things. My husband shows none of the three features.

HIs pain starts at the mid point between the navel and groin on the left side, and radiates across almost to the hip. He has a sharp pain,sometimes it helps to get up, rather than sit. We can't find any correlation between what he eats and the pain. I've read that there are a number of symtoms that do NOT suggest the diagnosis of IBS which include:
large volume stools, fever, blood in the stool and abdominal pain which awakens one from sleep. (He has had this pain that does wake him from sleep!)

So...............after an endoscopy, colonoscopy and barium, what do you think our next step should be?

Thanks in advance for your generous advice.
 Dr. Tamer Fouad - Mon Jan 24, 2005 5:12 pm

User avatar Dear LI2Boca,
We really should not be thinking about IBS at the moment at all. As we both agreed it should be a diagnosis of exclusion. Only after we have excluded all other causes should we consider the diagnostic criteria. I think an abdominal ultrasonography at the very least should be performed to excluded many other causes of abdominal pain that range from inflammatory conditions to stones to tumors. Keep in mind that symptoms vary from one individual to another and there are atypical presentations for any disease. However, one complaint that does not match the symptoms of IBS is pain waking a patient up at night. Not only that, but it is a serious complaint that indicates a serious cause should be excluded carefully.

So lets go first for an ultrasound or a CT scan if available.
Best regards,
 LI2Boca - Mon Jan 24, 2005 5:20 pm

Thanks so much for your reply.

We have an appointment tomorrow with the Dr. to see the resulsts of the barium.

I will let you know what he says.

thanks again for your advice.

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