Table of Contents
Common Questions
Chat with CodyMD
Cody's Chat with Patient
Cody's AI Summary
Top 3 AI Diagnosis List
Review by Dr Albert DiPiero
Dr. DiPiero Video Guide to this Case Study
Resource Center
Testimonials
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Case Study
Meet your host
Albert DiPiero, MD MPH FACP
I am a co-founder and the Chief Medical Officer at CodyMD and your host for this edition of Cody Grand Rounds. I have been a practicing physician and faculty member at medical schools for over 26 years.
About The AI Doctor Case Study
CodyMD is a partnership between Human Doctors and AI Doctors. Cody is an AI Doctor who helps thousands of people every day. At each Cody Grand Rounds, I select a real case and review it with Cody, the AI Doctor.
Each case is based on a real patient but has been modified to maintain privacy and to emphasize certain teaching points.
Common Questions
What could be causing chronic watery diarrhea in a middle-aged woman?
How is Small Intestinal Bacterial Overgrowth (SIBO) diagnosed?
Can diabetes lead to gastrointestinal issues like SIBO or IBS?
How can diet modifications help with chronic diarrhea?
What is the difference between IBS and Microscopic Colitis?
What is the role of antibiotics in gastrointestinal disorders?
How does one manage gastrointestinal symptoms along with mental health issues?
Chat with CodyMD
Click the button below to initiate a conversation with CodyMD, your AI Doctor.
Cody's Chat with Patient
Below is a conversation transcript between the patient and our AI Doctor CodyMd.
Cody, the AI Doctor
Good to meet you! Today, it sounds like you want to focus on your symptoms of watery diarrhea. Is that right?
Patient
Yes, that's correct.
Cody, the AI Doctor
Let's start by gathering some more detailed information. How long have you been experiencing the watery diarrhea?
Patient
It's been over eight years now.
Cody, the AI Doctor
That's quite a long time. Have you seen any doctors about this issue?
Patient
Yes, I've seen several doctors. Most of them just seem to think it's irritable bowel syndrome, but I feel like they're not taking me seriously.
Cody, the AI Doctor
I understand your concern. My aim is to provide you with a thorough evaluation. How old are you and what is your gender?
Patient
I am a 50-year-old woman
Cody, the AI Doctor
Other than the diarrhea, have you noticed any specific triggers or patterns related to your symptoms?
Patient
Not really. It just seems to happen all the time, no matter what I eat or what I do.
Cody, the AI Doctor
I see. Have you ever noticed any blood in your stool?
Patient
No, there's never been any blood.
Cody, the AI Doctor
Do you experience any pain associated with the diarrhea, like cramping or discomfort?
Patient
There's some mild cramping, but it's not always there and it's not severe.
Cody, the AI Doctor
Have you taken any courses of antibiotics in the past few years for any infections?
Patient
Yes, I’ve had antibiotics several times for UTIs and sinus infections.
Cody, the AI Doctor
Thank you for sharing that. Have you been diagnosed with any other medical conditions, such as diabetes?
Patient
Yes, I have type 2 diabetes.
Cody, the AI Doctor
All right, that's important to know. How is your diabetes managed? Are you on medication or insulin?
Patient
I'm on medication. I take metformin daily.
Cody, the AI Doctor
How long have you been taking metformin?
Patient
About two years.
Cody, the AI Doctor
Great, thank you for that. Could you tell me a bit about your diet and lifestyle? For example, how often do you eat out or consume processed foods?
Patient
I work in marketing, so I eat out quite often. My diet isn't always the healthiest because of my busy schedule.
Cody, the AI Doctor
Got it. Have you noticed any changes or improvement in your symptoms when you've taken antibiotics?
Patient
I can't say I've noticed any significant changes, no.
Cody, the AI Doctor
What about your mental health history? Have you ever been diagnosed with depression or anxiety?
Patient
I have had episodes of depression in the past.
Cody, the AI Doctor
I understand. Besides the diarrhea and mild cramping, are there any other symptoms you've experienced, like bloating, gas, or weight loss?
Patient
Yes, I do get a lot of bloating and gas. No significant weight loss though.
Cody, the AI Doctor
Have you ever undergone any tests or procedures like a colonoscopy or endoscopy?
Patient
Yes, I had a colonoscopy a few years ago, but they didn't find anything abnormal.
Cody, the AI Doctor
Thank you for providing all this information. Based on what you've shared, I have a few potential diagnoses in mind. I'll summarize what we've discussed and propose the top three likely conditions.
Cody's AI Summary
- 50-year-old woman who has been experiencing watery diarrhea several times a day for over eight years.
- You have seen multiple doctors who have tentatively diagnosed you with IBS but you feel your condition hasn't been properly addressed.
- You have also had multiple courses of antibiotics for UTIs and sinus infections and have type 2 diabetes managed with metformin, which you have been taking for about two years.
- Your lifestyle involves frequent dining out and less-than-ideal dietary choices.
- Additionally, you have a past history of episodes of depression.
Top 3 AI Diagnosis List
Based on the information and conversations with Cody, we have prepared a top 3 AI Diagnosis List.
1. Small Intestinal Bacterial Overgrowth (SIBO) (60 % probability)
SIBO is a condition in which excessive bacteria in the small intestine disrupt normal digestive processes, leading to symptoms like diarrhea, bloating, and gas. It can be triggered by diabetes and repeated antibiotic use. A breath test measuring hydrogen and methane levels can aid in diagnosis.
2. Irritable Bowel Syndrome (IBS) (25 % probability)
IBS is a chronic functional gastrointestinal disorder typified by symptoms like recurring abdominal pain, bloating, and diarrhea or constipation. There's no definitive test for IBS, and it is often diagnosed based on symptom patterns.
3. Microscopic Colitis (15% probability)
Microscopic Colitis is an inflammatory condition of the colon that can cause chronic diarrhea. Unlike IBS, it requires a biopsy for diagnosis. It often presents without the severe pain seen in other inflammatory bowel disorders.
Review by Dr Albert DiPiero
Dr. Albert DiPiero
The patient presents with a long history of watery diarrhea lasting over eight years, paired with mild cramping, no blood in stools, and additional symptoms like bloating and gas. Here’s a detailed analysis of the top three AI-generated diagnoses:
1. Small Intestinal Bacterial Overgrowth (SIBO) (70 % probability)
The history of antibiotic usage and diabetes highly supports the likelihood of SIBO. The chronicity and non-specific symptom triggers align well with this diagnosis. A breath test should confirm this.
2. Irritable Bowel Syndrome (20 % probability)
Symptoms of IBS are broad and often overlap with other gastrointestinal disorders. The long-standing nature, coupled with variable response to diet changes and lack of significant weight loss, makes IBS a plausible but less likely candidate.
3. Microscopic Colitis (10% probability)
Microscopic Colitis can cause chronic diarrhea but typically shows positive biopsy findings, which were not observed in the patient’s past colonoscopy. While still a possibility, it’s less likely without further inflammatory indicators.
4. Other considerations:
Given the patient’s history of type 2 diabetes, diabetic autonomic neuropathy should also be considered, as it can affect gastrointestinal motility leading to similar symptoms. Metformin, which the patient has been on for two years, should be also be considered as a cause. Although metformin can cause gastrointestinal upset, it is less likely to be the primary cause since the patient’s symptoms preceded the initiation of this medication. However, it could exacerbate existing symptoms and should not be completely dismissed.
Next Steps for Evaluation
Breath Test: To rule out SIBO, I recommend undergoing a breath test that measures hydrogen and methane levels after ingesting a sugar solution. This can confirm or exclude bacterial overgrowth as a cause of your symptoms.
Nutritional Evaluation: Additionally, reviewing your diet with a nutritionist and exploring possible adjustments could help manage your condition better.
Mental Health Support: Given your history of depression, a holistic approach considering both physical and mental health is also advisable.
Revisit Colonoscopy Findings on Microscopic Colitis: Possibly re-consider another colonoscopy or explore other diagnostic methods like an endoscopy if clinically warranted.
Review Metformin Use: Assess the potential contribution of metformin to gastrointestinal symptoms and explore alternative diabetes management strategies if necessary.
Potential Treatment Modalities
For SIBO: Antibiotics like rifaximin or herbal antimicrobials targeting bacterial overgrowth.
For IBS: Dietary management, potentially trialing a low FODMAP diet, fiber supplements, or medications like antispasmodics.
For Microscopic Colitis: Anti-inflammatory medications such as budesonide if confirmed.
Holistic Approach: Address underlying depression with a multidisciplinary team for optimal management.
Conclusion
The patient’s symptoms and history strongly point towards SIBO as the primary diagnosis, given the pattern of antibiotic use and diabetes. IBS remains a secondary consideration, with microscopic colitis being less likely without biopsy confirmation. Considering the duration of symptoms, metformin is assessed more as an exacerbating factor than a primary cause. A comprehensive plan involving diagnostic testing, nutritional assessment, and holistic mental health support is crucial for effective management and improved quality of life.
Dr. DiPiero Video Guide to this Case Study
Resource Center
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