Question: Hi,
I was diagnosed with TB 4 months back.
These were my complaints, symptoms and findings:
Abdominal pain and crampy feeling
Loss of appetite
Weight Loss around 4-5 kg
Slight breathing problem
My doctor advised me to do ultrasound and CT-Scan abdomen
Ultrasound revealed mild ascitis and moderate right pleural effusion (echogenic lesions were found on the liver which were attributed to benign haemangiomia which they said didnt require any treatment)
CXR revealed passive atelectasis of right lung,pleural effusion,enlarged mammary and cardio phrenic lymphnodes and parenchymal scars
CT abdomen showed mild peritoneal thickening,moderate ascitis,heterogeneously enhancing necrotic mesenteric and retroperitoneal lymphnodes, omental nodules, multifocal circumferential symmetric small bowel wall thickening
Ascitic and pleural fluid was aspirated.
Malignancy test was negative
WBC and RBC counts were higher in ascitic fluid
There was exudative lymphocytic effusion in both .pleural and ascitic fluid
ADA level was 36 in pleural and 40 in ascitic fluid
GeneXpert came -ve but based on above findings I was started on TB treatment
In follow up ultrasound after 1.5 months, pleural effusion and ascitis were not found
Some retroperitoneal lymphadenopathy was dere.
After 5 months, I still have almost a constant crampy abdominal pain..nd lot of burping and belching nd wind movement and gas formation..also frequent bloating..weight gain is not much around 1-1.5 kg
Stools are sometimes slightly constipated
Started with IMG,Rifamicin,Ethambutol nd Pyrazinamide for 2 months
Now continuing with R-Cinex
Antacids like Pantocid and digestives like aristozyme haven't really solved the digestive problem
Do such digestive symptoms appear in abdominal tb?it's causing lot of anxiety and making me feel low
I can attach my reports if requested
Could I be having some functional problem like IBS?
I did an upper GI endoscopy after completing 4 months..everything was normal..
I had the following queries
1.The thing disturbing me is the persistent stomach pain(crampy feeling and frequent distened abdomen).It is of diffuse nature.It stays all the time.Only changes in intensity with burping and passing wind.Food absorption is not happening properly and whatever I eat(even bland food) there is associated burping, belching and passing wind(count would be around 50 times a day I think).Also wind is trapped most of the time,drinking water helps release some of it.But there has never been any vomiting.When I drink water it forced out some gas..as a result I have not gained much weight also..like 1-1.5kg only in 4 months.Is the bowel wall thickening causing the digestive issues?Can exercises and yoga help?
2.Do you have any patients under you for abdominal TB currently or recently cured.Did they have such severe gastrointestinal symptoms or just mild gastritis?A word or two with them can help me a lot psychologically(I am under immense stress because I am in the dark about how its healing because people keep telling that one should gain more weight when one is responding to the treatment) at least on the initial symptoms and the impact after taking meds and the rate of healing.If possible can you share any of their contact details?Also my doctor says after 6 months CT will be done and most likely my treatment may be extended for 1-3 months more.How long(no of months-people keep saying that in 3-4 months people start feeling better usually) did your abdominal TB patients take to feel better and improved and relieved of GI symptoms
3.My diet is as follows usually( 4 times a day):
Breakfast(R-cinex 1 hour before breakfast in empty stomach) at around 9-9.30 am comprising of 2-3 cut fruits(1 apple, 1 banana, 1 orange/pomegranate) followed by a boiled egg and cornflakes/milk
Lunch around 1-2 pm comprising of rice,dal+vegetable curry/paneer curry/soyabean and rarely chicken/fish(maybe 2 times a month)
Snacks around 6-7 pm(dates or threptin biscuits with a glass of milk)
Dinner around 10-10.30 comprising of chapatti and some veg curry(mix of carrot,brinjal,potato)/ridge gourd/bottle gourd/paneer/soya/lady's finger etc.
Do you want to recommenced any changes?Could I be having some food allergy? I sometimes oversleep as I feel low and depressed...does that lead to more digestion probs?
4.Also my ascitic and pleural fluid culture failed to detect bacteria but doctor said that since fluids were resorped after 6 weeks,it is responding and i should continue. Also my ESR before hospital discharge hovered around 12(which they said high indicating inflammation). Last month it came 22.I know its non specific test but still any conclusions from it?Can chron's/IBS cause pleural effusion?
If you don't mind can you share me your mail id/contact no so that i can have a brief minute discussion?

Hi Sir,

Thanks for your advice.

Yeah, but the thing that bugs me is the persisting gastrointestinal symptoms.I agree ascites has resolved but there is a persisting crampy type of feeling like food is trapped in the intestines,
lot of gas which is released gradually throughout the day.Sometimes,it is accompanied by distended abdomen/bloating.The bloating causes fatigue and affects day to day activity
I had "multifocal symmetric circumferential small bowel wall thickening" in the initial CT.
Does gastrointestinal /abdominal tb cause such severe symptoms?
Is the pain due to scarring/blockage/stricture formation in bowel wall?
Because everywhere on the net I see people with Irritable Bowel Syndrome (IBS) having these symptoms
Somewhere i came to know lot of antibiotics can cause SIBO(small intestinal bacterial overgrowth) which causes such symptoms
After 4 months,my gastroenterologist did a gastroscopy/Upper endoscopy..since everything was normal he said the stomach problems must be due to TB meds sideffects.
Are the side effects of R-Cinex so severe because I am 5.5 months through treatment but the crampy feeling persists?
What tests should I do in next follow up to assess the intestinal activity and overall response?CT scan, MRI or anything else
Should i take any extra medicine for possible conditions like SIBO or perform any tests to see the possibility of IBS or SIBO?