Post-SIBO stool test results – still Bristol 6 stools, very low sIgA / bifidobacteria. What would you focus on next?

Hello everyone,

I’d appreciate some input on my latest stool test (full report attached).

Background • 35m • chronic gut issues for years • diagnosed SIBO and treated it recently (a few months ago) • pancreatic insufficiency (elastase historically 70–150) • taking PERT enzymes with meals

Main symptom that still hasn’t improved: every poo is Bristol 6 (sloppy).

I’ve also struggled for years with gaining muscle despite training, which is one reason I’m trying to figure out what’s going on with my gut.

Key findings from new test

Improved vs previous test: • stool histamine normalized • Klebsiella reduced • no pathogens detected

Still abnormal: • dysbiosis index high • very low bifidobacteria • Akkermansia essentially absent • secretory IgA extremely low (<167) • pancreatic elastase still low (~130)

Questions • Does this look like typical post-SIBO microbiome recovery, or something still off? • Any ideas what might explain persistent Bristol 6 stools? • What would you focus on next with this profile? • With these improvements, should digestion now be sufficient to gain muscle normally? • Has anyone successfully raised sIgA in a case like this? The number is exactly the same as the test 8 months ago.

Thanks for any feedback :)