Back from the GI Dr

mle_ii · Post by **mle_ii** » Tue Aug 14, 2007 2:37 pm

Here's another followup. Dr officially said no Fructose Malabsorption. Yeah! I've been eating apples the past week. Something I really missed eating.

Just got my Lactose Intollerance test today. So far it looks like I don't have that either, or at least anymore. Waiting for the official news from the Dr, but the test results are about the same as the last Fructose test.

Basically showed no spike in gas production, though it did show a baseline of methane. Methane might explain the past week of being a bit constipated here and there.

Next week is the big test, colonoscopy and endoscopy. I didn't eat gluten as suggested by my GI Dr. Too scared to ruin my better health.

More and more I'm leaning towards me having Bacterial Overgrowth for some time. Though who really knows the underlying cause.

Mike

mle_ii · Post by **mle_ii** » Tue Aug 21, 2007 9:57 am

Got back the results of my physical and blood tests. The only 2 things that seemed out of the ordinary for me were that my ALT levels were high out of range (this is a liver function test) and my Uric Acid levels were low (haven't looked much into this test).

EDIT It wasn't my Uric Acid levels that were low it was Specific Gravity. SP GRAV-UA (POC) 1.015 Range 1.016-1.022.

And today's the day for my Colonoscopy and Endoscopy. Boy is the prepwork fun. NOT! Have to take another bit of the nasty stuff today and then I go in at 3.

Post by **tex** » Tue Aug 21, 2007 12:45 pm

Mike,

Normally, low uric acid levels are not a cause for concern, but it may be connected with the high ALT level, if there is something going on with your liver function. Your doc can probably explain why those two readings came in the way they did.

Good luck with those "scopy" exams. The best part of them is being done with 'em.

Tex

mle_ii · Post by **mle_ii** » Tue Aug 21, 2007 1:31 pm

tex wrote:Mike,

Normally, low uric acid levels are not a cause for concern, but it may be connected with the high ALT level, if there is something going on with your liver function. Your doc can probably explain why those two readings came in the way they did.

Good luck with those "scopy" exams. The best part of them is being done with 'em.

Tex

Actually the low Uric Acid level was a mistake it was low Specfic Gravity instead. Helps to post info when I have the info right in front of me.

Yeah being done with them will be good. About 3 more hours.

mle_ii · Post by **mle_ii** » Tue Aug 21, 2007 7:23 pm

Still a little loopy from the drugs, but he said everything looks good thus far. Took biopsies but will take 5 business days until there are results.

mle_ii · Post by **mle_ii** » Tue Aug 28, 2007 2:08 pm

I'm starting to think it's coming back for me, last two days have been back to the same problems I had before I got treated. Long, small stool, and having to go again after having just gone. :( Seems that the symptom was treated and not the cause.

Still no results from the biopsies, I'll call today or tomorrow.

I'm also concerned about the elevated ALT results. I looked back and I see a slow but steady increase and then a jump in this last one.

Date ALT (SGPT) U/L
2/1995 14
2/2004 22
7/2005 24
8/2006 26
3/2007 33
7/2007 56

Normal range is 5-50 U/L.

AST is still within range but going up as well.

Post by **tex** » Tue Aug 28, 2007 8:03 pm

Well, as I'm sure you know, ALT and AST levels are of most value as indicators of a trend, and the ALT history you listed, definitely indicates a trend in an undesirable direction. The numbers have begun to climb at an accelerated rate, in the last few months, so something is definitely going on. Surely your doctor has an opinon about this, and some further tests in mind.

Tex

mle_ii · Post by **mle_ii** » Wed Aug 29, 2007 11:32 am

My GP didn't (which I find very strange) I'll have to talk with my GI dr about this or nag my GP after I show him the little graph I made. Doesn't look good to me. But perhaps in the context of other things it was still normal, though he never explained it to me. It could have also been the antibiotic I was taking for the latest one, supposedly erithromycin (sp) can effect ALT numbers, though I wasn't taking much of it.

What's strange is that some of the other liver labs don't really show much change, though perhaps I should go and look again just in case. Like billirubin didn't seem to go up, at least not any more than in the past. But I have had the feeling that somehow this is all related to what's wrong with me. I've found the connection between Vitamin D, Bile, Cholesterol, Probiotics, Glucocorticoids to be pretty convincing that something is amiss here. Given that my Vitamin B and glutathione levels were low in that one test and that the liver is the storage place for this among other things it has me wondering. And given that folks here have had gallbladder and other Liver associated issues it has me wondering even more.

Date Bilirubin Total mg/dL range 0.1-1.5
2/1995 0.7
6/1999 1.0
2/2004 0.8
7/2005 1.2
8/2006 0.8
3/2007 0.7
7/2007 1.1

Though I did notice Lymphocytes to be near the top of the normal range in the latest lab work.

Mike

Post by **tex** » Wed Aug 29, 2007 9:23 pm

Hmmmmmm.

A vitamin B deficiency tends to decrease the AST result, so that may have contributed to artificially keeping the AST reading lower than it might otherwise have been.

Tex

mle_ii · Post by **mle_ii** » Thu Aug 30, 2007 9:08 pm

Well, got the results from the Colon, Illeum and Douadnum (I know I mangled the spellings) biopsies and all were Normal. Ok, now what. *sigh* I suppose I'll have to set up another appt with the GI dr.

mle_ii · Post by **mle_ii** » Fri Aug 31, 2007 11:34 am

Well, I guess it didn't really sink in, but based on those biopsy results I guess that means I no longer have MC/LC.

What's strange is that based on the BMs I'm having I'm guessing I must be having some inflamation as the stools are flat and not round in shape and not very well formed. I'm getting more gas now too.

Post by **tex** » Fri Aug 31, 2007 12:05 pm

Well, actually, your MC is not necessarily gone, (cured), but it is apparently in remission, which is certainly good news.

The ribbon-shaped stools, may be due to constipation. That would also explain the sensation of feeling the urge to "go again", soon after a BM. Are you still taking the caltrate, (or am I confused here)? If so, a dosage reduction might help.

Of course, misshapen stools are often linked with cancer, but after a thorough colonoscopy, that should be ruled out. If I recall correctly, pencil-like, or ribbon-shaped stools are also associated with IBS, aren't they? I could be mistaken - I didn't have time to look that up to verify it.

Tex

mle_ii · Post by **mle_ii** » Wed Sep 05, 2007 12:45 pm

Sorry for not answering sooner Tex.

I'm not taking caltrate.

Not sure about the pencil like or ribbon shaped stools being associated with IBS, I'll have to see what I find as I haven't read anything about that before.

mle_ii · Post by **mle_ii** » Wed Sep 05, 2007 12:49 pm

Oh and here's an update, the GI Drs nurse called me after talking to the Dr. I'm going on a 14 day does of Rifaximin and Neomycin combined and I think the Rifaximin is doubled from last time. I know that Dr Pimentel recently changed what he's recommended for methane producers, or at least that's what my Dr says. And given there's a new article out by Dr Pimentel on Pubmed (that I can't seem to get a copy of) on just this topic I'm guessing he did. I'd really like to read that article if anyone has a copy.

And this is all just in time as the last three days my symptoms have been even worse. Going towards diarrhea, floating, smelly and even more gas. Fun fun fun... NOT!!! LOL

Leaving to go pick up the antibiotics now...

Thanks,
Mike

harvest_table · Post by **harvest_table** » Thu Sep 06, 2007 7:28 am

Is this the study your looking for Mike? Perhaps a more recent one....

Efficacy of Rifaximin vs Placebo in Reducing Symptoms in Adults With IBS

David A. Johnson, MD, FACG, FACP

The Effect of a Nonabsorbed Oral Antibiotic (Rifaximin) on the Symptoms of the Irritable Bowel Syndrome: A Randomized Trial
Pimentel M, Park S, Mirocha J, Kane SV, Kong Y

Ann Intern Med. 2006;145:557-563

Summary
Irritable bowel syndrome (IBS) is a prevalent condition that has been labeled as a "functional bowel disorder." By this delineation, its cause has been thought to be indefinable. The primary symptoms of this disorder include constipation, diarrhea, abdominal bloating, and cramping. Recent attention has focused on a potential infectious component of IBS.

In this study, Pimental and colleagues investigated the use of rifaximin in patients diagnosed with IBS as defined by the Rome I criteria. Rifaximin is a nonabsorbable, gut-selective antibiotic derived from the rifamycin family that may reduce bacterial overgrowth due to its broad-spectrum activity in vitro against gram-positive, gram-negative, aerobic, anaerobic, and microaerophilic bacteria.

This was a prospective, double-blind randomized controlled trial that involved 43 patients who received 400 mg of rifaximin 3-times daily and 44 who received placebo for 10 days. Patient symptom and stool diaries were completed prior to entry, during the study, and the week following treatment.

Global improvement was found to vary widely across weeks for most patients, and the data were reported as an averaging of the symptoms over all 10 weeks of the study. This percentage was significant as a function of group (P = .020), but not as a function of week (P = .78) or group-by-week (P = .96). The patients in the rifaximin group had a 36.4% improvement in global symptoms compared with 21.0% for the placebo group.

The rifaximin group also reported significantly less bloating on a visual analog scale compared with the placebo group (P = .010), a difference that persisted after controlling for differences between groups in baseline pain scores (P = .001). Besides bloating, none of the secondary endpoints improved with treatment compared with placebo on the visual analog scale: abdominal pain (P = .32), diarrhea (P = .67), and constipation (P = .069).

Viewpoint
Rifaximin is currently US Food and Drug Administration-approved for the treatment of traveler's diarrhea, although these study findings suggest a more expanded potential role for this antibiotic. However, before recommending widespread globalized use of this medication for all patients with IBS, healthcare providers should be aware of several limitations of this study. First, although this was a "multicenter study," there was a considerable imbalance between enrollment from the 2 study sites (83 participants vs 3 participants). Second, because the global measure includes pain, it is important to note that there was an imbalance in baseline pain scores between the 2 patient groups at entry. The imbalance (higher baseline pain scores in the rifaximin group) potentially favors the reduction in the global scores. Additionally, this primary outcome measure is unique in the spectrum of the recent treatment intervention evaluations for IBS trials, and therefore makes comparisons with other trials somewhat difficult. Third, the study authors relied solely on the use of the lactose breath test to define small bowel bacterial overgrowth. Future tests in this area should evaluate the use of other breath tests to define bacterial overgrowth in the small intestine. Fourth, the data suggest that rifaximin may be of more help in the subset of patients with bloating. In IBS, abdominal bloating is reported in more than 50% of patients, and a recent study suggests that changes in abdominal girth can reach 12 cm in more than 50% of patients.[1]

Clearly, this study highlights a new concept in the potential pathogenesis of IBS. An infectious cause may offer a tremendous opportunity to manage an otherwise somewhat frustrating disease -- both for patients and their treating physicians.

Abstract

References
Houghton LA, Lea R, Agrawal A, Reilly B, Whorwell PJ. Relationship of abdominal bloating to distention in irritable bowel syndrome and effect of bowel habit. Gastroenterology. 2006;131:1003-1010.

David A. Johnson, MD, FACG, FACP, Professor of Medicine, Chief of Gastroenterology, Eastern Virginia School of Medicine, Norfolk, Virginia

David A. Johnson, MD, FACG, FACP, has disclosed that he has received grants for clinical research from AstraZeneca, TAP, Wyeth, Novartis, and Abbott, and grants for educational activities from AstraZeneca and Novartis. Dr. Johnson has also disclosed that he has served as an advisor or consultant to AstraZeneca, TAP, and Novartis.

Medscape Gastroenterology. 2006;8(2) ©2006 Medscape

http://www.medscape.com/viewarticle/547055?src=mp

Best of luck with the new medications. Hang in there!

Love,
Joanna