Gastroenterology
IBS, Celiac, Whipple, Lactose
Gastroenterology

IBS, Celiac, Whipple, Lactose

Functional vs malabsorption.

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◆IBS (Rome IV)

  • •Recurrent abdominal pain ≥1 day/week for 3 months + ≥2 of: relief with defecation, change in stool frequency, change in form
  • •Red flags (require workup): weight loss, anemia, GI bleed, nocturnal symptoms, age >50, FH CRC/IBD
  • •Treatment: fiber, low FODMAP, antispasmodics; linaclotide/lubiprostone for constipation; loperamide for diarrhea

◆Celiac disease

  • •Chronic diarrhea + weight loss + bloating after gluten
  • •First test: anti-tissue transglutaminase IgA + TOTAL IgA (rule out IgA deficiency)
  • •Iron deficiency anemia common; dermatitis herpetiformis association
  • •DO NOT start gluten-free diet before testing
  • •Confirm: duodenal biopsy → villous atrophy + crypt hyperplasia + ↑IELs
  • •Strict lifelong gluten-free diet

◆Whipple disease

  • •Tropheryma whipplei (gram positive)
  • •Triad: diarrhea + arthralgia + neurologic symptoms (middle-aged man)
  • •May have hyperpigmentation, lymphadenopathy
  • •Small bowel biopsy: PAS-positive foamy macrophages
  • •IV ceftriaxone × 2 weeks → PO TMP-SMX × 1 year
  • •Fatal if untreated

◆Lactose intolerance

  • •Often after viral gastroenteritis → temporary lactase deficiency
  • •Osmotic diarrhea after lactose ingestion
  • •Lactose-free formula or lactase enzyme supplementation
  • •Usually self-limited
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