Irritable Bowel Syndrome/IBS?


I was told I had IBS about 5 yrs ago,as I was suffering with stomach spasms etc after certain foods. I'm 34 yrs old and female. Once I stopped the foods, things improved dramatically.
However for the last few months I have had constant upper right abdominal pain (mainly a dull ache) I have also been having very bad explosive diarrhea up to 3 or 4 times a day and it is the consistency of water and afterwards there is an oily sheen on top of the toilet water. I also have insulin resistance and non alcoholic fatty liver disease. I'm on metformin for the insulin and omeprazole for bad acid reflux. I have had negative tests for gallstones, celiac disease, lactose intolerance stool tests for infection and numerous blood tests. I am getting to the end of my tether and I'm getting to the point where I don't leave the house incase I'm caught out, and need a toilet. I have no appetite and am really ill if I eat meat, fast food, anything fried or sugary.
In your experience do you think this is just a bad case of IBS or is it something else?

Hi Jo, thank you for getting in touch. I’m not sure that the symptoms you are experiencing are due to your IBS as you have been experiencing abdominal pain with oily type or fatty stools. When you have fatty stools it suggests a problem with absorption in the small bowel and whilst you have had some investigations looking for causes, a couple of conditions come to mind which might be relevant here.

The first condition is small bowel bacterial overgrowth, a condition that is more common in diabetics. This condition occurs when the small bowel is populated by too much ‘bad bacteria’ which can occur for many reasons such as previous bowel surgery, antibiotic use, low immunity and many other causes. You can have a test called glucose – hydrogen breath test to look for evidence of this. If confirmed, it is normally treated with antibiotics to suppress the bad bacteria and probiotics to help replenish bacteria.

Pancreatic insufficiency, a condition where the pancreas doesn’t produce the lipase enzyme may be relevant. Lipase is an enzyme that is involved in the digestion of fats and this can be diagnosed by doing either a Pancreolauryl test or doing a stool test checking for faecal elastase. I won’t go in to the details of these, but you can discuss this with your doctor.
Finally, Metformin has a very common side effect of diarrhoea. This might be causing your explosive diarrhoea and only a trial off this in conjunction with your doctor will determine this. Also, Omeprazole can cause diarrhea in some people as a direct side effect, but also is associated with a condition called microscopic colitis.

You might like to discuss the above with your doctor as I certainly think it would be worthwhile investigating further. Whilst I’m not convinced this is solely your IBS you might find my web site, IBS Help Online helpful.

Best wishes and hope your better soon!


Irritable Bowel Syndrome

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Dr Peter Thatcher MBBS, MRCPI. IBS Physician & Gastroenterologist


I can answer questions on all aspects of IBS or the Irritable Bowel Syndrome, Medicine and Gastroenterology. This would include aspects of diagnosis, investigation and management of IBS and other gastroenterology or medical conditions.


I am a Consultant Physician and Gastroenterologist in the United Kingdom. I qualified as a physician in 1993 and have been practicing Medicine and Gastroenterology ever since. I regularly run gastroenterology clinics and 1:4 patients have IBS. I am also the web master of IBS Help Online, an Irritable Bowel Syndrome help site.

British Society of Gastroenterology Member of the Royal College of Physicians of Ireland Consultant Physician and Gastroenterologist, Royal Cornwall Hospital, Truro, Cornwall. UK

Consultant Physician and Gastroenterologist, Fully UK Trained Medical Degree at Kings College School of Medicine & Dentistry 1993 Membership of the Royal College of Physicians of Ireland Examinations 1997

Awards and Honors
MBBS 1993 MRCPI 1997

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