What other searches do I need to conduct?

Question #20679

46 days ago

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What other searches do I need to conduct? - #20679

Salsabil Bouheza

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

Age: 15

Pain

Ache

Stomach

Blood in stool

Dark stool

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Dr. Shayeque Reza

I completed my medical degree in 2023, but honestly, my journey in healthcare started way before that. Since 2018, I’ve been actively involved in clinical practice—getting hands-on exposure across multiple departments like ENT, pediatrics, dermatology, ophthalmology, medicine, and emergency care. One of the most intense and defining phases of my training was working at a District Government Hospital for a full year during the COVID pandemic. It was chaotic, unpredictable, and exhausting—but it also grounded me in real-world medicine like no textbook ever could. Over time, I’ve worked in both OPD and IPD setups, handling everything from mild viral fevers to more stubborn, long-term conditions. These day-to-day experiences really built my base and taught me how to stay calm when things get hectic—and how to adjust fast when plans don’t go as expected. What I’ve learned most is that care isn't only about writing the right medicine. It’s about being fully there, listening properly, and making sure the person feels seen—not just treated. Alongside clinical work, I’ve also been exposed to preventive health, health education, and community outreach. These areas really matter to me because I believe real impact begins outside the hospital, with awareness and early intervention. My approach is always centered around clarity, empathy, and clinical logic—I like to make sure every patient knows exactly what’s going on and why we’re doing what we’re doing. I’ve always felt a pull towards general medicine and internal care, and honestly, I’m still learning every single day—each patient brings a new lesson. Medicine never really sits still, it keeps shifting, and I try to shift with it. Not just in terms of what I know, but also in how I listen and respond. For me, it’s always been about giving real care. Genuine, respectful, and the kind that actually helps a person heal—inside and out.

45 days ago

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.

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Salsabil Bouheza Bouheza

Client

45 days ago

Thank you for your help, i‘m really worried and grateful that someone took me serious. I‘ll talk to my doctors in hope they will do something about it. Thanks really, i‘m glad ❤️🙏🏻

Dr. Bharat Joshi

I’m a periodontist and academician with a strong clinical and teaching background. Over the last 4 years and 8 months, I’ve been actively involved in dental education, guiding students at multiple levels including dental hygienist, BDS, and MDS programs. Currently, I serve as a Reader at MMCDSR in Ambala, Haryana—a role that allows me to merge my academic passion with hands-on experience. Clinically, I’ve been practicing dentistry for the past 12 years. From routine procedures like scaling and root planing to more advanced cases involving grafts, biopsies, and implant surgeries. Honestly, I still find joy in doing a simple RCT when it’s needed. It’s not just about the procedure but making sure the patient feels comfortable and safe. Academically, I have 26 research publications to my credit. I’m on the editorial boards of the Archives of Dental Research and Journal of Dental Research and Oral Health, and I’ve spent a lot of time reviewing manuscripts—from case reports to meta-analyses and even book reviews. I was honored to receive the “Best Editor” award by Innovative Publications, and Athena Publications recognized me as an “excellent reviewer,” which honestly came as a bit of a surprise! In 2025, I had the opportunity to present a guest lecture in Italy on traumatic oral lesions. Sharing my work and learning from peers globally has been incredibly fulfilling. Outside academics and clinics, I’ve also worked in the pharmaceutical sector as a Drug Safety Associate for about 3 years, focusing on pharmacovigilance. That role really sharpened my attention to detail and deepened my understanding of drug interactions and adverse effects. My goal is to keep learning, and give every patient and student my absolute best.

45 days ago

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

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Salsabil Bouheza Bouheza

Client

45 days ago

Thank you for your help 🙏🏻❤️

Dr. Aarav Deshmukh

I am a general physician with 8 years of practice, mostly in urban clinics and semi-rural setups. I began working right after MBBS in a govt hospital in Kerala, and wow — first few months were chaotic, not gonna lie. Since then, I’ve seen 1000s of patients with all kinds of cases — fevers, uncontrolled diabetes, asthma, infections, you name it. I usually work with working-class patients, and that changed how I treat — people don’t always have time or money for fancy tests, so I focus on smart clinical diagnosis and practical treatment. Over time, I’ve developed an interest in preventive care — like helping young adults with early metabolic issues. I also counsel a lot on diet, sleep, and stress — more than half the problems start there anyway. I did a certification in evidence-based practice last year, and I keep learning stuff online. I’m not perfect (nobody is), but I care. I show up, I listen, I adjust when I’m wrong. Every patient needs something slightly different. That’s what keeps this work alive for me.

44 days ago

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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