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Hello, I am a 15 year old female and I have been struggling with digestive problems. However, in the last 9 months my symptoms have become much worse and more concerning. I experience abdominal pain, bloating, and a strong feeling of pressure when I need to go to the bathroom. My bowel habits constantly change between constipation and diarrhea. Sometimes I am constipated for days, and it hurts really much when i‘m going to toilet. Then sometimes it changes to diarrhea. I have also noticed blood in my stool multiple times, which really worries me. My stool is sometimes even so dark it almost appears black. In addition, I have unintentionally lost around 8kg over the past months. I often feel tired and weak, my skin is very dry, and my nails are brittle. I already had several medical tests, including blood tests, stool tests, urine tests, abdominal ultrasound, and both a gastroscopy and colonoscopy. According to the doctors, the results were “normal” and no clear diagnosis was found. I was once told I might have fructose intolerance, but changing my diet did not improve my symptoms at all. Because my symptoms are persistent and affecting my daily life, I am worried that something might have been missed.

My questions are:
– What possible conditions could still explain these symptoms despite normal endoscopy results?
Are there specific tests or diagnoses that should be considered next?
What would you recommend as the next medical step?
Thank you very much for your time and professional opinion

Dr. Shayeque Reza · Accepted Answer

Your symptoms are not normal and should not be dismissed, especially given their severity, duration, and impact on your health and daily life. The combination of chronic abdominal pain, alternating constipation and diarrhea, visible blood in the stool, very dark (almost black) stools, unintentional weight loss, fatigue, dry skin, and brittle nails represents alarm features, even though your initial investigations were reported as normal.

Normal gastroscopy and colonoscopy do not rule out all gastrointestinal conditions, particularly those that can be patchy, functional, microscopic, inflammatory in early stages, or outside the reach of standard endoscopy. Conditions that may still explain your symptoms include inflammatory bowel disease in early or microscopic form, microscopic colitis, small bowel disease (such as Crohn’s affecting the small intestine), malabsorption disorders, celiac disease variants, motility disorders, or severe functional bowel disorders with secondary nutritional deficiency. Anal fissures from severe constipation can explain some bleeding, but they do not explain weight loss, black stools, or systemic symptoms.

The presence of black stools is particularly important, as it can suggest upper gastrointestinal bleeding or altered blood, which requires careful reassessment—even if earlier tests were normal.

In summary, your symptoms require further specialist evaluation, ideally by a pediatric gastroenterologist. Additional investigations such as repeat targeted biopsies, fecal calprotectin, iron studies, vitamin levels, celiac serology (including IgA levels), small bowel imaging (MR enterography or capsule endoscopy), and assessment for malabsorption or motility disorders should be considered.

Dr. Bharat Joshi · Answer

Hello dear 
See as per clinical history it seems gastric irritation only.
Differential diagnosis includes gerd or ibs.
You can carry out below tests for confirmation and share result with general physician medicine or gastroenterologist for better clarity 
Esr
CBC
Abdominal USG 
Colonoscopy 
Endoscopy 
Hopefully you recover soon 
Kindly take any medication without consulting the concerned physician 
Regards

Dr. Aarav Deshmukh · Answer

Given your situation, there are several potential conditions that could cause your symptoms, even with normal endoscopy results. The symptoms you're describing, such as alternating constipation and diarrhea, abdominal pain, and unintentional weight loss, could suggest conditions like Irritable Bowel Syndrome (IBS), or more rarely, Inflammatory Bowel Disease (IBD) which sometimes doesn’t show typical findings in early stages. Celiac disease might also be a consideration, as it sometimes evades detection in initial tests. Considering the black stools, which can indicate bleeding in the upper gastrointestinal tract, and the presence of blood in stool tests, it's crucial to rule out gastrointestinal bleeding or conditions like Peptic Ulcers and Carcinoid Tumors.

For further testing, you might want to consider a few additional avenues. Firstly, a fecal calprotectin test could help to rule out inflammatory conditions. Secondly, repeating a check for Celiac Disease with advanced genetic testing or repeat biopsies might be worthwhile. Another consideration might be Small Intestinal Bacterial Overgrowth (SIBO), which can be evaluated through a breath test. Lastly, an MRI or a CT scan of your abdomen might reveal abnormalities that ultrasound or endoscopy could miss.

It's also important to review any medications or supplements you're taking, as these can contribute to digestive symptoms and bleeding. Given the unexplained weight loss, persistent symptoms, and bleeding, follow-up with a gastroenterologist is essential to further investigate and where urgent intervention may be needed, such as after seeing dark stools indicative of upper GI bleeding. If symptoms suddenly worsen, or if you experience severe pain, seeking immediate medical attention would be prudent. Overall, ensure you discuss these options with your healthcare provider to tailor the best approach based on your specific condition.

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