Hello and thank you for the question. Answers given are for informational purposes only and are not meant to replace an exam by an in-person.
I am Dr. Sohaib, a practicing Internal Medicine Specialist and i will do my best to help you today.
He is suffering from chronic diarrhea and there are a number of reasons for this including;
1. Infections such as;
3. Bacterial Overgrowth
4. Other Malabsorption syndromes (coeliac disease, whipple disease etc)
5. Inflammatory bowel disease
6. Cancer (colon cancer or lymphoma)
Its great to hear that he has been treated successfully for his anemia with iron, but i wonder whether his doctor try to find out the underlying cause for anemia as well or not. Because if we simply replace the iron (which will correct anemia) and do not treat the cause for iron deficiency, the anemia will recur when the iron therapy is stopped.
Worm infestation is a common cause for iron deficiency but in his particular clinical context (chronic diarrhoea), this iron deficiency seems to be a part of over all malnourished state (secondary to malabsorption of iron and other essential nutrients) due to chronic diarrhoea.
I think sufficient duration has passed and its time now to have this evaluated in detail by a Gastroenterologist for a comprehensive clinical examination aided by tests such as;
1. Stool examination (3 sets) to look for ova and cysts of parasites. Also specialized staining can be ordered for parasites and to look for malabsorption.
2. Blood CBC/ESR, CRP and other inflammatory markers
3. Electrolytes, albumin, calcium levels
4. Colonoscopy and upper GI endoscopy with biopsy, aspirate for culture.
Other systemic causes like a thyroid disorder should also be ruled out.
The best way to proceed further is to have an appointment with a gastroenterologist, and discuss the above mentioned details for further clinical evaluation.
Keep him well hydrated.
A good nutritious and well balanced diet.
Both will be helpful.
I would have been worried too if i were at your place but let me reassure you that most of the conditions responsible for such symptoms are treatable and carry a good prognosis with appropriate management.
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