Doctors Lounge - Gastroenterology Answers
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Forum Name: Gastroenterology Topics
|Gasman - Fri Jun 18, 2010 3:23 pm||
Thanks so much for a brilliant website.
I would like to have some tests done and am hoping someone can recommend what I should check for.
I have been suffering for about 18 months.
My primary symptoms include:
• Excessive belching, especially after eating. I have taken care not to swallow air and have eaten very slowly. Similarly the belching also starts when my stomach is empty and when I wake in the mornings. It is usually a massive belch and I can feel it coming from really deep down in my gut.
• Flatulence, especially in the mornings after waking.
• Milky taste in mouth, especially in the mornings. I can scrape a white filmy gooey milky coating off my tongue in the mornings. It tastes almost like coffee creamer.
My secondary symptoms:
• Stomach pains, slight discomfort in stomach.
• Very seldom have diarrhoea.
• Dizziness and lack of breathe (this is probably unrelated).
My treatments to date:
The primary symptoms above led me to believe that I had a excessive candida or a bad case of irritable bowel syndrome. I then decided to treat it naturally by going on a very strict diet of no sugar, alcohol, yeast, dairy, wheat, coffee, vinegars, fish etc. I followed the canidida diet to a T.
I started eating very healthy, only allowed grilled and steamed vegetables, green apples and almonds, walnuts and berries etc. I only drink water, no fizzy drinks, no fruit juice, only reverse osmosis water and straight up herbal teas.
I also started doing a lot more exercise.
I have continued this diet for 6 months without fail. Never cheated once! However I still sit with the problem and it feels like its getting worse. I have also tried taking some natural pills that contain good pro-biotic cultures.
Nothing has helped to date. There is no difference at all.
I was wondering if any doctor would be so kind as to help recommend what tests I should go for. Something that could help me confirm what my symptoms are caused by. Also, it would be great if someone could recommend what kind of doctor I should see.
Thanks so much for the valued feedback.
|Dr.M.Aroon kamath - Thu Jul 08, 2010 5:29 am||
Thank you for your very detailed history.
Firstly, for the sake of completion, let me provide some information about candidiasis (which you may be aware of, already).
Candidiasis is the perhaps the most common opportunistic fungal infection. Candida are microscopic yeasts (4 to 6 microns) that reproduce by budding. Even though there are more that 150 species of Candida, no more than ten cause disease in humans with any frequency .
Candida spp. are normal commensals in humans and can be recovered from many sites in normal as well as ill individuals.
Candida spp. can cause infections in both otherwise healthy individuals and in immunocompromized individuals.
Distinguishing between colonization and infection can be a challenge.
Dramatic changes in the epidemiology of infectious diseases has occured in the last two decades on account of
- newer broader spectrum antibiotics,
- Advances in cancer chemotherapy,
- newer immunosuppressive agents,
- organ transplantation,
- parenteral nutrition,and
- advances in surgical techniques.
Candida spp. are thus competing with the bacteria as one of the leading pathogens in nosocomial infections.Of these, almost 100% of cases of oropharyngeal candidiasis and at least 90% of cases of Candida vulvovaginitis are caused by Candida albicans. Non-albicans species of Candida are also encountered with increased frequency.Pathogenecity increases with increasing fungal burden and colonization.
Clinical types of candida infections:
- Asymptomatic candidial colonization,
- Cutaneous cCandidiasis,
- Chronic Mucocutaneous candidiasis,
- Oropharyngeal Candidiasis
- Esophageal candidiasis,
- candidial Onychomycosis,
- candidial Vulvovaginitis
Candida spp. are part of the normal oral flora in 25-50% of healthy individuals(asymptomatic colonization). The most frequent colonizer (70-80%) is Candida albicans, but any of the non-albicans Candida spp. may be seen. Salivary pH, salivary flow, and salivary glucose concentration are some of the factors that modulate the frequency of oral candidal colonization in the general population.
Carriage rates are higher in:
- HIV-infected patients and patients with AIDS,
- Hospitalized patients,
- Denture users
- Neonates and the elderly,
- Neonates and the elderly,and
- Other causes of a immunocompromised state.
Transformation from asymptomatic colonization to symptomatic disease occurs most often in people in the extreme of their lives, in patients with debilitating conditions, immunocompromised individuals and in individuals receiving certain types of drug therapy.
Symptoms of oropharyngeal candidiasis:
include pain in the oral cavity and altered taste perception but
(some pts may be asymptomatic). Retrosternal dysphagia or odynophagia(painful swallowing) suggest esophageal involvement.
Characteristic lesions are white pseudomembranous, painless plaques that are easily scraped off ("thrush") of buccal, pharyngeal or tongue areas, and/or erythematous mucosal patches, or angular cheilitis.On scraping off, they leave an erythematous bleeding surface. White coated tongue without buccal or palatal lesions is less likely to be candidial.
Differential diagnosis: includes oral hairy leukoplakia. Oral HSV and aphthous ulcerations may be mistaken for erythematous mucosal patches of candidiasis.
- Usually made based on clinical appearance. No special tests are usually needed.
- Microscopic examination with potassium hydroxide (KOH) useful for identification of yeast and/or pseudohyphae(not always useful).
- Fungal culturs of mucosal lesions may allow identification of infecting Candida spp. and enables resistance testing. Cultures can not differentiate an infection from colonization.
It appears that you have adopted several truly commendable and immensely useful lifestyle changes based on mere suspicion of oropharyngeal/gastro-intestinal candidiasis. I suggest that you should make a begining by visiting your family doctor who, by simple physical examination will be able to suspect/diagnose oropharyngeal candidiasis.You may discuss with your doctor also about possible referral to a gastroenterologist.
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