Member Comments are provided by individuals and reflect their personal opinions only. Under NO circumstances should you act on any advice or opinion posted in this forum.  ALWAYS check with your personal physician before taking any action regarding your health! MedHelp International and our partners, sponsors and affiliates have no obligation to monitor any comments posted on this site, or the content and/or accuracy of such exchanges. MedHelp International does not endorse the views of any user.
Gastroenterology  (Expert Forum)
 | 
Acid Reflux and Stool Color
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D. Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Post a Question Back to Forum
MedHelp Member's Question

Acid Reflux and Stool Color

by Katenyc, Oct 24, 2003 12:00AM
Hello.



I am a 44 year old female.  Six weeks ago, I began suffering with burning in my chest, throat and tongue, as well as increase in bile and acid taste in my mouth.  I saw my doctor, who referred me to a GI doctor.  I was told that I have acid reflux and was given Nexium 40 mg twice/day.  After almost 3 weeks of taking it, and completely changing my diet to a gerd diet [eliminating coffee, fatty foods, chocolate, peppermint, etc. etc.], I was still burning up.  Was switched to Aciphex for 2 weeks, and that also did not help.  Just switched to Prevacid 3 days ago and so far that is not helping, either.  I am also taking Gaviscon, Tums, and I have just added Zantac 75 at nighttime.  In the meantime, I had an endoscopy done [showed esophagitis & normal stomach biopsies], a motility test [normal results] and a 24 hour ph test [normal results].  [Ironically, the day of the ph test was the best day I have had in 6 weeks.]



The doctor said that clearly I have gerd due to the esopagheal changes, but she is a bit perplexed that the PPI's are not working far for me.  At this point, she said to continue with Prevacid and everything else I am doing and see how it goes.



The other issue, which may or may not be a coincidence, is that my stool has changed to a green color.  [It is like an olive green color.]  This started about 5 weeks ago, and it has been consistent ever since.  I was not concerned about it because I thought it may be a reaction to the PPI drugs I was taking, but when I stopped taking the PPI's for 4 days before the ph test last week, the stools were still green.  In addition, I had severe diarrhea for 2 days last week, followed by 4 days of constipation.  This is not normal for me.  I am not taking any new supplements [I take a basic multivitamin and calcium every day], and I am not eating a lot of green vegetables.  I definitely don't believe the stool color is related to my diet.  



I have read some things here & there on the internet that the gallbladder could have something to do with green-colored stools.  I have also met a woman who had burning sensations in her chest, which were relieved when she had her gallbladder taken out.  Maybe I am grasping at straws here, but could there be a connection between this [so far] untreatable reflux and green stools?  One other comment:  I did have reflux once before two years ago when I was pregnant with my 1st child.  It was pretty severe on & off through the pregnancy, but went away as soon as I delivered the baby.



Thanks for your comments and any help on this.



Kate
Doctor's Answer

by Kevin Pho, MD, Oct 27, 2003 12:00AM
Erin, PA has kindly answered your question in her comments below and I agree with her comprehensive assessment.  



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Thanks,

Kevin, M.D.

Member Comments (22)

by GI.PA, Oct 25, 2003 12:00AM
At this point you and your GI need to consider a few things:



Perhaps you do have low grade acid refux disease which caused your esophogitis (seen on EGD) but perhaps acid reflux disease is NOT the cause of your symtoms.  This is supported by your normal 24 hour pH study, normal EMS, and most importantly, your lack of response to twice daily PPI's (multiple brands).



I would obtain a gallbladder ultrasound and perhaps a HIDA/CCK scan to look at the gallbladder which can mimick acid reflux symtoms.  The 24 pH probe can be repeated with the following modifications (do it while you are on PPI's..they ususally have them hold them for 7 days).  This would give an idea of if you are having inadequate acid suppression on high dose PPI's.  A motility study can be repeated with provacation (they put some acid at the probe to see if it replicates your symptoms, they use water as a control, they can also put a chemical in that causes your esophagus to spasm to see if this reproduces your pain..spasm can be unrelated to acid reflux).  A repeat EGD may be considered to "prove" that the esophogitis has healed, documenting acid reduction with PPI and taking esophogistis out of the mix.



Green stools are never a red flad in the GI world.  Although you alteration in bowel pattern may suggest more of a bowel component to your discomfort, or even on underlying irritable bowel/functional dyspepsia cause to your symptoms.  Stool studies (particularly a giardia antigen) can be obtained to rule out an infection with a paracite or bacteria and give clues to an underlying inflammations (stool for white blood cells).  A colonoscopy can be done to visualize the entire colon (particularly the loops in upper right and left quadrants.  This can exclude inflammation, cancer, polyps..ect.  Treatment with a non-bloating fiber supplement (fiber con 2 pills/day) may be helpful.  Your MD may consider other IBS medications.



Hope this helps.



Erin

GI.PA

by yoshi, Oct 25, 2003 12:00AM
i was on prevacid for months and i was constipated.if you read the labels ,it said either diarhea or constipation.

for me it was constipation,once i switch out of it,my bowel movement returns to normal.

hope this piece of information helps.

by TJV, Oct 25, 2003 12:00AM


  One thing for sure, you obviously have gerd because there is esoghageal damage.  



  It is logical  a ph and manometry would be negative if there were absolutely no symptoms at all on the day of the test. --  a repeat ph should be done -- i don't see gallbladder in the equation, it could be an additional problem to gerd of course--,and should be checked out,  but certainly speculation of gallbladder disease should not be based primarily on the fact of a negative ph  There were no symptoms on the day of the ph

  

Green stool means nothing in medicene and isn't significant . However your change of bowel habits are.  You should have a stool test for bacteria etc. and colonoscopy-- particularly to view the splenic and hepatic flexures.  Perhaps a gastric emptying test as well.







  



by tessa0825, Oct 25, 2003 12:00AM
To: Kate
Remember to ask about Bravo PH if you do need to have it repeated.....It might be better in the fact that it is a 48 hr. test rather than the normal PH probe at 24 hrs....Longer time frame to pick up symptoms.....That's the one I'm having at post-op evaluation in Dec.....Tessa

by GI.PA, Oct 25, 2003 12:00AM
The question is:



Yes, you have esophogeal damage and therefore GERD, but is GERD and the damage what is CAUSING the pain or just an incidental finding?  If a repeat endo is done and the damage has been nicely healed but the pain remains, one would arguee that with a failure on twice daily PPI's and endoscopy proven healing, an acid related condition is very unlikely.



GI.PA

by TJV, Oct 25, 2003 12:00AM


Ahhh But over have of people with gerd have negative endoscopy,ppis could have healed erosions, -- another ph test would be necessary to rule out gerd conclusively, since there were no symptoms on the first ph test. But of course an ultrasound is a good idea