Table of Contents
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.
What could cause intermittent lower abdominal pain and diarrhea in a 26-year-old woman?
The likely causes could include Irritable Bowel Syndrome (IBS), Celiac Disease, or Small Intestinal Bacterial Overgrowth (SIBO). Other considers would be Infectious gastroenteritis, lactose intolerance, food intolerance or allergies, inflammatory bowel disease, thyroid disorders, and microscopic colitis.
What is Irritable Bowel Syndrome (IBS)?
IBS is a functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits, often accompanied by bloating and fatigue.
What symptoms are associated with IBS?
IBS symptoms include abdominal pain, bloating, diarrhea, constipation, and fatigue.
How do you diagnose Celiac Disease?
Celiac Disease is diagnosed through blood tests for specific antibodies and a small intestine biopsy to check for damage.
What is the difference between gluten sensitivity (Non-Celiac Gluten Sensitivity or NCGS) and celiac disease?
Gluten sensitivity, also known as Non-Celiac Gluten Sensitivity (NCGS), causes similar symptoms to celiac disease but does not involve the immune system damaging the small intestine. Celiac disease, on the other hand, is an autoimmune disorder where gluten intake causes an immune response that damages the intestinal lining.
Can you have gluten sensitivity without having celiac disease?
Yes, it's possible to have gluten sensitivity (NCGS) without having celiac disease. Unlike celiac disease, NCGS does not show detectable markers in blood tests or damage to the small intestine but still causes similar symptoms.
How is gluten sensitivity diagnosed compared to celiac disease?
Gluten sensitivity (NCGS) is typically diagnosed based on symptom improvement after eliminating gluten from the diet and excluding celiac disease and wheat allergy. Celiac disease is diagnosed through specific serological tests (like anti-TTG antibodies) and confirmed with an intestinal biopsy showing damage to the villi.
What is Small Intestinal Bacterial Overgrowth (SIBO)?
SIBO is a condition where excessive bacteria are present in the small intestine, leading to symptoms like bloating, diarrhea, and sometimes weight loss.
What are the dietary triggers for Celiac Disease?
Ingestion of gluten (a protein found in wheat, barley, and rye) triggers symptoms in people with Celiac Disease.
When should I seek medical attention for abdominal pain?
Seek medical attention for abdominal pain if it is severe, persistent, or accompanied by other symptoms like fever, vomiting, blood in stool, or changes in stool color.
Click the button below to initiate a conversation with CodyMD, your AI Doctor.
Below is a conversation transcript between the patient and our AI Doctor CodyMd.
Cody, the AI Doctor
Hello, I'm Cody, your AI doctor today. What brings you in?
Patient
Hi Cody. I've been having abdominal cramping, diarrhea, fatigue, and flatulence for quite some time, and sometimes I miss my periods.
Cody, the AI Doctor
I see. How long have you been experiencing these symptoms?
Patient
For over three years now.
Cody, the AI Doctor
That's quite a long time. Have you seen any doctors about these symptoms?
Patient
Yes, but since I always look healthy, I feel like they don't take me seriously.
Cody, the AI Doctor
I'm here to help. Have you noticed any weight changes during this time?
Patient
No, my weight has been stable.
Cody, the AI Doctor
Thank you for sharing that. Have you done any recent blood work, like a CBC (Complete Blood Count) or CMP (Comprehensive Metabolic Panel)?
Patient
Yes, both were normal according to my doctors.
Cody, the AI Doctor
Got it. You also mentioned experiencing flatulence. Do you notice it is worse after certain foods?
Patient
It seems to be worse after eating bread, pasta, or stuff like that.
Cody, the AI Doctor
Understood. How often do you experience episodes of diarrhea?
Patient
It varies, but it can be quite frequent, sometimes several times a week.
Cody, the AI Doctor
When you have diarrhea, do you also have any stomach pain or cramping?
Patient
Yes, I do have cramping when I get diarrhea.
Cody, the AI Doctor
Have you ever noticed any changes in your skin, like rashes or acne?
Patient
Yes, I've had more breakouts over the past few months.
Cody, the AI Doctor
Thank you for that information. Have you noticed any other symptoms like nausea or vomiting?
Patient
No, I haven't had any nausea or vomiting.
Cody, the AI Doctor
That's helpful to know. Do you have any food or drink intolerances, perhaps dairy?
Patient
I haven't noticed any issues with dairy specifically.
Cody, the AI Doctor
Lastly, have you observed any other changes in your health, such as feeling more tired than usual?
Patient
Yes, I've been quite fatigued.
Based on the information and conversations with Cody, we have prepared a top 3 AI Diagnosis List.
1. Gluten Sensitivity (Non-Celiac Gluten Sensitivity or NCGS) (50% probability)
NCGS involves symptoms similar to celiac disease but without the immune system attacking the gut. Symptoms often occur after ingesting gluten and improve when gluten is removed from the diet.
2. Celiac Sprue (Celiac Disease) (30% probability)
This autoimmune disorder is triggered by consuming gluten, which leads to inflammation and damage in the small intestine. Symptoms include diarrhea, cramping, fatigue, and sometimes skin issues.
3. Irritable Bowel Syndrome (IBS) (20% probability)
IBS is a chronic condition affecting the large intestine, characterized by cramping, bloating, diarrhea, or constipation. Symptoms can be triggered by certain foods and stress.

Dr. Albert DiPiero
The patient's history of chronic gastrointestinal issues, fatigue, and amenorrhea is notable. Given the worsening of symptoms following gluten consumption, both non-celiac gluten sensitivity (NCGS) and celiac disease are highly plausible. Here's a breakdown:
1. Gluten Sensitivity (Non-Celiac Gluten Sensitivity or NCGS) (50% probability)
IBS is a functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits without an identifiable organic cause. Your symptoms of intermittent abdominal pain, diarrhea, and bloating align well with IBS, and the gradual onset over a long period supports this diagnosis. The lack of blood in your stool and absence of significant weight loss to suggest a more serious organic disease also fits this pattern.
2. Celiac Disease (20% probability)
Celiac disease can present similarly but typically shows serological evidence (anti-tissue transglutaminase antibodies) and histological changes (villous atrophy) upon biopsy. Although the patient's normal blood work does not rule it out entirely, further specific testing (e.g., anti-TTG antibodies) is needed.
3. Irritable Bowel Syndrome (IBS) (15% probability)
SIBO, often an overlooked condition, occurs due to the abnormal growth of bacteria in the small intestine, leading to symptoms such as bloating, diarrhea, and sometimes weight loss. While your symptoms match this condition, the intermittent nature of your symptoms, the lack of malodorous stool, and the lack of a direct correlation to antibiotic use or history of surgery reduces its likelihood compared to IBS and celiac disease.
4. Other considerations:
Lactose Intolerance - 5%: Given the absence of dairy-related symptoms, this is less likely. Hypothyroidism - 5%: Should be ruled out due to nonspecific symptoms like fatigue and gastrointestinal disturbance. Small Intestinal Bacterial Overgrowth (SIBO) - 5%: Can mimic IBS and should be considered if other diagnoses are excluded.
Next Steps for Evaluation
Potential Treatment Modalities
Conclusion
The patient's chronic and varied symptoms point strongly to a gluten-related disorder, particularly NCGS or celiac disease. Given the impact on her quality of life, a focused diagnostic approach and tailored interventions will be crucial for management and symptom relief.
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Easily confirmed what I suspected. Very thorough, definitely the best thing you can get without speaking to a human.
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Directions provided by Cody with every chat helped to proceed effortlessly.
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CodyMD is a very precise and accessible app. My consultation with CodymMD is commendable and I highly recommend it for others to try CodyMD especially for assessment and consultation purposes.
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