# IBS and SIBO



## eric (Jul 8, 1999)

Is there a relationship between IBS and small intestinal bacterial overgrowth?"Although the theory that SIBO causes IBS is tantalizing and there is much anecdotal information that supports it, the rigorous scientific studies that are necessary to prove or disprove the theory have just begun. Nevertheless, many physicians have already begun to treat patients with IBS for SIBO. In addition, a lack of rigorous scientific studies demonstrating benefit from antibiotics and probiotics has not stopped physicians from using them for treating patients.""Although it has been hypothesized that IBS may be caused by intestinal bacteria, specifically by small intestinal bacterial overgrowth, there is little rigorous scientific support for the hypothesis. "http://www.medicinenet.com/irritable_bowel...drome/page7.htm"The most popular theory is that patients with irritable bowel syndrome have a subtle abnormality in the function of their intestinal muscles that allows SIBO to occur." http://www.medicinenet.com/small_intestina...rowth/page5.htm Seccion de Gastroenterologia, Departamento de Medicina, Hospital Clinico de la Universidad de ChileChile.Small intestinal bacterial overgrowth (SIBO) is characterized by nutrient malabsorption, associated with an excessive number of bacteria in the proximal small intestine. Unfortunately, the diagnosis of bacterial overgrowth presents several difficulties and limitations, and as yet there is not a widespread agreement on the best diagnostic test. SIBO occurs when there are alterations in intestinal anatomy, gastrointestinal motility, or a lack of gastric acid secretion. The true association between SIBO and irritable bowel syndrome and celiac disease remains uncertain. The treatment usually consists in the eradication of bacterial overgrowth with repeated courses of antimicrobials, nutritional support and when it is possible, the correction of underlying predisposing conditions.PMID: 16446861 Hydrogen glucose breath test to detect small intestinal bacterial overgrowth:1: Aliment Pharmacol Ther. 2005 Dec;22(11-12):1157-1160. Related Articles, Links Hydrogen glucose breath test to detect small intestinal bacterial overgrowth: a prevalence case-control study in irritable bowel syndrome.Lupascu A, Gabrielli M, Lauritano EC, Scarpellini E, Santoliquido A, Cammarota G, Flore R, Tondi P, Pola P, Gasbarrini G, Gasbarrini A.Internal Medicine Department, Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy.Background: Studies assessing the prevalence of small intestinal bacterial overgrowth in irritable bowel syndrome gave contrasting results. Differences in criteria to define irritable bowel syndrome patients and methods to assess small intestinal bacterial overgrowth may explain different results. Moreover, no data exist on small intestinal bacterial overgrowth prevalence in a significant population of healthy non-irritable bowel syndrome subjects. Aim: To assess the prevalence of small intestinal bacterial overgrowth by glucose breath test in patients with irritable bowel syndrome symptoms with respect to a consistent control group. Methods: Consecutive patients with irritable bowel syndrome according to Rome II criteria were enrolled. The control population consisted of 102 sex- and age-matched healthy subjects without irritable bowel syndrome symptoms. All subjects underwent glucose breath test. A peak of H(2) values >10 p.p.m above the basal value after 50 g of glucose ingestion was considered suggestive of small intestinal bacterial overgrowth. Results: A total of 65 irritable bowel syndrome patients and 102 healthy controls were enrolled. Positivity to glucose breath test was found in 31% of irritable bowel syndrome patients with respect to 4% in the control group, the difference between groups resulting statistically significant (OR: 2.65; 95% CI: 3.5-33.7, P < 0.00001). Conclusions: The present case-control study showed an epidemiological association between irritable bowel syndrome and small intestinal bacterial overgrowth. Placebo-controlled small intestinal bacterial overgrowth-eradication studies are necessary to clarify the real impact of small intestinal bacterial overgrowth on irritable bowel syndrome symptoms.PMID: 16305730 and of course, Dr Lin







" Another diagnostic test that has increasingly gained interest in this setting is the breath test to detect small intestinal bacterial overgrowth (SIBO). It has been proposed that many IBS patients have symptoms due to the presence of SIBO, as measured by the lactulose breath test, which has been detected in as much as 78% to 84% of patients.[39,40] Harris and colleagues[41] presented a retrospective chart review assessing the presence of GI symptoms, in particular those associated with IBS, in patients referred for glucose hydrogen breath tests for SIBO. *They predicted that lactulose breath testing overpredicted the actual prevalence of SIBO in IBS. * Glucose hydrogen breath testing has a sensitivity of 75% for SIBO[42] compared with the sensitivity of 39% with lactulose breath testing for the "double-peak" phenomenon characteristic of SIBO.[43] There has been considerable debate regarding the accuracy of the lactulose breath test compared with small bowel aspirates to detect the number of bacteria, which has been considered the gold standard for diagnosing SIBO.[44] Of the 182 patient charts reviewed, 113 patients (88 women; mean age, 58 years) met the Rome II criteria for IBS (IBS-D, 56%; IBS-C, 32%; and IBS-A, 12%).[41] Only 11% of these patients had a positive breath test for SIBO. The study authors concluded that etiologic factors other than SIBO are likely involved in the pathophysiology of IBS. Despite the standard use of the Rome II diagnostic criteria for IBS, the prevalence of SIBO in these patients appears to vary widely depending on the patient population and type of methodology used."http://www.medscape.com/viewarticle/517739


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## 23770 (Nov 26, 2005)

From what I understand, most LHBTs don't test for methane which has been known to cause constipation, but only hydrogen. So if you're an IBS-C sufferer, you might not want to rule out SIBO even if your hydrogen test comes back negative. Here is a compilation of the links I've collected over time concering IBS and SIBO:Here is a link to a thread detailing my Neomycin Trial: http://ibsgroup.org/eve/forums/a/tpc/f/71210261/m/923102902Here is a link to a thread detailing my Rifaximin Trial:http://ibsgroup.org/eve/forums/a/tpc/f/71210261/m/809108081Here are links to some important studies:The Study that started it allEradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome-2000Bi-Directional Interplay between Intestinal Flora and MotilityInteractions Between Commensal Bacteria and Gut Sensorimotor Function in Health and Disease-2005Exciting new finding concerning methaneMETHANE, A GAS PRODUCED BY ENTERIC BACTERIA, SLOWS INTESTINAL TRANSIT AND AUGMENTS SMALL INTESTINAL CONTRACTILE ACTIVITY.Methane is linked with IBS-CMethane production during lactulose breath test is associated with gastrointestinal disease presentation.Neomycin to the rescue!Neomycin Improves Constipation in Ibs: Subanalysis Of a Double Blind Randomized Controlled StudySuccessful use of anti-biotics for SIBO/IBSIBS study shows that targeted antibiotics lead to long-lasting improvement in symptoms-2005Every IBSer should have this test doneI'm looking to get it done soon!Lactutose Hydrogen Breath Test for SIBOSpecific Anti-Biotics that you should discuss with your doctorTreatment of IBS based on the theory of small intestinal bacterial overgrowthEven Natural Anti-biotics helpPersonally, I've seen significant reduction of symptons with peppermint and garlicThe treatment of small intestinal bacterial overgrowth with enteric-coated peppermint oil: a case report - Peppermint Oil-2002


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