# Recent LEAP Physician Case Reports Podted



## Mike NoLomotil (Jun 6, 2000)

Posted 2/16/04 http://www.ibsgroup.org/ubb/ultimatebb.php...ic;f=5;t=000493 CASE SUMMARIESSubmitted by LEAP Affiliate PhysiciansCase # 1: Male, Irritable Bowel SyndromeThe patient is a 39 year old white male who complained of a six year history of having three to five loose, non-bloody bowel movements per day. He denied other symptoms including nausea, vomiting, constipation, weight loss, or fever. He reported that sometimes these symptoms seemed to increase with stress. He was seen by his primary care physician at which time a physical exam was unremarkable. He was placed on hyoscyamine 0.125 mg po every four hours as needed. Approximately five years ago he was referred to a gastroenterologist and underwent evaluation that included a colonoscopy with colonic biopsies, upper gastrointestinal series with small bowel follow through, stool studies for giardia antigen, Clostridium difficile toxin, ova and parasites, fecal white blood cells, and stool culture for salmonella, shigella and campylobacter. All the above studies were normal. A diagnosis of Irritable Bowel Syndrome was made and the patient was begun on dicyclomine 10 mg po twice a day. The dicyclomine initially resulted in a decrease his diarrhea. However, approximately one year later, the diarrhea worsened despite the ongoing use of dicyclomine, and the patient returned to the gastroenterologist. A complete blood count, Westergren sedimentation rate, and anti-transgluatminase IgA antibody were obtained and all were normal. The patient was told to continue the dicyclomine and use loperamide on an as needed basis. He returned approximately two years later stating that he had stopped the dicyclomine and found that if he used loperamide either once or twice a day on a regular basis his diarrhea was controlled. A decision was made to continue with loperamide and add amitriptyline 20mg po every night. Approximately, one year later the patient again presented complaining of the same symptoms. The amitriptyline was minimally effective, and the patient continued to require the frequent use of loperamide to control the diarrhea. The patient then underwent LEAP testing for food and chemical sensitivities and was counseled in a LEAP diet devoid of test-positive foods. Within two weeks the diarrhea had completely resolved and loperamide was no longer needed. He has been on the diet for six months and continues to do well. He has found that his symptoms often return when he consumes foods to which he has been found to be sensitive. ____________________Case # 2: Male, Irritable Bowel SyndromeThe patient is a 51 year old white male who has had years of left lower quadrant pain, flatulence and one to five loose bowel movements per day. His past medical history and physical exam were unremarkable. Three years ago he underwent a colonoscopy into the terminal ileum that was normal. He was placed on dicyclomine 10 mg po twice a day. The dicyclomine did not seem to be effective and the patient tried various dietary manipulations. He noted that his symptoms improved to some extent when he avoided milk products and several grains including wheat, corn, and rice. Because of the improvement of his symptoms on a wheat-free diet, he underwent an esophagogastroduodenoscopy to evaluate for celiac disease. The endoscopy including small bowel biopsies was normal. The patient then underwent LEAP testing for food and additive hypersensitivities. He was found to have several hypersensitivities including wheat and corn, but not rice. He was begun on a LEAP diet lacking in the offending foods. The patient very quickly noticed an improvement in his symptoms. He has now been on the diet for eight months and reports that he is markedly improved. His diarrhea, flatulence and cramping have decreased significantly. In addition, he previous had problems with gastroesophageal reflux and insomnia, and they have also significantly improved. _________________________Case # 3: Female, Irritable Bowel Syndrome and GERDThe patient is a 17 year old white female who has had a several year history of lower abdominal pain and cramping, diarrhea, gastroesophageal reflux, nausea, chest tightness, chronic sinusitis, headaches and allergies. The physical exam was unremarkable. An evaluation one year ago included an abdominal ultrasound, and abdominal and pelvic CAT scan which were normal. An upper gastrointestinal series showed moderate gastroesophageal reflux. An esophagogastroduodenoscopy showed grade I esophagitis and normal small bowel biopsies. The patient was started on esomeprazole 40 mg po once a day and noted a good improvement in her reflux, chest tightness and nausea. The lower abdominal pain and cramping did not improve with fiber supplementation and hyoscyamine 0.125 mg p.o. every four hours as needed. The patient tried a lactose free diet. She did not notice any improvement, but she did find that she had some improvement in her lower abdominal symptoms with the avoidance of fructose containing foods. However, a fructose hydrogen breath test did not show that the patient was fructose intolerant. The patient underwent LEAP testing for food sensitivities and was subsequently started on a LEAP oligoantigenic diet [that eliminated offending foods]. Within one month, the patient noted an improvement in her overall health with a marked decrease in her lower abdominal pain, cramping, diarrhea, heartburn, headaches, sinusitis, and chest tightness. Her level of energy has increased. She has been able to stop the esomeprazole. The patient has been on the LEAP diet for five months and continues to do well. She has noted that her symptoms quickly return when she varies from the diet and consumes any test-positive foods. ________________________Case # 4: Female, Irritable Bowel Syndrome and MigraineThe patient is a 47 year old white female who complains of years of heartburn, bloating, flatulence, diarrhea, and migraine headaches. Otherwise her history was unremarkable and her physical exam was normal. An upper endoscopy was performed that was normal. The patient was placed on ranitidine 300 mg twice a day and had good improvement in her gastroesophageal reflux symptoms but continued to complain of bloating, flatulence, and diarrhea. Fructose and lactose hydrogen breath tests were performed and were both negative. The patient underwent LEAP testing for food sensitivities and was subsequently started on a diet that eliminated offending foods. Within one month her flatulence, bloating, diarrhea, and headaches have completely resolved. She continues to take ranitidine 300 mg po twice a day but has noted less breakthrough reflux symptoms since starting the LEAP diet. She also has had less insomnia and fatigue and more energy. After five months on the diet she continues to do well, and has noted that her symptoms return if she strays from the diet. ___________________________Submitted by (2) LEAP affiliate Physicians 2/12/2004MNL


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## Mike NoLomotil (Jun 6, 2000)

...and I STILL cannot type!MNL


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