What Should I Ask On My Next Dr. Visit?

[David in Seattle]

I posted about a week ago about my 14 month odyssey into GI hell, and my suspicions about possible Celiac. A description of my symptoms is in this 1st post Over the last year, I have seen 2 gastroenterologists. I have an appointment with a 3rd in about a week, and I want to be sure I request anything which has not yet been done. So far, I have had the following tests:

Complete blood count (normal)

Complete metabolic panel (normal)

Sedimentation rate (normal twice)

Thyroid stimulating hormone (normal)

Cyclospora (negative twice)

Crytosporidium (negative)

Ova & parasite (negative twice)

Hepatic function panel (normal)

C Reactive protein (normal)

CT scan of abdomen and pelvis w/contrast medium (normal)

Creatinine (normal twice)

Tissue transglutaminase antibody, iga (Normal)

Fecal fat stain (increased twice)

Fecal fat quatitative (increase, 5.4g in 24 hours w/a normal max of 5.0)

Colonoscopy/esophageal endoscopy (normal, including one small bowel biopsy w/no sign of villious blunting)

C. difficle (negative)

Giardia antigen (negative)

Stool salmonella shigella campylobacter (negative)

CBD w/platlet differentiation (normal)

BUN (normal)

Electrolytes (normal)

IBD Serology:

Component Your Value Standard Range Flag

IBD PREDICTION Pattern Not Consistent with IBD

ASCA IGA ELISA LESS THAN 12.0 0-20.0 EU/ml

ASCA IGG ELISA LESS THAN 12.0 0-40.0 EU/ml

ANTI-OMPC IGA ELISA 2.2 0-16.5 EU/ml

ANTI-CBIR1 ELISA 5.1 0-21.0 EU/ML

NEUTROPHIL AUTOANTIBODY ELISA LESS THAN 12.1 0-12.1 EU/ml

IFA PERINUCLEAR PATTERN Not Detected

DNASE SENSITIVITY Not Detected

In addition to the above I have had a capsule endoscopy, with the result "multiple areas of erosion and erythema were seen in the proximal small bowel, with a few scattered in the mid and distal small bowel. A small ileal ulcer was also noted".

If anyone can give me some suggestions as what specifically I should be suggesting in my upcoming appointment, I would greatly appreciate it.

David

[burdee]

Hi David: It looks like your doc tested you for usual indices of celiac disease, as well as several parasites. Which test diagnosed the absence of parasites? Did your doctor consider other food allergies? I don't mean IgE or anaphylactic, immediate reaction, allergies. I mean IgG or IgA mediated delayed reaction allergies, which blood tests (like ELISA) can diagnose. I also didn't notice any test results for pathogenic or opportunistic bacteria or your 'good' bacteria levels. Other delayed reaction food allergies, bacterial infections and/or candida could also cause your gastro symptoms.

SUE

[mushroom]

Testing for vitamin and mineral deficiencies would help to determine whether you have leaky gut/poor absorption. Vitamins D, B12, folate, iron, zinc, magnesium, potassium. I do not see any specific stool testing for pancreatic sufficiency (the digestive enzymes). You do have increased fecal fat so maybe decreased lipase production. Have you tried digestive enzymes?

[David in Seattle]

Hi David: It looks like your doc tested you for usual indices of celiac disease, as well as several parasites. Which test diagnosed the absence of parasites? Did your doctor consider other food allergies? I don't mean IgE or anaphylactic, immediate reaction, allergies. I mean IgG or IgA mediated delayed reaction allergies, which blood tests (like ELISA) can diagnose. I also didn't notice any test results for pathogenic or opportunistic bacteria or your 'good' bacteria levels. Other delayed reaction food allergies, bacterial infections and/or candida could also cause your gastro symptoms.

SUE

Sue - The test results on the ova & parasite aren't specific as to species, they just say "No ova and parasite seen". No mention was made of food allergies, though the Elisa test does include a normal result for "ASCA IGA" & "ASCA IGG", both normal. Can you please elaborate on the specific tests that you mention in your last 2 sentences?

Thanks

David

[David in Seattle]

Testing for vitamin and mineral deficiencies would help to determine whether you have leaky gut/poor absorption. Vitamins D, B12, folate, iron, zinc, magnesium, potassium. I do not see any specific stool testing for pancreatic sufficiency (the digestive enzymes). You do have increased fecal fat so maybe decreased lipase production. Have you tried digestive enzymes?

They did check for potassium in the metabolic panel, but not for any of the others; I'll definitely ask about that. I did try the digestive enzyme drug "Pancrease" for a short while, seemed to have no effect. Please let me know if you have any other observations.

Thanks

David