Don’t despair at urgent, post-meal, ‘uh-oh’ moments

Don’t despair at urgent, post-meal, ‘uh-oh’ moments

Postprandial Diarrhea Syndrome (PPDS) – the unexpected and urgent bowel movement shortly after eating a meal – was the topic of a recently review article in The American Journal of Medicine. The authors of this review (from the Mayo Clinic) commented that this condition is often given the all-embarrassing moniker of irritable bowel syndrome (IBS).

But they go on to say that unlike IBS, where no cause is known, PPDS can have a treatable cause. The most common of these are food allergy, celiac disease, maldigestion due to bile acid malabsorption, pancreatic deficiency or an a-glucosidase deficiency.

Food allergy is best diagnosed by allergy skin testing. The treatment is avoidance of the allergenic foods. Celiac disease is an immune (non-allergic) reaction to gluten and can be diagnosed by blood test or intestinal biopsy. Again, the treatment is avoidance of wheat and other grains.

Bile acid malabsorption is best diagnosed by an empirical trial of a taking a bile acid-binding resin. There are sophisticated GI tests that can be done, but these are usually only available in a research medical setting. If the bile-acid binding resin controls the symptoms, then it is continued as a maintenance therapy.

Pancreatic insufficiency (lack of the digestive enzymes produced by the pancreas) can be diagnosed by a fecal fat analysis. Treatment consists of taking replacement pancreatic enzymes orally.

A-glucosidase deficiency is the lack of one or more enzymes that break down certain sugars. The most common ones are deficiency of sucrase, glucoamylase, maltase and isomaltase. Treatment involves avoidance of foods that contain the specific sugars.

Before embarking on a diagnostic trip for PPDS it is important to have proper gastro-intestinal evaluation to rule out more serious underlying conditions, such as cancer, Crohn’s disease or other inflammatory bowel diseases.

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