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Possible Small Bowel Strictures?

Hey guys, im new to the forum and have been reading all sorts of threads of undiagnosed members on here.

As a kid I had terrible on and off stomach pains and was always very gassy and backed up. I had food allergy tests done and small bowel follow throughs done. Nothing showed up on any tests. Recently, im 19 now, i had an upper and lower scope done. I had mild inflammation in my stomach and duodenum and not much in my colon. The biopsies came back negative for IBD. Also had another small bowel follow through and nothing showed.

Current symptoms:
Terrible bloating after eating most of the time
Sometimes cant eat again for 6-8 hours after eating
Very loud strange noises coming from my gut
Crampy aches in my gut
Bad reflux
pretty normal bowel movements despite the pain and distention
Trapped gas

I was wanting to know if anyone out there has had negative small bowel follow throughs but later found that they had strictures. I know the terrible bloating and gurgling is a sign of partial obstruction. What do you guys think?
 
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dave13

Forum Monitor
Location
Maine
Welcome,have you checked out posts in the intestinal blockage/obstruction support group section? Might be something there. I did have stricturing and eventual blockage in my duodenum but not after a negative test.
 
Welcome,have you checked out posts in the intestinal blockage/obstruction support group section? Might be something there. I did have stricturing and eventual blockage in my duodenum but not after a negative test.

What were your symptoms with that?
Thanks
 

dave13

Forum Monitor
Location
Maine
This was before I knew it was crohn's.Over the course of several months I would wake up at 2a.m. feeling awful,cramps in my abdomen.It was mild at first and I would feel better the next day.Long story short:eek:ver the course of a couple days it progressed to the point I was violently ill vomiting and the abdominal pain was intense daily at 2-3am.I went to the ER and through MRI,x-ray and ultrasound I was told it looked like a blockage.I had emergency surgery.It ended up being about 8 inches in my duodenum completely blocked.
 
This was before I knew it was crohn's.Over the course of several months I would wake up at 2a.m. feeling awful,cramps in my abdomen.It was mild at first and I would feel better the next day.Long story short:eek:ver the course of a couple days it progressed to the point I was violently ill vomiting and the abdominal pain was intense daily at 2-3am.I went to the ER and through MRI,x-ray and ultrasound I was told it looked like a blockage.I had emergency surgery.It ended up being about 8 inches in my duodenum completely blocked.
Wow! Had you had any previous supsicion of having crohns or did it just hit you that quickly? I havent experienced the vomitting yet but maybe it just isnt a full blockage yet either. Did you notice the weird gurgles and noises?
 

dave13

Forum Monitor
Location
Maine
I had no suspicion of crohn's.I have no family member that had/has crohn's.In retrospect I did have trouble when laying down for bed.I would get what I thought was acid reflux,a burning in my esophagus.It wasn't every night and coincided with eating late and alcohol.I don't have that anymore.I also don't eat late and rarely drink alcohol now.The time it went from mild cramping to violent vomiting and intense pain was no more than 48 hours.It was quick.
 
I had no suspicion of crohn's.I have no family member that had/has crohn's.In retrospect I did have trouble when laying down for bed.I would get what I thought was acid reflux,a burning in my esophagus.It wasn't every night and coincided with eating late and alcohol.I don't have that anymore.I also don't eat late and rarely drink alcohol now.The time it went from mild cramping to violent vomiting and intense pain was no more than 48 hours.It was quick.
I also get pretty bad acid reflux, ive been on meds for that and it didnt help much. Hopefully i get this figure out before it turns into an ER visit!
Thanks for the info
 

dave13

Forum Monitor
Location
Maine
I had what I thought was acid reflux for years.It can't be a coincidence it is gone after my resection.I see my surgeon this week and I will bring this up with him and see what he says.I'll let you know.
 
Hubby had blockage/obstruction small intestine back in 2006 he had a fever, severe cramping and vomiting. He was in the hospital for 11 days.
 
Many things can cause bloating and gurgling. Sometimes a bowel blockage can be indicated by a complete lack of noises. When I was in hospital my digestive system became paralysed (not the same as a blockage caused by strictures, but some similarities) and the doctors noted the lack of bowel noises and that was a bad sign.

Are all your symptoms chronic (i.e. have been going on weeks or months) or have you some at present that are new or of a new intensity? In particular, were you having symptoms at the time your tests were done? Did the doctors have any idea what the cause of your inflammation was if not IBD? (Sorry for all the questions!)

One thing you might want to look into: gastroparesis. There's a thread here: http://www.crohnsforum.com/showthread.php?t=58725 This condition isn't actually related to Crohn's usually - the thread is mainly because some of us have Crohn's and gastroparesis.

I mention gastroparesis as it can produce many of the symptoms you're having, especially not being able to eat for long periods and bloating.

However, I'm always wary of self-diagnosis. Don't assume you have a condition just because you have a lot of the symptoms - this goes for both gastroparesis and obstructions. So many conditions can cause digestive symptoms, and the only way you'll get real answers is having further testing. It can certainly be helpful to research the symptoms you're having, but just keep in mind that it's very hard to reach a diagnosis correctly in this way. If you're really concerned you have an obstruction or partial-obstruction, you should be seeking medical help straightaway. I think the first thing you should do is consider if you feel ill enough to be seeking urgent medical attention, or whether you've been able to deal with these symptoms for quite a while already without any immediate serious complications arising.
 
Many things can cause bloating and gurgling. Sometimes a bowel blockage can be indicated by a complete lack of noises. When I was in hospital my digestive system became paralysed (not the same as a blockage caused by strictures, but some similarities) and the doctors noted the lack of bowel noises and that was a bad sign.

Are all your symptoms chronic (i.e. have been going on weeks or months) or have you some at present that are new or of a new intensity? In particular, were you having symptoms at the time your tests were done? Did the doctors have any idea what the cause of your inflammation was if not IBD? (Sorry for all the questions!)

One thing you might want to look into: gastroparesis. There's a thread here: http://www.crohnsforum.com/showthread.php?t=58725 This condition isn't actually related to Crohn's usually - the thread is mainly because some of us have Crohn's and gastroparesis.

I mention gastroparesis as it can produce many of the symptoms you're having, especially not being able to eat for long periods and bloating.

However, I'm always wary of self-diagnosis. Don't assume you have a condition just because you have a lot of the symptoms - this goes for both gastroparesis and obstructions. So many conditions can cause digestive symptoms, and the only way you'll get real answers is having further testing. It can certainly be helpful to research the symptoms you're having, but just keep in mind that it's very hard to reach a diagnosis correctly in this way. If you're really concerned you have an obstruction or partial-obstruction, you should be seeking medical help straightaway. I think the first thing you should do is consider if you feel ill enough to be seeking urgent medical attention, or whether you've been able to deal with these symptoms for quite a while already without any immediate serious complications arising.
The pain and bloat and noises have been going on for about a year now. The bloat and pain ive had most of my life that i can remember but the noises are new to the past year or so. I had all these tests recently and am scheduled to talk with my GI in two weeks. Ive heard that a sign of partial blockage or narrowing can be the noises though because the bowels have to push harder to get the food through. I can literally feel stuff moving around constantly and with the noises i get a slight release in pressure. The minor inflammation she said was maybe just caused by some sort of bacteria and maybe h pylori even though i tested neg for that. The antibiotic regimen did not help at all so i have no idea whats going on

Being in college the noises are very hard to deal with. I dread taking exams becuase of this and its really affecting my grades.

Any suggestions on what i should ask/bring up when i go see my GI?
 
The pain and bloat and noises have been going on for about a year now. The bloat and pain ive had most of my life that i can remember but the noises are new to the past year or so. I had all these tests recently and am scheduled to talk with my GI in two weeks. Ive heard that a sign of partial blockage or narrowing can be the noises though because the bowels have to push harder to get the food through. I can literally feel stuff moving around constantly and with the noises i get a slight release in pressure. The minor inflammation she said was maybe just caused by some sort of bacteria and maybe h pylori even though i tested neg for that. The antibiotic regimen did not help at all so i have no idea whats going on

Being in college the noises are very hard to deal with. I dread taking exams becuase of this and its really affecting my grades.

Any suggestions on what i should ask/bring up when i go see my GI?
To be honest it sounds to me unlikely that you have a blockage. I'm not an expert of course, but as far as I know, a blockage is something you'd normally know about - it wouldn't be something that would go on chronically.

Noises can occur with a blockage, but my point was that so can the absence of sound - i.e. trying to deduce what is wrong with you by what symptoms you have is very tricky! Many conditions produce the same symptoms, sometimes one condition can cause opposing symptoms (e.g. a blockage could cause noises in one person, and silence in another).

I get how hard it is to cope with the noises. I had the same thing all through school and uni. Now I have an ileostomy which makes incredibly embarrassing noises. But through all those years of noises, I never had a blockage or obstruction... and when I did, it caused a lack of bowel sounds.

Do you think it would help if you explain to your friends and teachers that you are unwell and that your stomach may make noises? Sometimes it helps to get it out of the way - tell everyone that you're under investigation by doctors, and that your stomach may make noises. Then you won't have to worry about what people are thinking - they'll be thinking the truth - that you have a medical condition. It may also be worth making an arrangement that I had when at university: it was arranged with the university that I would sit my exams in a separate room rather than in a big exam hall with everyone else. I was allowed breaks to go and use the bathroom whenever I needed them, without time being missed from the exam - they'd stop the clock while I went to the bathroom, and since I was separate from other students, I wouldn't disturb them by leaving the room. I needed a doctors note to say that my breaks were for medical reasons, but the uni and my doctor were very accommodating.

Perhaps you could arrange something similar - either to sit your exams separately (I had just one invigilator present to ensure I wasn't cheating) so you're free from the embarrassment of everyone hearing the noises, or to arrange for breaks so if your stomach gets noisy only for short periods, you can leave the exam hall and come back when it's quietened down.

Definitely keep pushing your doctor for further tests. Have you been tested for coeliac disease or lactose intolerance? These are some of the most common causes of digestive problems in young people besides IBD. But I honestly don't think it sounds like you have an obstruction.
 
To be honest it sounds to me unlikely that you have a blockage. I'm not an expert of course, but as far as I know, a blockage is something you'd normally know about - it wouldn't be something that would go on chronically.

Noises can occur with a blockage, but my point was that so can the absence of sound - i.e. trying to deduce what is wrong with you by what symptoms you have is very tricky! Many conditions produce the same symptoms, sometimes one condition can cause opposing symptoms (e.g. a blockage could cause noises in one person, and silence in another).

I get how hard it is to cope with the noises. I had the same thing all through school and uni. Now I have an ileostomy which makes incredibly embarrassing noises. But through all those years of noises, I never had a blockage or obstruction... and when I did, it caused a lack of bowel sounds.

Do you think it would help if you explain to your friends and teachers that you are unwell and that your stomach may make noises? Sometimes it helps to get it out of the way - tell everyone that you're under investigation by doctors, and that your stomach may make noises. Then you won't have to worry about what people are thinking - they'll be thinking the truth - that you have a medical condition. It may also be worth making an arrangement that I had when at university: it was arranged with the university that I would sit my exams in a separate room rather than in a big exam hall with everyone else. I was allowed breaks to go and use the bathroom whenever I needed them, without time being missed from the exam - they'd stop the clock while I went to the bathroom, and since I was separate from other students, I wouldn't disturb them by leaving the room. I needed a doctors note to say that my breaks were for medical reasons, but the uni and my doctor were very accommodating.

Perhaps you could arrange something similar - either to sit your exams separately (I had just one invigilator present to ensure I wasn't cheating) so you're free from the embarrassment of everyone hearing the noises, or to arrange for breaks so if your stomach gets noisy only for short periods, you can leave the exam hall and come back when it's quietened down.

Definitely keep pushing your doctor for further tests. Have you been tested for coeliac disease or lactose intolerance? These are some of the most common causes of digestive problems in young people besides IBD. But I honestly don't think it sounds like you have an obstruction.
I have been tested for food allergies and gluten intolerance but nothing showed up. I will look into the accomodations im sure i could arrange something. Ive tried medicine that premotes intestinal contractions (prokinetic agents) and ive tried stuff that does the opposite (donnatal and bentyl) neither one seemed to make any difference in any of the symptoms. Do you think the rumbling could just be from active inflammation in the small intestine that they could not see with a scope?

Im going to ask my GI about a pill cam as the problem does seem to be in my small bowel.
 
I have been tested for food allergies and gluten intolerance but nothing showed up. I will look into the accomodations im sure i could arrange something. Ive tried medicine that premotes intestinal contractions (prokinetic agents) and ive tried stuff that does the opposite (donnatal and bentyl) neither one seemed to make any difference in any of the symptoms. Do you think the rumbling could just be from active inflammation in the small intestine that they could not see with a scope?

Im going to ask my GI about a pill cam as the problem does seem to be in my small bowel.
In my case the noises were just because a poorly functioning produces a lot of trapped wind! It's not related to where or how severe my inflammation is. Between an upper and lower scope they will have seen most of your intestines. What makes you think the problem is in your small bowel?
 
In my case the noises were just because a poorly functioning produces a lot of trapped wind! It's not related to where or how severe my inflammation is. Between an upper and lower scope they will have seen most of your intestines. What makes you think the problem is in your small bowel?
A poorly functioning what?

I also can get terrible trapped wind. Its painful!

Usually it occurs about 30 minutes after i eat rather than right away. Its also across my whole belly button region. Plus the colonoscopy didnt show anything abnormal. I know there is some sort of issue and i know that neither scope reaches very far into the small bowel so my conclusion is that it has to be there. I could be wrong but i just dont see the pain/noises/and bloat being IBS. I had an irritable stomach growing up but nothing like this
 
A poorly functioning what?

I also can get terrible trapped wind. Its painful!

Usually it occurs about 30 minutes after i eat rather than right away. Its also across my whole belly button region. Plus the colonoscopy didnt show anything abnormal. I know there is some sort of issue and i know that neither scope reaches very far into the small bowel so my conclusion is that it has to be there. I could be wrong but i just dont see the pain/noises/and bloat being IBS. I had an irritable stomach growing up but nothing like this
Sorry - missed some words out! A poorly functioning digestive tract.

If you believe it's something more than IBS, stick by your instincts. The difficulty is that not all the problems that can affect digestion are visible with endoscopy, or pill cam. For example, neurological conditions may not produce any inflammation, but they can certainly cause digestive symptoms (look up autonomic neuropathy if you're interested - this term covers many different conditions, many of which cause digestive problems, but is not diagnosed by endoscopy). Diseases or injuries affecting the brain or spinal cord can affect the digestive system (Parkinsons, MS, etc.).

I don't think you need to worry about any of these diseases affecting you, but I mention them to get across the idea that simply seeing your digestive tract with a camera may not identify the cause of your symptoms, even if the doctors are able to see all your digestive tract with a pill cam.

One thing which might relate to your problems is a motility disorder. This is another broad term which encompasses many different problems - the gastroparesis which I mentioned earlier in this thread is often classified as a digestive system motility disorder, for example - and there are various tests which can be performed to assess the motility of your digestive system, e.g. which measure how long it takes food to exit your stomach, or how long it takes for your bowel to empty. These conditions wouldn't always be found with a camera.

But that doesn't mean the pill cam won't show anything wrong - if you feel strongly that there's inflammation or a stricture somewhere, and your doctor agrees it's worth doing a pill cam, it's certainly not a bad idea and may identify something, or if not at least it will rule more things out.

But basically what I'm saying is that although it is possible for a pill cam to pick up on Crohn's when scopes haven't, you may find the pill cam also comes back negative, as there are many conditions that could be causing your symptoms which can't be diagnosed that way.

Btw - have you had any abnormalities in blood tests that suggest inflammation? With Crohn's, although it is possible to flare without bloods being abnormal, many people with Crohn's do have abnormal blood results which indicate inflammation or infection is present. Blood tests for people with Crohn's also sometimes show deficiencies - for example, anaemia (lack of iron). Also you can sometimes have a high temperate when you flare. These are all pretty simple tests and while they wouldn't specifically identify Crohn's, they can suggest the presence of an inflammatory process which would in turn suggest Crohn's to be a possible cause of your symptoms.
 
As far as blood tests go i dont know what they actually did but nothing came back abnormal. I know they tested for allergies but as far as inflammation goes im not sure. I will ask my GI about what blood tests were done and possible motility tests. I have tried medicine that should help with that and i didnt have any results.

Do you know of any medicines or treatments that should help with this? It makes sense because when i wake up i am full of gas and i cant pass any and then in about an hour it all starts to come out and i feel a little better. But i still have issues when eating later
 
As far as blood tests go i dont know what they actually did but nothing came back abnormal. I know they tested for allergies but as far as inflammation goes im not sure. I will ask my GI about what blood tests were done and possible motility tests. I have tried medicine that should help with that and i didnt have any results.

Do you know of any medicines or treatments that should help with this? It makes sense because when i wake up i am full of gas and i cant pass any and then in about an hour it all starts to come out and i feel a little better. But i still have issues when eating later
I never had any success with the standard "IBS" medications that are supposed to reduce wind either. But I know that for some people changing diet can help. Even before my ileostomy, I had a lot of problems digesting fibre and my symptoms (diarrhoea, wind and general discomfort) are significantly better on a low fibre diet. Now with the ileostomy I have to stick to a low fibre diet to avoid blockages anyway. Were you only tested for food sensitivities by blood test? I believe there are other ways for testing for coeliac disease and lactose intolerance besides blood tests. There is a diets section on this forum, but I'd be wary of trying any extreme diet, and don't give up any foods or food group unless test results show something is a problem for you. Reducing fibre isn't so extreme, so that may be something you could try.

I did used to find that loperamide and Lomotil helped with diarrhoea and discomfort. They're primarily for diarrhoea so I don't know if they'd help you, but I definitely found that as they slowed my digestive tract they made me generally more comfortable as well.

There are lots of meds for reflux - I'm guessing you've already tried some? I am generally given ranitidine to take before I have surgery (because it's dangerous to have reflux when under general anaesthetic, the doctors always give me a high dose of ranitidine before surgery). I used to take domperidone to help with nausea and fullness; it helped a bit for a little while but then seemed to stop working. At the moment my doctors have been prescribing various PPIs to try for reflux, but not much luck so far. I know that in extreme cases there are surgical procedures which can be performed to help with reflux and fullness.

I'm a big believer in keeping on trying medications and surgery until I find something that works. There's a seemingly never-ending list of treatments available, if you can find a doctor who will work with you and make sure everything you try is done safely. Personally I don't believe in any alternative medicine - every alternative treatment I tried was at best a waste of time. But I've had luck in finding treatments within mainstream medicine for various health problems that I have. It just takes a lot of trial and error, and finding a good doctor (or doctors) is important. If the pill cam doesn't come back with a conclusive diagnosis, it may be worth discussing with your doctor the possibility of aiming to treat the symptoms now rather than focussing on determining a diagnosis first, as the diagnostic process can take a long time.

Btw with the problems you have eating, have you lost weight at all? Unintentional weight-loss should signal to your doctors that there is something more than IBS going on - by definition, IBS cannot cause unintentional weight-loss. In fact, in someone young like you who is still growing, it doesn't even always take weight-loss to signify something is wrong with your digestion - failing to gain weight as you should at your age is also an indication that something more than IBS is going on, so if your weight has stayed the same for a while, definitely make a point of bringing it up with your doctors. If your doctors don't seem to be that concerned or are making you wait a long time for tests, if you are losing weight or failing to gain it, that may be something to focus on during appointments, as it is not something they can disregard as "just IBS".

(Other indicators that it's not IBS are fever and passing blood, which in many cases suggest to a doctor that Crohn's or ulcerative colitis are more likely than IBS.)

And was it ever suggested to you that the inflammation found could have been the result of reflux? I get such bad reflux, and when I had an upper endoscopy, they found severe inflammation in my stomach and oesophagus, that was distinct from Crohn's inflammation - my stomach was inflamed (gastritis) from the contents of my intestine flowing back up from my intestine, and my oesophagus was inflamed (oesophagitis) from the stomach contents flowing back up my throat.
 
I never had any success with the standard "IBS" medications that are supposed to reduce wind either. But I know that for some people changing diet can help. Even before my ileostomy, I had a lot of problems digesting fibre and my symptoms (diarrhoea, wind and general discomfort) are significantly better on a low fibre diet. Now with the ileostomy I have to stick to a low fibre diet to avoid blockages anyway. Were you only tested for food sensitivities by blood test? I believe there are other ways for testing for coeliac disease and lactose intolerance besides blood tests. There is a diets section on this forum, but I'd be wary of trying any extreme diet, and don't give up any foods or food group unless test results show something is a problem for you. Reducing fibre isn't so extreme, so that may be something you could try.

I did used to find that loperamide and Lomotil helped with diarrhoea and discomfort. They're primarily for diarrhoea so I don't know if they'd help you, but I definitely found that as they slowed my digestive tract they made me generally more comfortable as well.

There are lots of meds for reflux - I'm guessing you've already tried some? I am generally given ranitidine to take before I have surgery (because it's dangerous to have reflux when under general anaesthetic, the doctors always give me a high dose of ranitidine before surgery). I used to take domperidone to help with nausea and fullness; it helped a bit for a little while but then seemed to stop working. At the moment my doctors have been prescribing various PPIs to try for reflux, but not much luck so far. I know that in extreme cases there are surgical procedures which can be performed to help with reflux and fullness.

I'm a big believer in keeping on trying medications and surgery until I find something that works. There's a seemingly never-ending list of treatments available, if you can find a doctor who will work with you and make sure everything you try is done safely. Personally I don't believe in any alternative medicine - every alternative treatment I tried was at best a waste of time. But I've had luck in finding treatments within mainstream medicine for various health problems that I have. It just takes a lot of trial and error, and finding a good doctor (or doctors) is important. If the pill cam doesn't come back with a conclusive diagnosis, it may be worth discussing with your doctor the possibility of aiming to treat the symptoms now rather than focussing on determining a diagnosis first, as the diagnostic process can take a long time.

Btw with the problems you have eating, have you lost weight at all? Unintentional weight-loss should signal to your doctors that there is something more than IBS going on - by definition, IBS cannot cause unintentional weight-loss. In fact, in someone young like you who is still growing, it doesn't even always take weight-loss to signify something is wrong with your digestion - failing to gain weight as you should at your age is also an indication that something more than IBS is going on, so if your weight has stayed the same for a while, definitely make a point of bringing it up with your doctors. If your doctors don't seem to be that concerned or are making you wait a long time for tests, if you are losing weight or failing to gain it, that may be something to focus on during appointments, as it is not something they can disregard as "just IBS".

(Other indicators that it's not IBS are fever and passing blood, which in many cases suggest to a doctor that Crohn's or ulcerative colitis are more likely than IBS.)

And was it ever suggested to you that the inflammation found could have been the result of reflux? I get such bad reflux, and when I had an upper endoscopy, they found severe inflammation in my stomach and oesophagus, that was distinct from Crohn's inflammation - my stomach was inflamed (gastritis) from the contents of my intestine flowing back up from my intestine, and my oesophagus was inflamed (oesophagitis) from the stomach contents flowing back up my throat.
The tests they did for all food allergies were by blood so far. I never really get the D im mostly pretty regular if i eat decent. Sometimes when i have a bad flare of pain my stool is a little looser and kind of burns, also pretty thin. But not D. The inflammation they found in the stomach and throat was thought to be reflux so i was put on a PPI and it helped somewhat with the reflux but all other symptoms were the same. Reflux still does not explain the mild inflammation in the duodenum and stomach really. Those places are supposed to have acid right?

Also i have tried going low fiber. It doesnt really help with gas it just makes me less regular. Any Carbohydrates seem to just turn straight into gas and proteins and fats im not sure about. Sometimes fatty stuff makes the pain worse and other times im fine with it
 
The inflammation they found in the stomach and throat was thought to be reflux so i was put on a PPI and it helped somewhat with the reflux but all other symptoms were the same. Reflux still does not explain the mild inflammation in the duodenum and stomach really. Those places are supposed to have acid right?
Reflux can cause inflammation in the stomach, it's just a different kind of reflux. I have inflammation in the stomach (gastritis) from bile reflux: http://www.mayoclinic.org/diseases-conditions/bile-reflux/basics/definition/con-20025548
 
What can you do to treat bile reflux? Also could this cause problems elsewhere? Ive heard of people having problems with an overactive gall bladder.
Check out the link I gave you and click on the "Treatments and drugs" and other sections on the menu on the left-hand side - it explains better than I can.
 
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