Chronic Gastrointestinal Symptoms with Food Intolerances in a Young Adult

Case at a Glance

A 26-year-old non-smoking female presented with a 6-month history of severe gastrointestinal symptoms including gastroesophageal reflux, weekly diarrhea episodes, and abdominal pain. Extensive diagnostic workup revealed elevated fecal calprotectin, intestinal metaplasia, widespread GI inflammation, and positive IgG food sensitivity markers.

Patient's Story

The patient initially experienced sudden onset of gastroesophageal reflux disease accompanied by weekly episodes of diarrhea. She described her symptoms as 'stomach hell' that significantly impacted her quality of life over six months. She denied smoking or alcohol consumption. Initial medical consultation resulted in empirical treatment with esomeprazole and testing for H. pylori and peptic ulcers, both of which were negative.

Initial Assessment

The patient sought a second medical opinion due to persistent symptoms and concern that her condition was not being adequately addressed. Initial differential diagnosis included inflammatory bowel disease, celiac disease, gastric pathology, and infectious gastroenteritis. Comprehensive stool analysis was performed including occult blood, parasitology, inflammatory markers, and bacterial/viral cultures.

The Diagnostic Journey

Laboratory investigations revealed normal results for occult blood, parasites, and infectious agents. However, fecal calprotectin was elevated at 116 mg/kg (normal <50). Upper and lower endoscopy demonstrated 1.5 cm area of intestinal metaplasia in the gastric mucosa with inflammation present throughout the stomach, small intestine, and colon. Duodenal biopsies were insufficient to definitively rule out celiac disease. IgG food sensitivity testing showed elevated levels for multiple foods: gluten (37.1 u/mL), wheat (46.9 u/mL), dairy products (>50 u/mL), egg whites (20 u/mL), and several other foods.

Final Diagnosis

Non-celiac gluten sensitivity with multiple food intolerances, chronic gastritis with intestinal metaplasia, and pan-enteric inflammation. The elevated calprotectin and endoscopic findings suggested ongoing intestinal inflammation, while the food sensitivity panel indicated potential triggers.

Treatment Plan

Complete elimination diet removing gluten, dairy, and other highly reactive foods identified on IgG testing. Patient advised to discontinue all offending foods immediately rather than gradual elimination. Continuation of acid suppression therapy and probiotic supplementation (ProGastro 825) as tolerated. Plan for lactose intolerance breath testing to further characterize dairy sensitivity.

Outcome and Follow-up

Patient counseled that symptom improvement should occur within several months of strict dietary adherence. Education provided regarding gluten-free and dairy-free lifestyle modifications. Follow-up planned to monitor symptom resolution and consider further celiac disease testing if symptoms persist despite dietary modifications. Patient expressed feeling overwhelmed but committed to the elimination diet approach.