How can chronic diarrhoea be treated?

Q: I am a 50 years old woman suffering from slight diarrhoea for the last one year. I have taken antibiotics and completed my medication course. After the completion of medication course, the symptoms recurred within a week or 10-15 days. Three months back, I consulted a gastroenterologist who asked me to undergo sonography, endoscopy and colonoscopy. After reviewing all the reports, doctor told me that I have a sub-mucosal bulge just above the GI area. The doctor advised me to undergo chest CT scan and prescribed Secnil 500, single dose and Doxycycline for two months. Recently my husband had a heart attack and I was unable to maintain the further treatment. Now the medication is over and I am experiencing gastric problem and stomach ache. What is sub-mucosal bulge? How can it be treated?

A:Chronic diarrhoea can be a very distressing symptom and I note that you have had a few essential investigations carried out by a gastroenterologist. The "bulge" mentioned by your specialist is something I cannot comment on as I do not know what he meant. Long term antibiotics do not appear to have helped, as I note in your mail. You need to get your colon and small bowels reexamined endoscopically with multiple biopsies to see if you have inflammatory bowel disease and if so control of symptoms can be achieved with appropriate therapy.

Another important condition that needs exclusion is coeliac disease which is due to wheat allergy and can be tested by biopsies of the small bowels and blood tests. After excluding these conditions you need to exclude infections both bacterial and parasitic which your specialist will be able to do. If all investigations are normal one has to accept the diagnosis of irritable bowel syndrome and get symptomatic treatment from your doctor.