# Advice Please! IBS-D; Fat Malabsorption



## nomorecookies (Oct 5, 2012)

*Some Background Unfo:*I am 24 years old; been suffering "stomach" issues since I was around 10 years old.For about a year, things have gotten really bad (see symptoms below).In the past, I have been told I have IBS-D after doctors check my blood and all is normal.Just started going to new gastroenterologist. FINALLY one test came back abnormal- The Fecal Fat- Increased Split fat (fat malabsorption). Now the gastroenterologist wants to do UPPER ENDOSCOPY TO BIOPSY FOR CELIAC AND FLEXIBLE SIGMOIDOSCOPY TO CHECK LOWER BOWEL FOR COLITIS.BUT I think I have a SIBO! All the blood test for celiac came back negative. However, he has not mentioned SIBO at all. So I wrote him a message asking if the malabsoption could be due to SIBO since I've read about this online. I am still waiting for his response.Can anyone relate with similar symptoms? Can you offer me any advice? Should I do these test? Should I push for a hydrogen breath test? Anyone have any experience with fat malabsorption?Thank you so much for any help.







*SYMPTOMS *BURNING PAIN in my left back side (right below rib cage) ALL DAY







; worse after meals, even worse after big meals.Diarrhea/ loose stool sometimes immediately after eatingToo many bowel movements- More than 5 but less than 10 most daysReally bad bloating/ gas/ belchingFATIGUE- I can't stay awake past 8.00 PM. I will fall asleep if I am laying down/sitting. Unless I am standing, I cannot stay awake in the afternoon.Undigested food in my stoolPassing a lot of mucus with or without stoolSmelly stool/difficult to clean/feel like there is more that needs to come out*Tests I've had done:*CLOSTRIDIUM DIFFICILE TOXINS A & B- NegativeFECAL FAT, QUALITATIVE	- FECAL NEUTRAL FAT- Normal;FECAL SPLIT FAT-IncreasedOVA AND PARASITE EXAMINATION- Negative	CELIAC DISEASE PANEL- All NegativeCBC WITH DIFFERENTIAL- NormalC-REACTIVE PROTEIN- NormalSEDIMENTATION RATE- NormalCOMPREHENSIVE METABOLIC PANEL- All normal except BLOOD UREA NITROGEN - Low


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## nomorecookies (Oct 5, 2012)

Dr. responded and said SIBO tests are unreliable, best thing to try is trial of Xifaxan.I am not sure if insurance will cover it. I guess that will determine if I proceed with that.Symptoms still horrible! : (


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## rudibear (Jul 28, 2012)

nomorecookies said:


> Dr. responded and said SIBO tests are unreliable, best thing to try is trial of Xifaxan.I am not sure if insurance will cover it. I guess that will determine if I proceed with that.Symptoms still horrible! : (


My doc said the same thing about SIBO tests and started me on Xifaxan. He was able to give me the drug for free out of his medical samples. You might see if your doc can do that for you. But the drug has only caused me grief. Lots of constipation. Hopefully you will have more success.


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## nomorecookies (Oct 5, 2012)

Thanks rudibear. At this point constipation would be a welcome relief from this nonstop bowel movements/diarrhea.Hopefully I can find a way to get it at a reduced cost or free. Thanks for your input! Hope things get better for you.


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## Linda46 (Jan 2, 2012)

Constipation is not fun. I had this prior to my cystoscopy for IC. I think frequency is preferable, especially with a family member who ended up with total rectal prolapse from codeine induced constipation. Linda


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## rudibear (Jul 28, 2012)

nomorecookies said:


> Thanks rudibear. At this point constipation would be a welcome relief from this nonstop bowel movements/diarrhea.Hopefully I can find a way to get it at a reduced cost or free. Thanks for your input! Hope things get better for you.


Don't know about constipation being preferable. It is pretty brutal. Good luck getting the xifaxan. I called my doc today. He is trying me on augmentin. Will probably start it Friday. Want the constipation gone before I use it. Maybe your doc could consider other options too. Best of luck.


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## MaryAnn51 (Apr 3, 2010)

nomorecookies said:


> *Some Background Unfo:*I am 24 years old; been suffering "stomach" issues since I was around 10 years old.For about a year, things have gotten really bad (see symptoms below).In the past, I have been told I have IBS-D after doctors check my blood and all is normal.Just started going to new gastroenterologist. FINALLY one test came back abnormal- The Fecal Fat- Increased Split fat (fat malabsorption). Now the gastroenterologist wants to do UPPER ENDOSCOPY TO BIOPSY FOR CELIAC AND FLEXIBLE SIGMOIDOSCOPY TO CHECK LOWER BOWEL FOR COLITIS.BUT I think I have a SIBO! All the blood test for celiac came back negative. However, he has not mentioned SIBO at all. So I wrote him a message asking if the malabsoption could be due to SIBO since I've read about this online. I am still waiting for his response.Can anyone relate with similar symptoms? Can you offer me any advice? Should I do these test? Should I push for a hydrogen breath test? Anyone have any experience with fat malabsorption?Thank you so much for any help.
> 
> 
> 
> ...


Hi. I too have been suffering with sibo for about a year and a half. I have had a diagnosis of IBS for over 30 years, but last few years, symptoms changed and I was officially diagnosed with small intestinal bacterial overgrowth last year with a hydrogen breath test. What sent me to the doctor was floating stools. I have had them on occasion, but never constant and last June I noticed every single stool I had floated; was difficult to clean; (sorry to be gross), but...!! Smelled BAD. I was sent for abd. ultrasound which was negative; bloodwork and endoscopy for celiac - negative. Stool samples were negative for parasites, but like you, I had increased split fat. I've also had complete bloodwork which showed nothing alarming. I've been treated 4 or maybe 5 times now with the antibiotic xifaxan. I feel great on it, but it comes back within a month or less. So, I first tried giving up refined sugars and white carbs and took VSL#3 probiotic. It came back anyway and I think the probiotics make me worse. I have tried them off/on with worsening symptoms. I went gluten free about 2 months ago and the bloating is GONE. However, my stools are still not normal and I still have alot of gas especially when I eat too many sugars/carbs. I have tried on a few occasions just eating protein/vege's, etc. for a few days and all my symptoms just about disappear. As soon as I add carbs or eat a little bit sugar, the gas returns. I also get bad gas pains in my shoulder blades and back. I also have left-right sided pain right under my rib cage off/on. Let me know what else you find out. I still worry about my stool issues/malabsorption because even after taking all those antibiotics and changing my diet, they have not gone back to normal. MaryAnn


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## nomorecookies (Oct 5, 2012)

MaryAnn51 said:


> Hi. I too have been suffering with sibo for about a year and a half. I have had a diagnosis of IBS for over 30 years, but last few years, symptoms changed and I was officially diagnosed with small intestinal bacterial overgrowth last year with a hydrogen breath test. What sent me to the doctor was floating stools. I have had them on occasion, but never constant and last June I noticed every single stool I had floated; was difficult to clean; (sorry to be gross), but...!! Smelled BAD. I was sent for abd. ultrasound which was negative; bloodwork and endoscopy for celiac - negative. Stool samples were negative for parasites, but like you, I had increased split fat. I've also had complete bloodwork which showed nothing alarming. I've been treated 4 or maybe 5 times now with the antibiotic xifaxan. I feel great on it, but it comes back within a month or less. So, I first tried giving up refined sugars and white carbs and took VSL#3 probiotic. It came back anyway and I think the probiotics make me worse. I have tried them off/on with worsening symptoms. I went gluten free about 2 months ago and the bloating is GONE. However, my stools are still not normal and I still have alot of gas especially when I eat too many sugars/carbs. I have tried on a few occasions just eating protein/vege's, etc. for a few days and all my symptoms just about disappear. As soon as I add carbs or eat a little bit sugar, the gas returns. I also get bad gas pains in my shoulder blades and back. I also have left-right sided pain right under my rib cage off/on. Let me know what else you find out. I still worry about my stool issues/malabsorption because even after taking all those antibiotics and changing my diet, they have not gone back to normal. MaryAnn


MaryAnn- thanks so much for your response. It has been really helpful.







You sound exactly like me! I didn't know floating stools are a bad thing - I get them all the time- it was the constant need to go and the mucus that worried me the most. I really hope I can get my hands on the xifaxan. Althought it is dissapointing to know it has not worked 100% for you.







I have been taking a liquid probiotic and I am starting to think it makes thing worse since it has sugar/dairy in it. I will try looking for something else.I had not thought of giving up carbs and sugars since most of recommendations of "safe" IBS food are carbs. I will give this a try and see if it works. I had noticed that when I eat mostly veggies, I feel normal.Was your doctor concerned at all about the long term effects of malabsorption? I worry about that. Is he going to do any additional testing for you? Thanks so much for your help!


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## MaryAnn51 (Apr 3, 2010)

nomorecookies said:


> MaryAnn- thanks so much for your response. It has been really helpful.
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> ...


I would say the xifaxan has helped somewhat - it was amazing the first time I took it - I felt better within a day or two - it was amazing. But it always came back-but I would say each time it did come back, it was not quite as bad. But from all the reading I have done and talking to tons of people with SIBO, it really just needs to be controlled - never really goes away completely. I don't think I have spoken to one person that says there's is 100% gone. I would ask your GI doc for the breath test - its very simple and not expensive at all. I think diet plays a big part, but not everything. Oh yes, I did lower my intake of dairy significantly too. I use Lactaid milk in my coffee and lactose free yogurt and I am thinking of trying kefir.Heard its great for the sibo. I did have a 2nd breath test after the 4th time on xifaxan and it was worse than the first time though. I was shocked. But you cannot stay on antibiotics forever; so..I am trying the gluten free and low intake of dairy/carbs/sugars .. they all feed the bad bacteria. I think I am getting used to feeling horrible somedays. I may just need to do a course of antibiotics every few months. ??? None of the doctors I saw (2 GI doctors and my regular doc) are not that concerned with my floating, sticky gross stools??? Bothers me though cause they have not been "normal" in 16 months. MaryAnn


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## nomorecookies (Oct 5, 2012)

Wow... so it might never go away.







Ughh! Have they figured out how you got the infection in the first place?Have the doctors done any other test to check your organs or check you for deficiencies that might not show up in a basic blood test? Also, how are you doing energy wise? I honestly have none at all- I feel tired/loopy/unfocused ALL the time. Did anything help you with that?I spent some time reading about SIBO online and found some great info but non is comforting regarding a permanent cure.


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## nomorecookies (Oct 5, 2012)

Bad news. Insurance won't cover the Xifaxan completely. They will give me 9 pills for $50 then want me to pay ~$500 for the other 33. Feel worse every day.







If anyone has any ideas on how I can get the Xifaxan, pls reply! Thanks.


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## Kathleen M. (Nov 16, 1999)

http://www.salix.com/about-us/corporate-responsibility/patient-medication-assistance.aspxThey have a patient assistance program. Don't know if you would qualify but it may be worth a shot.Also the doctor may be willing to write a letter to the insurance company and sometimes if they do that the insurance will cover a drug they normally won't, or for longer than they usually would.


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## nomorecookies (Oct 5, 2012)

Thanks you for your advice. I called their hotline for assistance. They have some people that specialize in dealing with the insurance company. They said they would help. Unfortunately, I probably won't get anything done today and will have to wait till next week to hear back.I am having horrible bowel movements- tons of mucus, explosive, tmi, sorry.Does anyone know if it is a bad idea to mix Dicyclomine (anticholinergics) with Imodium?The Dicyclomine is not working so I will stop taking it but I am afraid if there is some left inside of me before I take the imodium. I just can't handle this nonstop movements!


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## Kathleen M. (Nov 16, 1999)

Top of my head, I think it would be OK, but let me use one of the drug checkers to see if they interact.Well got a mix. One said no problem, a couple others said it could increase the effect of the Imodium, so I would err on the lower dose if you do take it before the dicyclomine has cleared. 50% should be gone by the 5 hour mark, 75% by 10 hours.


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## nomorecookies (Oct 5, 2012)

I wasn't able to reply earlier bc of the board update. But thanks for your help Kathleen! : ) I waited until the next day to take the imodium and I was fine. Thx.


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## faze action (Aug 6, 2009)

MaryAnn51 said:


> I would say the xifaxan has helped somewhat - it was amazing the first time I took it - I felt better within a day or two - it was amazing. But it always came back-but I would say each time it did come back, it was not quite as bad.


This is EXACTLY my experience with taking rifaximin. It worked amazingly the first time I took it and in all subsequent courses it seemed to work less and less each time. Gluten-free has also helped me tremendously (and generally limiting sugar/carbs., which is more difficult). Whenever I eat gluten foods for more than a day (like string 2-3 consecutive days together) my symptoms return with a vengeance, including all fat malabsorption symptoms. It's terrible. I went away for Canadian Thanksgiving a couple of weeks ago and it took me a full week to recover from eating gluten just for 2-3 days (and that was only small amounts ike in sauces, etc.).


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## nomorecookies (Oct 5, 2012)

*faze action*, sorry to hear that the rifaximin is working less and less each time. I am trying to give up sugar and limit carbs. But it is so hard. I had been doing good for a week and yesterday I drank a sugary beverage and of course, I am suffering the consequences. : (Have you found a website that helps you determine what foods have gluten in them?! I don't know where to start.Also if you have any other tips, feel free to share. Thanks!I am going to pick up my xifaxan script from the DR. tomorrow. They are giving me samples but only for 7 days. We'll see how that goes.


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## MaryAnn51 (Apr 3, 2010)

faze action said:


> This is EXACTLY my experience with taking rifaximin. It worked amazingly the first time I took it and in all subsequent courses it seemed to work less and less each time. Gluten-free has also helped me tremendously (and generally limiting sugar/carbs., which is more difficult). Whenever I eat gluten foods for more than a day (like string 2-3 consecutive days together) my symptoms return with a vengeance, including all fat malabsorption symptoms. It's terrible. I went away for Canadian Thanksgiving a couple of weeks ago and it took me a full week to recover from eating gluten just for 2-3 days (and that was only small amounts ike in sauces, etc.).


*Hi - yes you do sound like me! Unfortunately though for me, even doing the gluten free (and I have not cheated once since I started a few months back), my stools are still not normal. They will on occasion sink like they used to, but mostly they float, are sticky and sometimes it looks like an oil slick in the bowl. Again, gross !! What were your fat malabsorption symptoms? Like mine? Thx*


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## Kathleen M. (Nov 16, 1999)

Short answer.If the food has no wheat in any form, or any variety, no barley, no rye it is gluten free. The problem is a lot of food additives may be made from wheat or barley. So most whole/real foods (meat fruit veggies, rice) are OK but once they are processed you really have to check the ingredient list carefully.http://www.celiac.com/categories/Safe-Gluten%252dFree-Food-List-%7B47%7D-Unsafe-Foods-%26amp%3B-Ingredients/ has the long much more detailed answer.


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## MaryAnn51 (Apr 3, 2010)

nomorecookies said:


> *faze action*, sorry to hear that the rifaximin is working less and less each time. I am trying to give up sugar and limit carbs. But it is so hard. I had been doing good for a week and yesterday I drank a sugary beverage and of course, I am suffering the consequences. : (Have you found a website that helps you determine what foods have gluten in them?! I don't know where to start.Also if you have any other tips, feel free to share. Thanks!I am going to pick up my xifaxan script from the DR. tomorrow. They are giving me samples but only for 7 days. We'll see how that goes.


*Basically when you go gluten free, you need to read every single label of the foods you are eating. You cannot have wheat, barley, rye and some people are sensitive to oats too. Most large supermarkets have a huge selection of gluten free products. You cannot believe the amount of foods that contain wheat...processed foods are a big no-no which is a good thing because they are no good for you anyway. There are tons of great books you can buy that can help you learn about how to do it and websites online too. And I truly believe that you need to eliminate sugars as much as possible with the SIBO. *


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## nomorecookies (Oct 5, 2012)

*Thank you for all the great advice! *Just picked up the Xifaxan samples. Unfortunately Dr. only gave me enough for 7 days.







Fortunately, I will be seeing him on the day I finish the antibiotics.I just took the first pill! Hope it helps. Otherwise, I'll have to schedule more invasive testing.Oh I wish I knew what it is like to be normal for once.


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## nomorecookies (Oct 5, 2012)

Update on the xifaxan.Been taking it for 3.5 days now. One notable thing is that the burning pain I felt after eating is gone. : ) The bad thing is I am still popping like crazy. I tried to eat a lot since the med supposedly works better with food, so that wasn't so smart. Basically same that goes in goes out.And now I have strep throat and I've been Rxed 850mg amoxicillin. Great. Now I'll really wreck havoc on my interestines/stomach/body even more.







Anyone have any experience taking xifaxan and another antibiotic at the same time?I would love to be normal for just one day.


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## faze action (Aug 6, 2009)

MaryAnn51 said:


> *Hi - yes you do sound like me! Unfortunately though for me, even doing the gluten free (and I have not cheated once since I started a few months back), my stools are still not normal. They will on occasion sink like they used to, but mostly they float, are sticky and sometimes it looks like an oil slick in the bowl. Again, gross !! What were your fat malabsorption symptoms? Like mine? Thx*


My fat-mal symptoms were the typical ones I think: floating stools, oil slick on the water in the bowl, and very difficult to flush. Weird thing is this happened to me this morning, and I have been very careful about gluten for the last 2 weeks. Last night I ate quite a bit of sugar and other carbs though, so I think that's what did it. I seem to generally have problems digesting carbohydrates, esp. if they contain sugar.


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## sick2much (Jan 18, 2012)

You could already be diagnosed by now, but the pains you are having in the loser back just under the rib sound like the large intestine known as the spleenic flexure. The most common cuase of fat malabsorption is gallblader. With that there is bilary duct block and stones. Have you been checked for either?

If the spleenic flexure the swelling is usually pretty immense and painful. You and hopefully someone to assist you, should be able to push on the front side under the ribs, complete opposite of the pain area, and it should make it bulge. Then another person can use a clock wise motion on the area about two to three inches and half a circle to move it. Then rub downwards to bring closer to the sigmoid.


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## MaryAnn51 (Apr 3, 2010)

sick2much said:


> You could already be diagnosed by now, but the pains you are having in the loser back just under the rib sound like the large intestine known as the spleenic flexure. The most common cuase of fat malabsorption is gallblader. With that there is bilary duct block and stones. Have you been checked for either?
> 
> If the spleenic flexure the swelling is usually pretty immense and painful. You and hopefully someone to assist you, should be able to push on the front side under the ribs, complete opposite of the pain area, and it should make it bulge. Then another person can use a clock wise motion on the area about two to three inches and half a circle to move it. Then rub downwards to bring closer to the sigmoid.


*Hi - if you were talking to me, I was given an abd. ultrasound a year ago. It was all normal, however, I keep thinking I may have a gallbladder problem too. I am making an appt to see my GI doctor again soon because I am due for a colonoscopy and I have been told I should have a HIDA scan. I will speak to him further about that. Thank you, MaryAnn*


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