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?