instruction: hello doctor I am 28 years old female 2006dlbcl treated with chop and radiation remission ever since last 15 years diarrhea got worse for last years they suspect autoimune
output: hi looking at your clinical history and present symptoms my opinion is as follows chronic diarrhea is really difficult period patients with autoimmune disorders are very much prone to lymphoma and risk is always present previously probably you were not diagnosed with autoimmune disorder and dlbcl was possibly your first diagnosis females are at a higher risk of autoimmune disorder and can be present with localized or systemic manifestations infections would not usually present for this long and this amount of chronic diarrhea should be autoimmune rarely recurrent infection due to immune suppression secondary to chop therapy could be present investigations necessary are stool examination to rule out infections bacterial or parasitic also any presence of blood requires evaluation fecal fat estimation can be done and if positive points towards malnutrition colonoscopy to rule out ulcerative colitis or crowns disease autoimmune disorders biopsy is necessary for confirmation other causes could be irritable bowel syndrome if no cause is identified or malabsorption disorders possibility are rare at this age get a colonoscopy and endoscopy done if any ulcerations is seen biopsy needs to be taken based on biopsy further treatment is essential biopsy can help in identifying whether you require medical or surgical line of therapy do get a colonoscopy and stool examination done due to absence of reports I cannot comment further take a fiber rich diet increased risk of malabsorption and malnutrition is going to be present along with decreased body fluid volume take good amount of fluids along with a balanced diet avoid unnecessary medications and drug interactions can also cause diarrhea at present difficult to suspect this long