# Why aren't IBS people having more stool tests???



## Jackie (Sep 15, 2004)

Did you know that stool testing isn't all it should be? Research (and not just one study either!) has shown that one stool sample isn't always enough to detect an infection, that's if you're lucky enough to have a stool test ordered!You can read about it hereit's primarily about a bug called D.fragilis but it has info. regarding other amoebic parasites as well) http://member.rivernet.com.au/bara/testingfordf.htm Jackie


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## flux (Dec 13, 1998)

This is probably correct, but I suspect that few IBSers are really walking around with undiagnosed parasite infections.


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## Jackie (Sep 15, 2004)

Flux,I really don't want to get into this with you because your answers are only ever subjective - you never come up with anything in the way of research to back up your arguments. This is my only reply on the subject unless you come up with something interesting....which I somehow doubt.Jackie


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## moldie (Sep 25, 1999)

Another question might be to ask why aren't doctors doing more tissue biopsies for microscopic colitis during colonoscopies with certain previous findings of blood in the stool, pain, abdominal bloating/swelling, and a recent history of being on drugs that can lead to bacterial/fungal over-growth?


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## Jackie (Sep 15, 2004)

I agree, but it would save a lot of time if they tested stool samples properly the first time and then went on to to perform the other tests. If only 20% of those with IBS have some kind of infection which isn't being picked up - that's 20% too many don't you think? It would save a lot of ill health and misery in the community if they did things properly.I definitely agree with your comment re microscopic colitis.....I only became aware that they don't do this as a matter of routine AFTER I'd had two done. I'm pretty sure I've now got (microscopic) colitis induced by this infection. The other issues you raised re bacterial overgrowth due to antibiotic use are important as well - but could be adequately addressed by the correct testing methods in the collection and testing of stool samplesJackie


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## flux (Dec 13, 1998)

> quote:If only 20% of those with IBS have some kind of infection which isn't being picked up - that's 20% too many don't you think? I


I don't think anyone knows what the infection rate is because that stuff isn't well-reported in the US but most infections are self-limited and IBS is not. In many cases, good clinical history can distinguish between infection and IBS. And 20% seems too high to be a realistic value at least for the US. Most of the time IBS is IBS.


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## Jackie (Sep 15, 2004)

You say most infections are self-limiting - that may be true in some cases, mine certainly isn't.....neither is anyone's on my website diagnosed with D.fragilis. In fact these people had to use a strong anti-parasitic drug such as Iodoquinol and risk blindness in order to get themselves cured. And in some cases even this hasn't worked. I used an arbitrary figure in quoting 20% - it could be 100% - I am trying to make the point that infections aren't picked up because:a) they either aren't tested foror







the testing isn't good enough.which brings me to the point that:IBS could conceivably in many people actually be an undiagnosed infection. Here's another story which illustrates my point: About 6 months ago I was recommended to a biochemist who is one of the few people in the Sydney area knowledgable about and excellent at detecting D.fragils, uses all the right criteria ie. stool in fixative, more than one sample, staining techniques relevant to D.fragilis etc. He's known around in medical circles as the poo doc. Anyway I got talking to the lab assistant, an older woman who's been working there for years. She said over the years she has seen many undiagnosed infections attributed to IBS (straight from the horses mouth wouldn't you agree???), and cited one of the more memorable cases....such as the woman who had chronic diarrhoea for 17 YEARS! couldn't leave her house, and was diagnosed as having IBS.Guess what, in the 17th year of her illness some bright doc. sent her to this biochemist, who found an infection. She was treated with a drug and cured. Just one case from many, in a large public hospital to illustrate the case for infections as a cause for IBS.How about this from a paper published in the British Medical Journal:"The laboratory reports of the CommunicableDisease Surveillance Centre show that in 1992, 68 cases of D fragilis infection were reported from seven laboratories and that by1996 this figure had increased to 231 cases reported from 20 laboratories (unpublished data). These results reflect an increase inthe number of laboratories performing faecal stains. It can be assumed, however, that the true incidence of D fragilis infection ismany times higher: there are an estimated 450 diagnostic laboratories in the United Kingdom, most of which do not look for thispathogen."A survey of path labs in my city (Sydney) revealed that many don't find EVEN ONE case of D.fragilis, and the most cases a year were 5 in a city of millions of people.I've had to fight doctors for 8 years telling me that "infections don't last long and usually clear up of their own accord" - the implication being that my IBS couldn't possibly be attributed to an infection.Also I'm wondering what you mean by "a good clinical history"? Proper stool testing???Jackie


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## badfoot (Oct 5, 1999)

My experience with stool testing, biopsies and a couple of rounds of flagyl, tinidazole, etc. is that parasitic infections may play some part in exacerbation or onset of IBS, but they don't seem to be a clear causative factor. Subjective, but borne out by most of the research I've encountered over the last 12 years.


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## Jackie (Sep 15, 2004)

I know of no large scale tests which disprove this theory. In fact thats the basis of the problem - those of us with IBS aren't being properly tested in the first place, so how can anyone form any kind of opinion which disproves this theory. Until large scale testing is done, it is all just guessworkon behalf of the "infection with bacteria/parasites don't cause IBS" camp.However, the theory that infection causes IBS has much research behind it. The bacteria Helicobacter pylori has been upsetting human digesting for probably hundreds of years. However it's only was only relatively recently that someone performed large scale testing of those with ulcers and chronic stomach complaints. This research was widely refuted by medical profession at large for years.Regarding the parasite I have: I recently wrote to the author of this letter printed in the BMJ: More laboratories should test for Dientamoeba fragilis infection http://www.bmj.com/cgi/content/full/318/71...l&pmid=10074031 Here is part of his reply:"I was interested to hear you talking about IBS and D. fragilis as I have a colleague working in London who is detecting >20% D. fragilis in IBS patients with around 40% being positive for Blastocystis hominis. However, his work hasn't been published yet unfortunately. It is unknown whether it is an alteration of the bowel flora which enables the D.fragilis to proliferate, or whether D. fragilis mimics the symptoms of IBS, but for whatever reason it certainly seems associated with these patients."Jackie


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## Mike NoLomotil (Jun 6, 2000)

MY COMMENT ON THE THREADIt is counterintuitive to argue against routine culturing for all suspected pathogens in any patient presenting with symptoms of GI dysfunction so as to rule out infection before throwing the patient in the diagnostic dustbin of IBS and sending them on with instructions to calm down, eat fiber, avoid dairy, and a pat on the head.There is no way to gauge the fraction of the IBS population which remains subject to chronic GI dysfunction from undiagnosed pathogens of one or more possible types.Self-limiting is not the same as self-resolving. While it is true that most infective diseases are self-resolving in the gut, there are (esp. in these these days of heightened pathogen resistance) instances of chronuic long term "self limited" low grade gut infection (ie: the immune system works locally to contain the infective agents).If it was found ONCE and only once, that is more than sufficient proof that it can and does exist, and the degree of debilitation of chronic lower GI dysfunction is sufficiently life-disrupting to warrant inclusion of inexpensive efficacious rudimentary stool exams for pathogens as a matter of standard DD when the patient presents with any symptoms that may suggest such a thing might be present.The only question to be resolved is which "stool tests" are bona fide and efficious and it seems there is sufficient info already available on each to render reasonable judgement.CAUSE NO HARM and RULE OUT are watch words that should be applied to all workups for patients with these miserable, painful, and psychologically damaging symptoms so as to ensure every possible chance at any hope of a permanent recovery. For what comes after ruling out organic or infective disease is not an easy row-to-hoe to manage IBS with present methods.Have a DFD and get a stool exam tooMNL____________________ www.leapallergy.com [This message has been edited by Mike NoLomotil (edited 10-04-2000).][This message has been edited by Mike NoLomotil (edited 10-04-2000).]


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