Chronic changes in bowel habits are a symptom, not a diagnosis. Diarrhea lasting months has a cause — and beyond the usual suspects, I routinely find exocrine pancreatic insufficiency (EPI) and bile acid malabsorption, two conditions so under-recognized I've done entire podcast interviews on them. Chronic constipation likewise has drivers: motility, pelvic floor, methane-producing organisms, medications, thyroid.
Systematic testing to find the actual mechanism — stool testing including elastase, breath testing, and a careful medication and dietary history. Treatment targets the mechanism: enzyme replacement for EPI, bile acid strategies, motility support, or microbiome treatment as your case dictates.
New patient visits in person in Portland or by telehealth. I've spent 18 years on complex GI cases — including my own.
