
Suffering From Severe IBS-D And Arthritis. What Treatment Should Be Done?

I can fully understand your frustrations about
the ineffectiveness of the drugs that you have tried
to control the diarrhea. I am assuming that your doctors
have completley ruled out all other potential causes for
your problem including Celiac Disease, Severe Lactose
or fructose Intolerance, and Microscopic colitis by doing
biopsies.
I can see why codiene or Tramadol would work. Tramadol
is a synthetic analog of codiene and is called a pseudo-opioid.
I am sure you have also tried taking Loperimide (Imodium)
to control diarrhea.
What you don't mention is whether you are taking any
probiotics on a daily basis. If you have not tried this,
I would recommend that you go to the drug store and find
"Digestive Advantage-Irritable Bowel Syndrome XXXXXXX and start
taking it one tablet everyday. You may notice the benefits
within a couple of weeks. Also adding bulking agents daily
such as Effersyllium or Citrucel 1-2 tablespoons a day with
a glass of water will add the fiber needed and make the stool
firmer. Many think this may make the diarrhea worse, but
quite the contrary.
Recent research on IBS has shown that the drugs we treat
Inflammatory Bowel Disease such as Crohn's or ulcerative
colitis which includes Mesalamine class , can also help
IBS-D in controlling symtoms. This has to be taken in a cycliic
fashion. This is given in a dose of 750-1000mg. once a day
for a period of 12 weeks.
If the symptom relief is obvious, then the drug can be used
in a cyclic fashion , may be 10-14 days a month.
The other drug that is very effective is Rifaximin.
This drug is approved for Traveler's diarrhea and Hepatic
Encephalopathy (Severe Liver Disease). This drug is given
in a dose of 550mg. daily for two weeks. Again this can be used
in a cyclic fashion for three to six months. I think you can
discuss these opptions with your gastroenterologist or your PCP.
I personally think, Rifaximin is more locally acting drug and has
much less systemic side effects.
I wish you the very best.

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