Sehcat scan

[B52s]

Hello, 4 years ago I had a sechat scan and the results 2.7% which indicates severe bile acid malabsorption. The problem is my main symptom isn't diarrhoea i do go to the toilet urgently with diarrhoea but normally only once a day. I have severe tummy pain and bloating. I have tried colesevelam but cannot tolerate it. My professor has long suspected that I also had sibo. I had a hydrogen breath test which was negative but I also had a small bowel aspiration which was positive for sibo. so I had a week course of antibiotics. I think I saw a couple of days of improvement but now I'm back to same. I repeated the colesevelam but again I could not tolerate the side affects. I was fairly sure that the Sehcat scan was incorrect as with that score I should of been going to the toilet 10 times a day. My symptoms are no difference if I eat fatter foods. I had repeat sechat scan earlier this month and the result is worst at 1.5%. ( I had a right hemicolectomy for bowel cancer in 2013 ) I have gallstones. I am on b 12 injections every 3 months for life and have vit D deficiency and folic acid deficiency. I have looked all over the internet to see why I score is so low and not have the main symptom going to toilet 10 times a day just once mainly. Does anybody have this score and are experiencing like me any information would be appreciated.Many thanks

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Your symptoms sound awful. Did you experience more bowel actions per day after your hemicolectomy, something which occurs not infrequently? Did you have any success with taking Cholestyramine, or did it affect you adversely? Your underlying SIBO makes taking a probiotic problematic. I cannot make any comment on your low score- what does your specialist have to say about this?

The only suggestion I have is to ask your GP for cholestyramine, but I suspect you have already tried this. Are you taking a standard anti-diarrhoeal such as Imodium, or possibly codeine phosphate which can be used in the situation? Lomotil used to be available but do not know whether it’s still approved. Amitriptyline has a constipating effect, and although used now in small doses for the control of pain, can be increased to higher doses, and might reduce bowel frequency.

There is Enterosgel which is used as a treatment to reduce the symptoms of acute infective diarrhoea, but has been shown to be useful in patients with IBS-D, but which might help. Ask your GP or specialist as its adsorbent properties might effect the absorption of medication which you are taking.

Finally, I took melatonin a while ago for the pain associated with my IBS-C, and found that it was very constipating, as my wife found as well. It can have the opposite effect. You can only obtain this medication through an NHS prescription, but I’m sure your GP might be sympathetic, especially if diarrhoea awakens you at night. It can be obtained abroad, but this is not legally acceptable.Interestingly, CBD oil, obtainable legally in this country, had the same effect on my bowel actions, producing constipation.

In any event, I wish you better.