Brief Answer: There is no direct test for gut flora Detailed Answer: Hi Mrs. XXXXXXX Thanks for your query. I fully understand your concerns about your daughter's health. I agree with you that use of excessive antibiotics can alter the gut flora and lead to a condition called malabsorption syndrome, in which the nutrients of the ingested food are poorly absorbed into the blood. There is no direct test to confirm this, except for stools examination- which will show the presence, if any, of a pathological bacterial infection of the intestine. Other causes of unexplained significant weight loss are :- 1. Colitis :- which too causes malabsorption syndrome and would be diagnosed on impending colonoscopy. 2. Disease of the Pancreas, which too impairs digestive process and causes malabsorption. Addition of digestive enzymes to Lactobacilli will give significant relief in this case. 3. A chronic bacterial infection of the intestine, such as Non-Tropical Sprue. 3. Lymphoma of the intestine. A biopsy taken during colonoscopy will be diagnostic. 4. Hyper-functioning thyroid problem (Hyperthyroidism) 5. Chronic infection, such as, Tuberculosis 6. Anorexia Nervosa, a common psychological condition seen particularly in young females, in which the patients tend to eat very little. A 4-6 weeks' course of a Probiotic such as, Lactobacilli, along with digestive enzymes will regulate the gut flora and promote absorption. You have not mentioned the various tests that have been performed. It is therefore recommended that, apart from the tests already done and, the impending gastroscopy + colonoscopy, the following tests should also be done :- * Pancreatic functions test * Evaluation for Tuberculosis * Thyroid function test, if not done so far * Breath test for H.pylori (a bacteria) infection. Consult your doctor and apprise him of my opinion. I am certain that he will agree with me and will prescribe the advised drugs in appropriate doses. I would be keenly awaiting the gastroscopy/colonoscopy reports. Hope I have addressed to your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. Take care, Dr. Rakesh Karanwal

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Brief Answer: Gastroscopy/Colonoscopy will establish the cause Detailed Answer: Thank you Mrs. XXXXXXX for the invaluable information, which has helped me in narrowing down to the diagnosis of Malabsorption Syndrome (MAS) as the most likely cause of unexplained weight loss. It would be helpful to you in learning more about MAS, in which, impaired absorption can be due to several causes, such as, Gluten or Lactose intolerance, worms infestation, amebic/H.pylori/C.diff infection, Inflammatory Bowel Syndrome (ulcerative colitis and Crohn's disease), non-specific colitis (such as, collagenous colitis), Irritable Bowel Syndrome; or- in rare cases- lymphoma of the intestine, just to name a few. Gastroscopy, colonoscopy, stools examination for bacteria/ova/cysts/worms; and, Pancreatic function tests will identify the exact cause. Let's wait for the Gastroscopy + Colonoscopy reports. PLEASE REQUEST THE DOCTOR TO TAKE A BIOPSY OF THE INNER LINING OF THE STOMACH AND COLON when conducting the referred tests. I would be very pleased if you share the reports with me, once they are available. Till then, Fond regards, Col (Dr.) Rakesh Karanwal

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