Persistent travellers diarrhoeaSeptember 2nd, 2013
Approximately 2-3% of travellers with severe travellers’ diarrhoea will develop persistent diarrhoea – ie symptoms lasting more than four weeks.
To get this sorted, it is strongly recommended the sufferer seeks medical attention from a doctor familiar with this condition. The doctor will take a history, make an examination and often order stool and blood tests.
Possible causes of persistent gut symptoms are
- A bacteria or parasite in the gut ( this becomes less likely after 3 months )
- Damage to bowel wall from the initial episode/s of infection while away
- Inflammatory Bowel disease set off by the episode
- Unveiling some other condition that was going to happen sometime
There are many possible germs that can cause persistent gastro-intestinal symptoms:
Giardia, E. histolytica , D. Fragilis , cyclospora, cryptosporidium, I belli, C. difficile
While travelling, with limited access to modern medicine, it is common and reasonable to take antibiotics in the hope of guessing the cause and affecting a rapid cure. However, when you get home, it is not the best treatment to take antibiotics (like tinidazole or flagyl) ‘just in case’ — the antibiotics can interfere with the accuracy of stool testing. The best plan is to get professional help.
I have seen patients with persistent diarrhoea, who have been suffering for months, who are rapidly cured by modern medical attention.
The longer a germ persists, the more potential damage it can do, so don’t wait, get it checked.
Several stool tests are recommended to accurately identify germs that may be causing trouble in the bowel. ( Ideally 3 tests are recommended, but the Australian Medicare system will only fund 2) The detection rate is lower if only one test sample is investigated.
There are some germs that are often not recognized from a regular stool test. If the stool sample is mixed with preservative – at the time of testing, these germs are easier to find, and a more accurate diagnosis can be made. This is why it is often recommended that persosn with persistent diarrhoea have a stool test with fixative. This is not difficult; a small amount of faecal matter is placed in the watery looking fixative immediately after the sample is passed. This is in addition to the regular stool test.
If a person takes multiple sample, each stool samples should be taken from separate stools on different days, and ideally should be delivered to the lab within 30 minutes. The samples are examined under a microscope and also placed in a culture material to see what will grow. This process takes time, so an accurate test may take up to a week for a result to be available. Various other molecular tests are often undertaken on stool tests.
Sometimes doctors will recommend antibiotics after the stool test has been sent to the lab, but before the results have been provided.
Depending on the result of the stool test, some persons may be recommended blood tests, or referral to a gastroenterologist who can use a special camera to examine the wall of the bowel ( endoscopy or colonoscopy ) and take small samples (biopsies). These biopsy samples can be examined under a microscope, to aid in diagnosis and treatment of the problem.
Calprotectin is a protein occurring in large amounts in white blood cells of the immune system. It is an amazing chemical and has antibiotic properties and helps the white cells to kill invading germs.
Calprotectin can be found in stool tests and has been shown to help doctors determine how much inflammation is occurring in the bowel. It is useful to help diagnose some types of bowel problems such as ulcerative colitis, Crohn’s disease, and may help patients avoid having unnecessary endoscopies or colonoscopies
A final note
I have seen patients with persistent diarrhoea, who have suffered for months, but are cured by modern medical attention. The longer a germ persists, the more potential damage it can do, so if the symptoms have persisted longer than 4 weeks, don’t wait any longer, get it checked.
For a list of Australian doctors with expertise in this problem click here.