OTHER SYMPTOMS
01/25/04
QUESTION 2
I have experienced constant and debilitating diarrhea since before my PBC diagnosis, in 2/98. I have been tested for many possible causes, and everything turns out negative. Hence my hepatologist has stated that this is from PBC and that 25% of PBC patients will experience this. I would like the Doctors Panel opinion as to whether this is a PBC symptom, but even more so I would like to ask what the process is - most especially what causes the diarrhea - what medication might be recommended (I think I've tried everything there is but it never hurts to ask).
ANSWER 2
Diarrhea may have many causes in people with PBC. First, diarrhea may be a side effect of some medications used in the treatment of PBC, such as URSO and colchicine, or of cholestyramine, a medication used to control itching.
Second, people in advanced stages of PBC who are cholestatic are unable to absorb fats efficiently- a condition known as fat malabsorption. This is caused by a failure to secrete bile salts necessary to absorb fats due to bile duct destruction that occurs within the livers of people with PBC. The fats that these people are unable to absorb are eliminated from their bodies in their stools, which tend to be light in color, loose in consistency, and frothy in texture. These stools are characterized by their ability to float on top of water, and it commonly takes as many as five attempts to flush them down the toilet. This type of stool is known as steatorrhea. People with fat malabsorption are unable to absorb the fat-soluble vitamins - A,D,E, and K. Thus, it is usually necessary to correct these vitamin deficiencies promptly.
Third, an autoimmune disease known as celiac sprue can be the cause of diarrhea in people with PBC. Celiac sprue is a disease characterized by an inability to absorb gluten (a protein found in wheat, rye, oats, and barley). This is known as a gluten-intolerance. Celiac sprue is approximately ten times more likely to occur in people with PBC than among members of the general population. The association of PBC with celiac sprue is important to recognize since people suffering from these diseases jointly can obtain relief from diarrhea and its associated weight loss by adhering to a gluten-free diet.
Diarrhea can also be due to ulcerative colitis, which may require treatment with prednisone, a steroid medication, or diarrhea may be due to a pancreatic disorder, which requires treatment with pancreatic enzyme replacement. Therefore, it is important to accurately diagnose why a person with PBC has diarrhea, as the treatment differs greatly dependent upon the cause.