Gastrointestinal Issues: When to Consider Further Testing

Gastrointestinal issues

Thank you, doctor, for responding to my questions.
I am a patient from the article #183591 on https://adoctor.tw/article/183591.
I would like to ask if, after undergoing an enteroscopy (where a scope is inserted through the mouth to place a clip, and then through the rectum to locate the clip) and a colonoscopy, is it still necessary to perform a sigmoidoscopy? Additionally, could bowel obstruction, bowel displacement, or bowel adhesions possibly occur due to binge eating? Doctors have suspected these three conditions, but there has been no definitive diagnosis, only suspicion.
Therefore, another doctor has arranged for me to have a CT scan because the issue of bloating is very troubling for me; I experience bloating after eating, along with a feeling of tightness in my right flank, and sometimes a sensation of a foreign body in the right upper abdomen.
It improves somewhat after passing gas or having a bowel movement.
I don't understand why I had no issues after fasting and losing weight; I didn't experience stomach pain or bloating then.
I was able to live normally for seven days, which led me to binge eat one meal, after which the sudden bloating and sensation of a foreign body have persisted for a year.
This is why I am considering laparoscopic examination, but I am concerned about potential additional harm.
Since this has affected my daily life, could you recommend any doctors in the Taipei area who could help me, either in internal medicine or surgery?
Additionally, I found an X-ray from before my fasting and weight loss, which seems to show some intestinal gas, but at that time, I had no symptoms.
I have saved it in the file name.
Could you please check if there are any clues from it? Is it possible that when you reviewed the X-ray, you confused the pre-existing intestinal gas with the condition I later developed? Thank you, doctor.

Zhang Ke O, 30~39 year old female. Ask Date: 2022/07/03

Dr. Ke Fangxu reply Surgery

If you have already undergone both a colonoscopy and an enteroscopy, then there is no need to perform a sigmoidoscopy.
I do not recommend laparoscopic surgery either, and I certainly would not suggest it to your physician.
The presence of gas in the intestines is a natural phenomenon.
I hope you trust your doctor and refrain from overthinking or coming up with your own ideas.

Reply Date: 2022/07/03

More Info

When it comes to gastrointestinal issues, understanding when to consider further testing is crucial for effective diagnosis and treatment. Based on your situation, it seems you have undergone both small bowel and colonoscopies, which are significant diagnostic procedures. However, the necessity for a sigmoidoscopy (a procedure that examines the lower part of the colon) depends on several factors, including your symptoms, previous findings, and the specific concerns your healthcare provider has.

When to Consider Further Testing
1. Persistent Symptoms: If you continue to experience symptoms such as bloating, abdominal pain, or changes in bowel habits despite previous testing, it may warrant further investigation. Symptoms that persist or worsen can indicate underlying issues that may not have been fully addressed by earlier procedures.

2. Previous Findings: If your previous tests revealed any abnormalities or if there were areas that could not be fully assessed (for example, due to fecal impaction), additional testing may be necessary to ensure that no significant pathology is overlooked.

3. New Symptoms: The emergence of new symptoms, such as significant weight loss, persistent pain, or changes in appetite, should prompt a reevaluation of your condition and possibly further testing.

4. Concern for Specific Conditions: If there is a suspicion of conditions such as bowel obstruction, adhesions, or other structural issues, imaging studies like a CT scan can provide valuable information. In your case, the CT scan may help clarify the cause of your bloating and discomfort.

Addressing Your Concerns
Regarding your concerns about bowel twisting, displacement, or adhesions due to overeating, it is essential to understand that while overeating can lead to temporary discomfort and bloating, it is less likely to cause significant structural changes like adhesions or twisting of the intestines. These conditions are typically associated with previous surgeries, inflammatory diseases, or other underlying issues.

If you are experiencing persistent bloating and discomfort after eating, it may be beneficial to explore dietary modifications, such as reducing portion sizes, avoiding certain trigger foods, or considering a low-FODMAP diet, which can help alleviate symptoms of bloating and gas.

Diagnostic Imaging and Procedures
The decision to undergo laparoscopic surgery or any invasive procedure should be made carefully, weighing the potential benefits against the risks. If your symptoms significantly impact your quality of life and non-invasive measures have not provided relief, discussing the possibility of laparoscopic exploration with your healthcare provider may be warranted.

Recommendations for Specialists
In terms of finding a specialist in Taipei, I recommend seeking a gastroenterologist who has experience with functional gastrointestinal disorders, as they can provide a comprehensive evaluation of your symptoms. You may also consider consulting a surgeon if there is a suspicion of structural issues that may require surgical intervention.

Conclusion
In summary, if your symptoms persist or worsen, or if new symptoms arise, further testing may be necessary. It is essential to maintain open communication with your healthcare provider about your concerns and symptoms. They can guide you through the decision-making process regarding additional testing and potential treatments. Always ensure that any diagnostic imaging or procedures are justified based on your clinical presentation and history.

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