Don't know what's going on

I don't know if I am officially dxed as "IBS" but that's how my doc is proceeding.  Typically, over the last several years, I will have a very acute episode of cramping and diarrhea that typically lasts 3-4 hours, then get a respite for a few weeks until it happens again. 

Starting with last Tuesday (coincidentally the morning of my GI appt) I have had cramps and either loose bowels, diarrhea or really gross looking white flecked stools (mucous?) every morning with the sole exception of the day after I downed 2 immodium b/c I had to go somewhere and needed this crap to stop.   It has been like clockwork - about 2 hours after I wake up, it starts until I have anywhere from 1-3 BMs.  I haven't changed anything, and I'm getting ready to start a course of Xifaxan as soon as I can get my butt to the pharmacy. 

There was a question of Crohn's when I was being tested b/c of a Serology blood test, but is this typical of IBS?  It is not typical for me.  I am supposed to see my doc again in October and am supposed to keep track of my symptoms to see how they compare (pre and post-Xifaxan).

Is mucous worrisome at all?  I am pretty positive that's what it is, but I am not going to examine my BMs unless absolutely necessary (i.e. doc's orders. :))

Thanks,

May   

Just that my Prometheus IBD serology came back positive for Crohns. That's all. No ulcers, just inflammation of my stomach (gastritis) and my esophagus but the pathology never showed anything like granulomas, or even microscopic colitis. I had multiple lymphoid nodules in my colon, but he said that's nothing to worry about.

I had slight blood every so often, which is why my GP referred me mainly, but the c-scope saw internal hemorrhoids.

I know bleeding isn't characteristic of IBS. But now that I have known hemis, I'm sure that any future bleeding will be blamed on them.

So since he excluded IBD to the best of his ability (3 different kinds of scopes), he said he wasn't going to dx based on the blood test w/o being able to confirm the dx visually/pathologically. Crohnies are on some pretty wicked meds, so honestly I appreciate it.

I guess it's hard b/c the there is so much overlap b/t IBS and IBD. What are the symptoms that IBSers never have?

Mayok, this "inflammation of my stomach (gastritis) and my esophagus" is not part of IBS.

Did they diagnose you with "stomach (gastritis)"?

It maybe possible I think that certain meds may cause this as well and something to note.

Just fyi also

Clin Chem Lab Med. 2008;46(9):1275-80.

Diagnostic performance of rapid tests for detection of fecal calprotectin and lactoferrin and their ability to discriminate inflammatory from irritable bowel syndrome.
Otten CM, Kok L, Witteman BJ, Baumgarten R, Kampman E, Moons KG, de Wit NJ.

Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.

Erratum in:

Clin Chem Lab Med. 2008;46(12):1798.
Abstract
BACKGROUND: Ruling out somatic bowel disease, such as inflammatory bowel disease (IBD), is an important goal in the management of abdominal complaints. Endoscopy is commonly used but is invasive and expensive. Mucosal inflammation in IBD can be detected through fecal biomarkers, though the present enzyme-linked immunoabsorbent assay (ELISA) tests require laboratory facilities. We validated the diagnostic performance of two new fecal rapid tests (FRTs) for the detection of calprotectin and lactoferrin and assessed their potential to differentiate IBD from irritable bowel syndrome (IBS). METHODS: The calprotectin and lactoferrin FRTs and ELISA tests were performed on the fecal samples of 114 patients referred for endoscopy, 80% of whom had IBS and 20% IBD, and validated against the endoscopic diagnosis. RESULTS: The sensitivity and negative predictive value of the calprotectin FRT were both 100%, whereas they were 78% and 95%, respectively, for the lactoferrin FRT. The specificity and positive predictive value were slightly higher for the lactoferrin FRT. Both FRTs had similar diagnostic accuracy as the corresponding ELISA tests. CONCLUSIONS: The calprotectin and lactoferrin rapid tests are as good as the ELISA tests in detecting colonic inflammation. Given their simple use, FRTs can support the non-invasive exclusion of IBD, notably in primary care.

http://www.ncbi.nlm.nih.gov/pubmed/18597588

Fecal leukocyte proteins in inflammatory bowel disease and irritable bowel syndrome.
Silberer H, Küppers B, Mickisch O, Baniewicz W, Drescher M, Traber L, Kempf A, Schmidt-Gayk H.

University of Heidelberg, Germany.

Abstract
The aim of this prospective study was to compare five different leukocyte proteins in feces of patients with chronic inflammatory bowel disease (IBD), irritable bowel syndrome (IBS) and healthy persons who underwent prophylactic colonoscopy. METHODS: The leukocyte proteins calprotectin, lactoferrin, lysozyme, myeloperoxidase, and PMN-elastase were determined with immunoassays in fecal samples of three consecutive feces (e.g. three days) in 40 healthy persons, 39 patients with chronic IBD (of these 21 with Crohn's disease and 18 with ulcerative colitis), and 40 patients with IBS. RESULTS: ROC curves calculated for healthy persons and patients with IBD yielded the following areas under the curves (AUCs): PMN-elastase 0.916, calprotectin 0.872, myeloperoxidase 0.750, lysozyme 0.726, and lactoferrin 0.693. The AUCs of PMN-elastase and calprotectin were not significantly different (p = 0.327), whereas PMN-elastase or calprotectin vs. the other proteins were significantly different (p < 0.001). PMN-elastase and calprotectin correlated with the endoscopically classified severity of inflammation. All fecal leukocyte markers in IBS were found in the range of the healthy persons. Data on storage stability of leukocyte proteins in fecal supernatants are given. CONCLUSION: Fecal PMN-elastase and calprotectin support the differentiation of chronic IBD from IBS and correlate with the severity of inflammation.

http://www.ncbi.nlm.nih.gov/pubmed/15819166

These are simple stool test that can help differentiate between IBS and IBD conditions.

a lot of people with IBS also have hemmies. With blood its in part the color. IF its dark red in the stools as oppose to bright red, but bleeding should also be checked out.

In IBD there is over inflammation that can be seen with the tests. There also can be malabsorbtion on nutrients, weight loss, bleeding and red flags for an IBS diagnoses.

Diagnostic Testing in Irritable Bowel Syndrome: Theory vs. Reality

http://giresearch.org/site/gi-research/iffgd-research-awards/2007/diagnostic-testing

Diagnosis of IBS

Warning Signs and Symptoms
Warning signs and symptoms are not typical of IBS. The doctor may want to run extra tests if you have any of the following:

anemia and other abnormal blood tests,
blood in the stool,
unexplained weight loss,
fever, or
a family history of inflammatory bowel disease or other diseases of the colon
http://aboutibs.org/site/about-ibs/symptoms/diagnosis

Hope some of this info helps.

You also might want to get a second opinion perhaps.

@Shawn12:

I don't know what my actual dx is, if any. I know that the upper GI inflammation isn't characteristic of IBS, but I don't know that those two things would cause lower GI symptoms, which is what I have. He didn't seem to think too much of the gastritis, as he told me that b/c of the acid, everyone's stomach is in a constant state of semi-inflammation and that pathologists like to label tissue as being "something." He didn't see it on the endoscopy (he actually saw the inflammation of my esophagus, but didn't biopsy there for some reason), it was the pathologist report from the tissue biopsies.

Interesting about the stool test. I don't know why he didn't do any stool tests. I guess in his opinion, he pulled out the big guns, so to speak, by doing all the scopes. He did the pill cam after the IBD serology came back positive, thought that it picked up an area of narrowing, but it was just sharp angulation of my duodenum which the EGD assessed.

Thanks for all the links. When I get a few minutes, I will check them out. You are a good source of information, for sure. :)