OTHER SYMPTOMS
Doctors
Panel Answers the PBCers
Private Practice Long Island, NY
Specialty: Gastroenterology and
Hepatology
01/25/04
QUESTION
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
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.
End