Beyond the Pylorus

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Beyond the Pylorus

• Helen M. Shields, MD, AGAF
• Moderator

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Case 32 Year Old Dance Instructor with
Diarrhea, Bloating, Gas and Excessive Mucus

• The patient notes she was fine until three months
  ago when she developed crampy diarrhea in Belize.
  The resort physician prescribed a quinolone
  antibiotic. Her stools returned to normal except
  for excess mucus.
• After the flight home, she noted fever, nasal
  stuffiness and right facial pain and was
  diagnosed with sinusitis and given
  amoxicillin-clavulinic acid for two weeks. After
  ten days of treatment she noted three to five
  loose stools per day. A C. difficile toxin test
  was negative.
• Stopping milk seemed to decrease the frequency.
  She wonders if other foods are contributing to
  her symptoms.

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Beyond the PylorusQuestions

• Could she have a lingering infectious cause of
  diarrhea from Belize?
• Does she have C. difficile?
• Is testing for lactose or wheat intolerance
  recommended?
• What is the work-up for chronic diarrhea?
• How do you diagnose a post-infectious irritable
  bowel?
• Will probiotics be helpful?