Testing for B12 malabsorption causes

[Elvee]

I am a 67 year old male; I've had IBS since my teens. Most of my life its been fairly mild, with a cramping/diarrhea episode (followed by a couple of days of constipation) every few weeks to once a week. Over the years it's become more severe, but not very bothersome.

About 8 years ago, I suddenly developed heavy continuous diarrhea (3 to 4 movements a day), together with mild nausea. This went on for a few months, and then gradually tapered off so that I had one movement a day, sometimes followed by a day or two of constipation, no normal movements. It would seem to improve for a couple of months, and then worsen again. I had a barium meal, and that was normal. I lost about 35 lb. over 2 years, and then my weight stabilized. Sometimes some heavy rectal bleeding (bright to dark red) lasting about a week.(my doctor said this was haemorrhoids.)

About 4 -5 years ago, I developed peripheral neuropathy. Starting with a sudden numbness in my left foot, it started a month later in my right foot, and then slowly, over the next 2 years went up my legs to about mid thigh. I went through a huge number of blood tests, which didn't show anything significant, except for a marginal B12.(RBC & WBC are marginally low.) The neurologist's test confirmed I had axonal peripheral neuropathy (idiopathic). (I also found, through one examination, that I had Raynaud's phenomenon.)A xylose test together with testing for methylmalonic acid and Homocysteine confirmed that I had a B12 absorption problem. About a year ago I started monthly B12 injections.

About 2 years ago, the diarrhea became suddenly worse again, and the same pattern as 8 years ago. I had a colonoscopy which didn't show anything significant and a stool examination (bacteria and parasites) which was also negative. After about 9 months it gradually tapered off, and the current pattern is now 1 to 3 bowel movements (very soft, long stringy varying to brown water) per day for 1 -3 days, followed by 1 - 3 days of constipation. No normal movements.

Fom reading, I've found that malabsorption can cause diarrhea, and that malabsorption can be caused, most commonly, by small bowel bacterial overgrowth (SBBO), lack of gastric acid, insufficient pancreatic output. I've never been tested for these.

My questions are:
1.Does the stool bacterial test(negative for Salmonella, Shigella, Campylobacter, Edwardsiella, Escherichia Coli & Yersinia) show that I don't have SBBO, or is a different test required (If so what test)?

2. What tests are required to determine achlorhydria/hypochlorhydria, and pancreatic sufficiency?

[Kevin Pho, MD]

To answer your questions:
1) The tests for bacterial overgrowth are a hydrogen breath test or jejunal aspirate.  

2) There are a variety of pancreatic function tests that can be considered to evaluate for insufficiency.  This can include various stimulants like CCK or secretin.  The pancreatic secretions can be tested for enzyme content.

A biopsy as well as a 24-hr pH study can be considered to look for further causes of gastritis.  A test for H Pylori should be considered as well.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

[Elvee]

Thank you for your information. You did not however include what test(s) is/are required to check for achlorhydria or hypochlorhydria. (When I asked my family doctor, he didn't know, and was going to find out).

[CalGal]

You might consider asking your doc to check for celiac problems. There are numberous individuals these days who seem to be showing up with 'adult-onset' gluten-intolerance problems. I know it might sound slightly outlandish, but my husband was one of those and it took us several years to figure out what was going on. He didn't test positive with the normal blood test for celiac, but he tested positive using both the fecal antibody test (which I understand many in the medical profession do not believe in) and genetic testing route.

He also didn't have the violent GI problems you're having, but did have some other 'strange' symptoms that included incredible fatigue and non-traditional skin problems. I've since learned from speaking or corresponding with others with the same problems that the symptoms run the gamut. Many do have unresolvable diarrhea or in some cases constipation. And many go on to develop neuro-related problems. Some have other autoimmune-related problems and many have what has come to be called 'brain fog.' It's perplexing and difficult, at times, to pinpoint.

Many of these individuals had been tested via the blood tests and found to be 'negative.' Many had also had duodenal biopsies which turned up negative, or at the best "possibly positive." When some of those finally gave up in despair and tried a gluten-exclusion diet they were helped (although some also had to cut out casein, since they were 'cross-reactive).

This might be something to look into. If this is the problem, it's not going to resolve overnight and you have to be patient and extremely diligent with your diet. There's NO cheating, no 'days off.' But the results are well worth it - if it's your problem.

[PAJ]

You are describing classic symptoms of a yeast overgrowth.as are many on this forum .The unfortunate thing is mainstream medicine does not recognise the condition . Yeast infections are endemic ,the situation is very worrying .I suffered for decades with IBS Chronic fatigue ,brain fog and all the other delights of the condition..I self treated after finding Dr Cranton's information.
  

google... Dr Cranton yeast, Dr Crook yeast ,and Dr Truss yeast for an insight
I can answer specific questions if you have any ...

[MLWTR]

Crohn's disease is a possibility. You might request an upper endoscopy (which would also identify celiac disease, if present). Although you have had a colonoscopy and a barium test, it is still possible to have Crohn's lurking in the small intestine. It can be a very difficult diagnosis to make, but could cause chronic diarrhea/constipation/B12 deficiency, low white blood count, etc..

Good luck.

[DVK]

Yes, I would check for Celiac, I had problems with feeling similar with low potasium etc including elevated pancreas lipase slightly not even 1 fold, 150 points over normal range, all ultrasounds and CT scans were good, But after posting on this site he said to check for celiac and I have although the tests are inconclusive, however as I am almost 6 days in on a Gluten Free Diet I am feeling so much better. But as always ask the doc first, but as I found sometimes there are no answers from them on this issue as to so many doctors even think about this disease. Good Luck www.celiac.com

[megmike]

A related discussion, b 12 was started.