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Dear Dr. Roach: My son, who is 28, has always had issues with his gut. Almost everything passes through his intestines quickly. He frequently sees undigested vegetables in his stool. He had intestinal pain and underwent upper and lower GI scopes because the doctor suspected Crohn's or inflammatory bowel disease. But he found nothing other than inflammation in his stomach, for which he ordered Protonix; this helped with the pain.
His BMI is below 18 and has always been this way. He says that if he eats healthy, it makes his gut worse, and if he eats fast food or other non-healthy foods, it gets better. I understand, but it's not a good choice. I know a BRAT (bananas, rice, applesauce and toast) diet helps, but he can't do this forever. It's a chronic condition. Do you think taking Bentyl or some other medication would help? -- S.B.
ANSWER: A BMI of 18 suggests Malnutrition and is associated with poor health outcomes, so I'm seriously concerned about your son's health. The undigested food strongly suggests malabsorption. Crohn's disease can sometimes cause this, but there are many other conditions that can keep a person from absorbing their food properly. The most common among generalists like me is celiac disease, but this is by no means the only one.
Dicyclomine (Bentyl) is an antispasmodic, which is occasionally used in some people with irritable bowel syndrome (IBS). I'm uncomfortable with the diagnosis of IBS in your son given his very low BMI. Slowing the gastrointestinal (GI) transit time can sometimes be helpful for people with malabsorption, but I'd definitely want to see a more thorough evaluation prior to trying something like loperamide to slow the bowel.
One good screening test for malabsorption is a stool test for fat. Fat shouldn't normally make it to the stool, so the presence of fecal fat indicates the need for a more comprehensive workup. In the meantime, highly processed "fast" foods probably aren't a good option. I recommend working with a registered dietician (in addition to a gastroenterologist) who has expertise in malabsorption to help him find a better tolerated and healthier diet.