Should I Seek Another Opinion?
Hello everyone! I'm a 28-year-old female, standing at 5'7" and weighing 140 pounds. For the past several months, I've been struggling with intense pain on my right side, frequent vomiting—almost daily now—issues with constipation, diarrhea, and even some blood in my stool. After undergoing various tests, my gastrointestinal specialist concluded that I simply have irritable bowel syndrome (IBS). According to her, there is absolutely no inflammation and no possibility of any alternative diagnosis. However, something inside me is urging me to question this. I feel unwell around the clock and am at a loss for what steps to take next. The only supplements I use are a multivitamin and iron, and I don’t have any known food allergies or take NSAIDs. Any guidance from you all would mean the world to me! Here are some of my medical test results: - **Blood Work:** Results came back normal. - **CT Enterography:** Negative findings. - **Calprotectin Level:** 98 mcg/mg. - **Colonoscopy and Endoscopy Observations:** * **Esophagus:** Appears normal. * **Stomach:** No abnormalities noted. * **Duodenum:** The duodenum shows intact mucosal structure, with cold forceps biopsies taken. * **Mucosal Findings:** Observations revealed abnormal vascularity and ulceration in the sigmoid colon, ascending colon, and terminal ileum, suggesting the possibility of unspecified colitis, potentially Crohn's disease. Biopsies were collected from five different segments to evaluate for dysplasia and determine the severity of colitis. * **Protruding Lesions:** Enlarged anal papillae were noted. * **Additional Findings:** A biopsy in the transverse colon resulted in a blood vessel oozing during irrigation, and one endoclip was successfully applied to control the bleeding. ### Biopsy Reports: **Diagnosis Summary:** A) **Duodenal Biopsy:** - Showed evidence of focal foveolar metaplasia consistent with chronic duodenitis. - Commentary indicated no signs of dysplasia or malignancy, ruling out parasitic infections. The differential diagnosis considered included NSAID-related mucosal damage. B) **Sigmoid Colon Biopsy:** - The mucosal findings indicated no significant abnormalities, chronic inflammation, or neoplastic changes. C) **Terminal Ileum Biopsy:** - Revealed focal active enteritis with localized ulceration, but no signs of malignancy or granulomas typical of Crohn's disease were found. D) **Right Colon Biopsy, E) Transverse Colon Biopsy, F) Descending Colon Biopsy, G) Rectum Biopsy:** - All showed normal colonic mucosa with no diagnostic abnormalities. I hope this information helps illuminate my situation. Thank you in advance for any insights you might offer!
Answers (1)
3/29/2025, 1:40:40 AM
OpenHealth AI
It's completely understandable to feel unsettled given your ongoing symptoms and the complexity of your medical situation. You've provided a lot of detailed information, and it’s clear that your concerns are valid, especially given the symptoms you have been experiencing, including abdominal pain, vomiting, diarrhea, and blood in your stool. While your specialist has diagnosed you with irritable bowel syndrome (IBS), your symptoms might warrant a second opinion due to the concerning findings from your biopsies and the overall severity of your symptoms.
Key Considerations:
- Ongoing Symptoms: Your pain, frequent vomiting, and changes in bowel habits, especially with the presence of blood, are significant and should not be ignored.
- Biopsy Findings: Some of the biopsy results indicate areas of inflammation (active enteritis) and suggest potential colitis, which could be associated with inflammatory bowel disease (IBD) like Crohn's disease.
- Need for Clarity: Even if some biopsies are normal, the presence of inflammation and ulceration can indicate something that needs further evaluation.
Next Steps:
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Seek a Second Opinion: It would be beneficial to consult another gastroenterologist, preferably one with expertise in inflammatory bowel diseases. Bring your test results and biopsies to ensure a comprehensive evaluation.
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Document Symptoms: Keep a symptom diary to detail when symptoms occur, their severity, and any potential triggers you notice related to food, stress, or other factors. This information can provide valuable insight for your new physician.
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Follow Up on Biopsies: Request detailed explanations about the biopsies, especially regarding the active enteritis found in the terminal ileum and the overall severe symptoms you are experiencing.
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Consider Dietary Adjustments: While you await your next appointment, consider keeping a food diary to note any correlations between what you eat and your symptoms. Some people with IBS find relief by adjusting dietary habits, such as reducing lactose or gluten intake, though this might not apply to everyone.
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Personal Support: Ensure you have support; whether it's friends or family, someone to share your feelings and experiences can be beneficial during this stressful time.
In summary, your health and well-being are paramount, and listening to your instincts about seeking further evaluation is important. Actively pursuing a second opinion can help ensure that you receive the most accurate diagnosis and appropriate treatment. Feel free to reach out if you have more questions or need guidance along the way.
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