This topic is about a person who has had an ileostomy for 40 years following an amebic infection and the removal of the terminal ileum. Recently, they experienced their first small-bowel obstruction, which was treated in the hospital without surgery. Since then, they have been dealing with episodes of severe, mostly nighttime, watery diarrhea, leading to dehydration, fatigue, and nausea. They are seeking advice and long-term solutions for this issue.

Here are some insights and suggestions shared by others:

1. Extensive stool cultures have come back negative, and blood tests show only mild elevations.
2. Cholestyramine, taken twice daily, helps thicken the output but may risk another obstruction and doesn't address the underlying cause.
3. A two-week course of Flagyl (metronidazole) temporarily normalized the output, but symptoms returned afterward.
4. Current self-care includes taking oral probiotic capsules and drinking probiotic beverages.
5. Possible diagnoses include small-intestinal bacterial overgrowth (SIBO) and malabsorption.
6. A recent endoscopy showed mild reflux and a small hiatal hernia, with biopsy results from the esophagus, stomach, and duodenum pending.
7. There is a concern about being advised to simply "live with" the chronic watery output, and experiences from others with similar post-obstruction diarrhea are sought.

Additional questions and information include:

- Inflammatory markers, including CRP, are negative, although there was previous inflammation in the large bowel, not the small bowel.
- Small-bowel biopsies were taken recently, with results expected in two weeks.
- There is curiosity about whether the loss of the terminal ileum, which occurred 40 years ago, could suddenly cause diarrhea now.
- Tests for coeliac disease and lactose intolerance have come back negative.
- There is a question about whether a stoma can be scoped and if SIBO might be confined to the jejunum.
- Food seems to transit to the pouch within 20–30 minutes, and the massive watery output disrupts sleep three times a night.
- An elimination diet is being considered, as raw vegetables and brown rice are not tolerated, and a food diary is planned.

Advice and insights offered include:

1. Try an elimination diet: Consider a plant-based, gluten-free, and dairy-free diet for about three weeks, then reintroduce foods one at a time to identify any intolerances. Resources like the "Forks Over Knives" documentary, website, and cookbooks may be helpful.
2. Investigate inflammatory causes, such as a Crohn’s-like recurrence: Request a full small-bowel endoscopy through the stoma with multiple biopsies, as blood markers alone might miss gut inflammation.
3. A diagnostic tip (not a recommendation): A short course of oral prednisone (15–20 mg) could suppress inflammation but not infection. Observing any changes in symptoms might help differentiate between an inflammatory or bacterial origin.