# Question for Flux/Bonnie or anyone with SIBO knowledge



## Pete (Jan 20, 2000)

Flux/BonnieAs you have read I am doing well taking 200mg of rifaximin daily. My doc thought it would be a good idea to have a breath test while still on rifaximin since I still have some symptoms. I would say I'm 80% better but still do get gas attacks at times. Well I did the lactulose breath test yesterday and will give you the exact results but I was told it was still mildly positive with a peak at 75 minutes. Flux, could 75 minutes be a colonic response? Also from 4-8 hours after the test I never passed so much gas. What does this mean? Does it mean that most of my symptoms are fermentation in the colon which would point to dysbiosis causing symptoms rather then SIBO? My doc is happy that rifaximin is helping so much but is concerned that it will not last because of eventual bacterial resistance in the gut. Does this make sense. I am really impressed by rifaximin and was really dismayed after the test to see that I am still capable of passing so much gas. I will talk to my doc tomorrow to discuss this furth er. She did mention that I should probably take a small dose of erythromycin at bedtime.Thanks for any helpPete


----------



## bonniei (Jan 25, 2001)

> quote:still mildly positive with a peak at 75 minutes. Flux, could 75 minutes be a colonic response?


The normal transit through the small intestine is 90-120 mins. I would say it is unlikely that it is colonic. Don't they have your previous tests to determine transit? That is pretty amazing that even with Rifaximin, you are producing so much.


----------



## flux (Dec 13, 1998)

> quote: Flux, could 75 minutes be a colonic response?


How long did the study last? Presumably, if that was the peak and the study lasted beyond this point, it *had to be colonic*.What was the peak and how much lactulose did you consume?


> quote:Also from 4-8 hours after the test I never passed so much gas. What does this mean? Does it mean that most of my symptoms are fermentation


Having the actual values would be make it easier to say, but it could just be you aren't making much gas. SIBO is never a source of gas. There can't be enough bacteria to equal what the colon makes and you need a really high value to translate into a substantial volume.


----------



## Pete (Jan 20, 2000)

Flux,I should have the exact results today. She did say 75 minutes is too soon to be colonic. Why would SIBO not cause gas? Does this mean that if gas is my main symptom that you feel it is not caused by SIBO?Also do you agree that rifaximin will probably stop helping because of antibiotic resistance?Thanks


----------



## bonniei (Jan 25, 2001)

> quoteresumably, if that was the peak and the study lasted beyond this point, it had to be colonic


flux, I think you mean "presumably if it was the only peak."


----------



## flux (Dec 13, 1998)

> quote:I think you mean "presumably if it was the only peak."


No, if it was *the* peak, then it had to be colonic.


----------



## bonniei (Jan 25, 2001)

Oh so you mean the highest peak- absolute maximum and all - not just where its derivative is zero?


----------



## bonniei (Jan 25, 2001)

> quote:SIBO is never a source of gas


This is news to me. Never? "However, sometimes large numbers of bacteria do indeed grow in the small intestine and they can cause both loose stools and gas with bloating when they do"http://www.vh.org/adult/patient/internalme...rome/chap7.html


----------



## flux (Dec 13, 1998)

> quote:This is news to me. Never?


Most people don't get much gas from the colon, so how is SIBO could be that much of an impact?


----------



## SpAsMaN* (May 11, 2002)

Flux,if there is fermentation in the small bowel then this bacterial fermentation will spread to the colon.I assume that the gas volume can take more expantion in the colon because the bacterias population is exponential in the proper conditions. See Flux how happy your bacterias are:


----------



## 22770 (Aug 18, 2005)

This SIBO has never been mensioned to me by anyone, in fact, i have only heard it on this forum. I'm seeing my doc tomorrow evening. Under what conditions would it be worth asking about? What symptoms let you know that you may have the bacteria?Sorry if this doesn't make sence but i have been asking my doc questions based on what i read here and if it's an idea to get checked for this then i will ask him about it.Sorry again for the vagueness!!Lisa


----------



## Jeffrey Roberts (Apr 15, 1987)

I heard Dr. Pimental's talk about SIBO at the World Congress of Gastroenterology in Montreal this week. I intend to write it up along the lines of what Flux did from his Boston talk.I suggest you search on SIBO for additional postings about the subject.Incidentally, Dr. Pimental would be happy to field some questions directly and/or join us in a moderated chat session sometime in the near future.Jeff


----------



## bonniei (Jan 25, 2001)

> quote:Most people don't get much gas from the colon, so how is SIBO could be that much of an impact?


Makes sense.Hi Jeff, that is a wonderful idea to have a moderated chat with Pimentel. Will keep a look out for it.


----------



## bonniei (Jan 25, 2001)

> quote:What symptoms let you know that you may have the bacteria?


IBS.


> quote: Also do you agree that rifaximin will probably stop helping because of antibiotic resistance?


With antibiotics there iis always a risk of resistance. And while rifaximin has a good safety profile over a long time resistance could build up. Have you heard from the doc as uyet, Pete?


----------



## SpAsMaN* (May 11, 2002)

> quote:Most people don't get much gas from the colon, so how is SIBO could be that much of an impact?


IBSers produce more gas or just more toxic one,that's why they get positive Lactulose test.Yes we produce more gas,hey why do you think we are so bloated?Whenever i look ### my colon it's always bloated.


----------



## bonniei (Jan 25, 2001)

The Small intestine gas + colonic gas could lead to more gas after lactulose, flux. After all no studies have been done on gas after meals and so postprandially IBS'ers could have more colonic gas from the colon, flux. Sorry didn't think of it earlier. I just woke up.


----------



## flux (Dec 13, 1998)

> quote:IBSers produce more gas or just more toxic one,that's why they get positive Lactulose test.





> quote:Yes we produce more gas,


IBSers don't produce any more gas than anyone else really.


> quote:hey why do you think we are so bloated?


Gas and bloating are generally not related.


----------



## SpAsMaN* (May 11, 2002)

Thanks for the automatic reply Flux.







Then what cause bloating?If you fill a balloon with helium,are you gonna says no it is not the helium who makes the balloon bigger.


----------



## bonniei (Jan 25, 2001)

> quote:IBSers don't produce any more gas than anyone else really.


No post-prandial studies of gas in IBSers have been done. So we don't really know. Also there has been one study by Koide et all which suggests more gas in the SI in IBSers in fasting state.


----------



## flux (Dec 13, 1998)

> quote:Then what cause bloating?


We don't really know.


----------



## SpAsMaN* (May 11, 2002)




----------



## SpAsMaN* (May 11, 2002)

Ok Flux see the membran expand,i can't be more clear:


----------



## flux (Dec 13, 1998)

> quote:The eyes can't lie Flux


In human bloating, there is nothing to see, at least as far we can see


----------



## SpAsMaN* (May 11, 2002)

> quote:In human bloating, there is nothing to see,


AFAIK,the Bonnei and Joanfarc pics WAS visible bloating.


----------



## 16487 (Mar 28, 2005)

Here is an article that defines bloating and distension as two different things. I think most IBSers have distention, the extra girth, and not bloating. They still don't say what causes the distension however.http://www.medscape.com/viewarticle/483079_1


----------



## flux (Dec 13, 1998)

> quote:AFAIK,the Bonnei and Joanfarc pics WAS visible bloating


Yes, technically distension, but what's going on in there to cause that? Gas it is most probably not. A mystery!


----------



## SpAsMaN* (May 11, 2002)

Flux,how do you explain my improvements with Cefuroxime since you claim there is no pro-motility agent in it?:-Had liquid diarrhea with it-No head aches-Stomack of steel,able to eat anything without problemsFlux,are we intolerant to our stools?







Or the flora is producing methane resulting in C?I challenge anybody here to explain about these anodectal improvements!


----------



## eric (Jul 8, 1999)

FYI"Abdominal Bloating: Relation to Rectal Hypersensitivity and Menstrual CycleAbdominal bloating and visible abdominal distension are commonly reported by patients with IBS.[17] Despite the introduction of tegaserod, which has been shown to relieve symptoms of bloating in female patients with IBS-C,[18] bloating can still be challenging to treat because of the lack of understanding of the pathophysiologic mechanisms underlying these common symptoms.[19] While some patients with bloating have associated abdominal distension, others do not. Although patients with IBS with abdominal bloating, with and without associated visible abdominal distension, are quite similar in the majority of parameters, eg, those with both bloating and distension are more likely to be female, are more likely to report a greater perceived symptom severity, and are more likely to have less diurnal variation in symptoms.[20] In addition, abdominal bloating is reportedly worse in women during the late luteal and early menses phases of the menstrual cycle.[21]Lea and colleagues[22] performed several studies to further evaluate the impact of these associated factors (ie, diurnal variation, abdominal distension, and menstrual cycle) in patients with IBS with bloating. In one study, they evaluated the diurnal variation of abdominal girth in 16 patients with IBS-C, 21 with IBS-D, and in 20 healthy control subjects. Abdominal distension was measured using a recently validated objective technique of Ambulatory Abdominal Inductance Plethysmography.[23] Abdominal girth was greatest in the early evening in approximately 60% of both IBS-C and IBS-D patients, but only correlated with worsening bloating symptoms in the IBS-C patients.In a second study,[24] these investigators assessed whether rectal sensitivity differed between female patients with IBS with abdominal bloating, with and without increased abdominal distension (total n = 37). Those patients who did not exhibit physical abdominal distension (compared with healthy controls) had significantly lower rectal pain thresholds than both patients with IBS who were distended and healthy controls. The investigators concluded that the symptom of bloating in the absence of visible abdominal distension may be due to increased visceral sensitivity to gastrointestinal events.In their third study, Lea and colleagues[25] sought to determine whether perimenstrual bloating is associated with abdominal distension. Abdominal girth was recorded for 24 hours in 12 women with IBS and in 10 healthy female volunteers during the various menstrual cycle phases. Both women with IBS and control females reported more bloating during menses and the premenstrual phase, although bloating was rated as more severe in the patients than in the controls. However, abdominal girth was not different between the different phases of the menstrual cycle in IBS patients or in controls. Taken in conjunction with the results from the first study and with the previous finding that rectal perception is increased during menses compared with the other menstrual cycle phases in women with IBS,[26] these results lend support to the hypothesis that abdominal bloating is related to visceral hypersensitivity in IBS.Summary. Abdominal bloating is a common symptom reported by patients with IBS, although its pathophysiology is not well understood. Several findings suggest that abdominal bloating may be related to visceral hypersensitivity: (1) bloating without distension is associated with lowered rectal pain thresholds; (2) bloating is reported as worse in the premenstrual and early menses phases of the menstrual cycle; and (3) rectal sensitivity is increased during menses compared with the other phases in women with IBS. If abdominal bloating is related to visceral hypersensitivity, it is not clear whether this is due primarily to visceral hyperalgesia (ie, increased pain perception to noxious visceral events) or to a hypervigilance towards expected aversive events arising from the viscera."http://www.medscape.com/viewarticle/480232?src=searchThere is more I will find and post though that has to do with abdominal muslces themselves.


----------



## Jhouston (Nov 9, 2003)

Spas, I do not think others would agree that Liquid d is an improvement. Antibiotics can cause d and hopefully resolve on its own. otherwise it would be something to treat. kow what I mean? Joann


----------



## SpAsMaN* (May 11, 2002)

JJ,it is known that IBS-C is worst than D.So the side effect of D ARE beneficial for C-ers.Remember that true C-ers need their colon to be removed to cure their illness.As far as i know,D-ers do not aggravate that much.


----------



## Jhouston (Nov 9, 2003)

Spas, I am/was ibs c, recently that has changed. I would rather be c than d! Or do you mean you had a few bms? not d. d from antibiotics is not a GOOD thing. IMO. Joann


----------



## SpAsMaN* (May 11, 2002)

I had liquid diarrhea and fine with it,no head aches, and had a stomack of steel which is almost a miracle to eat everything...


----------



## Jhouston (Nov 9, 2003)

Why not try laxatives instead of antibiotics? Joann


----------



## SpAsMaN* (May 11, 2002)

Laxative usually works the first day and the second day it is the rebound effect.Head aches far worst and hit without warning.Gas more trapped etc...Maybe i should try magnesium citrate.I don't know. ?Thanks for asking


----------



## Pete (Jan 20, 2000)

My breath test result on rifaximin was as follows:At 60 minutes H2(ppm) 9At 75 minutes H2 (ppm) 26At 90 minutes H2 (ppm) 45At 120 minutes H2(ppm) 43At 150 minutes H2 (ppm) 47She claims this is positive for SIBO and has increased my dose of rifaximin.My capsule endoscopy continues to show ulcers at the terminal ileum even though I tend not to have any Crohn's symptoms.I assume rifaximin is a good choice because it is used for SIBO as well as IBD.


----------



## SpAsMaN* (May 11, 2002)

Wow Pete an ulcer at the illeum,what is your symptoms?Do you feel the alteration?


----------



## flux (Dec 13, 1998)

> quote:At 60 minutes H2(ppm) 9At 75 minutes H2 (ppm) 26At 90 minutes H2 (ppm) 45At 120 minutes H2(ppm) 43At 150 minutes H2 (ppm) 47


This is SIBU, small intestinal bacterial undergrowth.


----------



## SpAsMaN* (May 11, 2002)

> quote:This is SIBU, small intestinal bacterial undergrowth.


----------



## bonniei (Jan 25, 2001)

This is Pete's graph. The trough of that peak was not deeper than 2 ppm so I don't see a peak,flux. But by Pimentel's new standards it is SIBO


----------



## flux (Dec 13, 1998)

> quote:But by Pimentel's new standards it is SIBO


That's not even SIBO in Martians.


----------



## bonniei (Jan 25, 2001)

Have you read The Management of SIBO paper by Lin,flux?Maybe you should write to Pimentel and sort it out. For them normal is no peak earlier than 90 and a peak concentration no greater than 20 ppm. Anything else is abnormal.


----------



## Pete (Jan 20, 2000)

Flux,You believe this is normal? I did have gassy symptoms at that time. Pimental didn't do the study. UCLA did it and conclude that it is SIBO. Can you explain why it isn't?


----------



## flux (Dec 13, 1998)

> quote:You believe this is normal?


Those results are normal at worst and even *subnormal* at best.


----------



## Pete (Jan 20, 2000)

Can you explain why?


----------



## SpAsMaN* (May 11, 2002)

Pete,you've missed my post.









> quote:Wow Pete an ulcer at the illeum,what is your symptoms?Do you feel the alteration?


----------



## flux (Dec 13, 1998)

> quote:Can you explain why?


Granted, you don't have data prior to 60 minutes, but 9 is a really low value for that time. You have virtually no bacteria in your distal small bowel or maybe you have gas-eating bacteria there. The rest is just a colonic rise and it's not that high. You'd probably have to double those numbers to have real gas volume.


----------

