Any Advice On Gastrointestinal Specialist

[Ijustwannateach]

A good friend of mine has been getting progressively sicker and weaker from a lack of proper digestive function. He seems to have constant constipation and discomfort, enough that it also prevents him from sleeping properly. He is a bit older (in his 60s) and has enjoyed very good health and appetite until the last 5-6 months (shortly after a trip to Viet Nam) when this problem appeared and grew worse; as a result he has lost several kilograms already (and he was not a heavy man).

He has been to BNH several times and been given pretty much every diagnostic that they have- including full endoscopy up and down both ends. This has eliminated cancer as a cause (of course they also tested for parasites, viruses, what-have-you). The only thing they are left with is "irritable bowel syndrome," which seems to me to be a long-winded way of saying "we don't know what's wrong with you." Usually I trust this hospital, but it seems to me maybe they've gone through their checklist and that's all they're willing to do.

Does anyone know a really good gastrointestinal specialist who might be more prone to thinking outside the box or possibly know a wider range of problems/solutions? Would it be advisable to ask my friend to switch hospitals (with or without his test results)? Should he perhaps even gently be asked to consult a psychiatric specialist in case it's psychosomatic (though he has had no recent big stresses that I know of and leads an enjoyable pensioned retirement)? I'm beginning to worry about him a lot as he has become a bit depressed and has decided to go off the meds that BNH gave him (which were making him feel even worse).

"Steven"

[taxexile]

i can wholeheartedly recommend dr. nusont kladcharoen at bumrungrad hospital.

a quiet guy , dosent say a lot , but will answer your questions , very good english

qualified as a doctor in the uk in 1978 , professor at mahidol??? university.

can book with him on the website for bumrungrad.

gastro intestinal specialist.

had some g.i. problems myself recently , no appetite , lost a few pounds , discomfort etc. and also underwent cameras up and down.

the relief at knowing it was not malignant seemed to settle everything down actually.

i did some reading up on the digestive system and it seems that unexplained symptoms are very very common and often after ruling out malignancy and checking blood chemistry , not much can be done. medication can go a long way to reducing any discomfort.

i was told i had irritable bowel too , but since the diagnosis , its all settled down.

there is a good book by dr. sarah brewer , (titled irritable bowel syndrome , published by thorsons , isbn 0 7225 3392 6) which explains a lot about this strange complaint and its myriad of symptoms , and the many options for dietary self help.

have they checked for something called "tropical sprue" , a stomach bug often picked up whilst travelling and can result in weight loss.

if your pal does decide to change hospitals , then take the test results along as it might save the expense of repeating them.

i got full colour dvd's of my stomach endoscopy and colonoscopy.

its like watching surreal porno.

[Zen]

I'm also worried for a friend of mine who has almost the same problem as your friend. MyThai friend is 22 years old and she often feels like throwing up after meals. She tried to avoid spicy and sour food and the situation improved a little - she doesnt feel like throwing up that often any more. However, she has been losing weight and is now very much Underweight. She says that whenever she eats she feels that her stomach "doesnt want to do any work" (as in the food doesnt digest), and she gets constipation.

I asked her to see a doctor quickly and do an endoscopy but she refuses, because it's too expensive for her. Yet she doesnt wanna go to the cheaper, Government hospitals either, citing long procedures and Queues as a reason.

[Ijustwannateach]

Thank you both for your thorough and helpful answers... I will certainly recommend the specialist you mention to my friend, Taxexile, and the book as well.

Zen, the sad thing is- if I understand correctly- the only thing the endoscopy rules out is cancer. So if she doesn't have cancer, she's left with the same unexplainable symptoms [unless she has parasites- which should also be tested]- but if she does have cancer, she would have even more financial problems than before .

I can't believe government hospitals would really give such an endoscopy as an option under the "30B" scheme. They'll give her an aspirin and tell her to go home and die quietly.

"Steven"

[Sheryl]

I'm also worried for a friend of mine who has almost the same problem as your friend. MyThai friend is 22 years old and she often feels like throwing up after meals. She tried to avoid spicy and sour food and the situation improved a little - she doesnt feel like throwing up that often any more. However, she has been losing weight and is now very much Underweight. She says that whenever she eats she feels that her stomach "doesnt want to do any work" (as in the food doesnt digest), and she gets constipation.

I asked her to see a doctor quickly and do an endoscopy but she refuses, because it's too expensive for her. Yet she doesnt wanna go to the cheaper, Government hospitals either, citing long procedures and Queues as a reason.

She should try the following on her own, first. Cheap and safe:

1) Take a single 400 mg tablet of albendazole (available everythwere, various brand names). This will eliminate most parasites if she has any. It is simpler than testing for them, and tests give a lot of false negatives.

2) Wait 1-2 weeks after the above. If still no better, problem was not parasites. Next likely cause is gastritis and/or ulcer. She should try taking any of the following (all widely available without presecription, and pretty safe):

omeprazole

cimetidine

ranitidine

Those are the generic names, many brand names. Dose schedule varies with the drug so ask the pharamcist. If she tries one and has unpleasant side effects, she can try one of the others. Whichever she tries, take it continuously for a week. If improvement, Keep taking it for a full 3 months. If no improvement, then the problem is not realted to acidity.

If both #1 and 2 fail, there is really no recourse but to see a doctor. But majority of complaints like this will respond.

BTW -- if she went to a government hospital, what I outlines above is what they would do, too, long before considering an endoscopy.

One important caution though --- be sure she is not pregnant. That could cause the nausea and vomiting, and weight loss in turn could follow from them. And it would not be safe to take the above mentioned medicines if she is pregnant. So rule out pregnancy first.

[taxexile]

Next likely cause is gastritis and/or ulcer. She should try taking any of the following (all widely available without presecription, and pretty safe):

omeprazole

cimetidine

ranitidine

correct me if i am wrong sheryl , but before taking acid reduction medication for gastric ulcers shouldnt a patient be tested for the presence of helicobacter pylori in the stomach , and if found to be present , this bacteria should be eradicated with antibiotics.

[meadish_sweetball]

I am no expert, but taxexile's idea seems sound.

This is what the Nobel Prize for Medicine (to Australians Barry J Marshall and J Robin Warren) last year was all about. Have a look here:

http://www.cdc.gov/ulcer/md.htm

[kat]

Seeing this thread has made me feel a little paranoid. I had stomach problems for about 2 months and went to BNH for the first time a little over a month ago. They tested me for giardia, and the doctor could not believe I contracted it in Bangkok. I have not left Thailand for close to a year.

She treated me with four tablets that you take in 1 shot after dinner, and no alcohol for 48 hours. Things seemed fine for a couple of weeks, but symptoms started again. I don't know if it was the same problem or reinfection, or something else.

I went back to BNH 2 weeks ago, tested negative for giardia, but was given the same tablets again. So far, it seems as if my stomach is recovering, but I have been going light on chillies and street food; we'll see.

Last week, 4 kids were out in my class due to stomach flu. I was also feeling the effects of extreme fatigue, so who knows. In these last 2 weeks, I have heard of several people suffering from stomach problems. One guy I know had to stay in the hospital for a few days due to food poisioning.

Sometimes I wonder if we are merely being slowly poisioned due to dirty food or water, or chemicals or some other such phenemona, which have ceased to be reported to the public.

Like I said, paranoid.

[Sheryl]

Next likely cause is gastritis and/or ulcer. She should try taking any of the following (all widely available without presecription, and pretty safe):

omeprazole

cimetidine

ranitidine

correct me if i am wrong sheryl , but before taking acid reduction medication for gastric ulcers shouldnt a patient be tested for the presence of helicobacter pylori in the stomach , and if found to be present , this bacteria should be eradicated with antibiotics.

Correct for foreigners. However most Thai doctors feel it is not useful to test for helipbacter in Thais because it is highly endemic here -- a very high percentage will test positive even among people with no symptoms.

What I described is the usual Thai medical practice ofr Thais. However, nothing wrong with treating it for heliobacter if the initial response to acid reduction is positive (symptoms improve). The treatment for heliobacter is omeprazole + 2 antibiotics, and it is sold in kits with all 3 drugs in a pack, 1 week supply.

[Zen]

Wow thanks a lot for the info. I'll let my friend know about it

Are there any side effects of these drugs? Eg. Pple with certain drug allergy should stay away from the drug?

Thanks a lot again

[sabaijai]

Albendazole is for eradicating worms and certain parasitic infections (such as echinococcosis) and microspores. If you're going to head in the direction of mass germicide, you'll need to do a course of something that attacks common GI bacteria (eg E coli) such as ciprofloxacin. Add to that a course of metronidazole, the only drug that works against amoebas and giardia. Then you've covered all the bases (and cleaned your GI tract of all the 'good' bacteria too, so better to get a proper diagnosis and the right drugs at the outset).

A colonoscopy (endoscopy is from the top down only) can also help diagnose parasitic infections of the colon, it's not just for cancer diagnosis. I had a case of a amoebas a few years ago that puzzled the docs until colonocopy photos showed their telltale trails in the colon. It was my 3rd time to get amoebas (1st time in India, 2nd Indonesia 3rd Burma).

While most people get loose bowels when infected by amoebas, some don't. I had the more 'traditional' symptoms the first two rounds. The 3rd time there was just gradual weight loss and fatigue over a series of months, and once in awhile a small amount of blood in the stool. Docs were stumped before the colonoscopy. Metronidazole knocked them out within a couple of days.

So if your friend does decide to treat himself, he might want to give all three treatments a try.

[Sheryl]

Wow thanks a lot for the info. I'll let my friend know about it

Are there any side effects of these drugs? Eg. Pple with certain drug allergy should stay away from the drug?

Thanks a lot again

Only if allergic to specifically that drug, which she has probably never taken.

Allergy to the drugs I mentioned are rare.

Some people find though that they get headaches and/or insomnia from them. Most people do fine.

[katana]

...A colonoscopy (endoscopy is from the top down only) can also help diagnose parasitic infections of the colon, it's not just for cancer diagnosis. I had a case of a amoebas a few years ago that puzzled the docs until colonocopy photos showed their telltale trails in the colon...

Hi,

Wouldn't just a simple stool test have picked up amoebas? Or are they easy to miss without a colonoscopy/sigmoidoscopy?