# Some expert SIBO information for the forum



## eric (Jul 8, 1999)

FYIhttp://ibsgroup.org/groupee/forums/a/tpc/f...261/m/886108272


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## eric (Jul 8, 1999)

FYII am trying to understand somethings in relationship to SIBO. I posted here so you both may see it. I am looking into but am not sure about somethings that you guys can possibly help with.Okay altered motlity can cause bacteria to enter the small bowel where it should not be really, at least in high counts, because its a pretty sterile environment. For the moment I am just looking at the altered motility reason for SIBO. What are small intestinal bacteria overgrowth symptoms? The symptoms of SIBO include:excess gas, abdominal bloating and distension, diarrhea, and abdominal pain. "A small number of patients with SIBO have chronic constipation rather than diarrhea. "How does small intestinal bacterial overgrowth cause symptoms?When bacteria digest food in the intestine, they produce gas. The gas can accumulate in the abdomen giving rise to abdominal bloating or distension. Distension can cause abdominal pain. The increased amounts of gas are passed as flatus (flatulence or farts). The bacteria also probably convert food into substances that are irritating or toxic to the cells of the inner lining of the small intestine and colon. These irritating substances produce diarrhea (by causing secretion of water into the intestine). There is some evidence that the production of one gas by the bacteriaâ€"methaneâ€"causes constipation. http://www.medicinenet.com/small_intestina...rowth/page2.htmAny Idea what those irritating substances are?This means these are just in the wrong place and not specific or multiple pathogens?A "classic" bacterial infection or a reaction to "all" the bacteria there themselves?ThanksFluxMy guess is that they are intending to refer to the prevailing belief that bacterial overgrowth results in deconjugation of bile acids. Bile acids help digest fats, but in conjugated form (that is, bound to certain other chemicals).The deconjugated acids are "irritating" to the intestine and they trigger the colon to secrete fluid into colonic lumen resulting in diarrhea.Interestingly, Pimental seemed to be telling me that this was not occurring at least as of June 2005. However, I don't think anyone has published anything on SIBO patients and their bile acid level. (It's conceivable that such a study has occurred since that time.)Bile acid malabsorption has been noted in IBS patients. See http://www.ncbi.nlm.nih.gov/entrez/query.f...l=pubmed_docsum,[/URL] For whatever reason, it doesn't seem to have been pursued.Thanks Flux, I am going to ask some Doc's hopefully about this, but was looking for some input on it all.I will let you know what I find out as well.I'm exactly sure what they would mean by toxins in this case.Random assorted theoretically ramblings ahead. Nothing below should be seen as scientific fact or data-supported in anyway.I mean anything metabolically active produces by-products that they don't want inside them, but usually the normal colon or mouth bacteria aren't generating something that makes people sick (or we would each and every one of us be sick).Now I know that some things like bile seem to be tolerated in the small intestine, but irritating to the large. I'm thinking along the lines of the stomach lining is designed to handle the normal things in the stomach sort of thing. I haven't seen any thing that would prove this, but it could be the colon or the cells lining it are protected from bacterial metabolic byproducts in a way that small intestinal cells are not. After all colon cells really only need to remove water from the stool so may have different functionality from the small intestine that absorbs all kinds of things along the way. The other out is there is something that is normally not sticking around long enough to get to the colon so that the normal bacteria never get to have much of it, but in the small intestine where the stuff is in higher concentration because it isn't absorbed it is now processed by the bacteria and it's byproducts are a problem. Why it would be more irritating for bacteria in the small intestine to do this then the exact same bacteria in the colon is something I couldn't explain. I think in some of the more traditional SIBO you are getting problems with absorption (as weight loss can be a symptom) and that may mean things that don't normally feed bacteria are now fuel and so you may have different byproducts. Unless all the absorption problems are because the bacteria ate it all first.I'm thinking that maybe it is more of one of those based on logic this sounds right sort of generalizations, but no one really did an experiment to prove or disprove it. You do see that from time to time, like the fat makes stool float thing, or the why you get a stitch in your side when you run that I posted about awhile ago. Logically it makes sense, but there isn't data to back the assumptions you based the logic on.K.One of the standard responses of the colon to irritants of any sort is to dump water in and move everything along rapidly and forcefully out of the body.Usually if it is "trapped" that fits with constipation rather than diarreha."Irritation" doesn't mean in pain. Just means some stimuli that the colon reacts to by getting whatever it is out of the body ASAP. This can be a totally painless process other than the urgency when the liquid hits the rectum.For what it's worth some of the diarrheal diseases that kill people do so because the toxin produced is so potent that the person ends up dumping more water and electrolytes out the back end than they can swallow. This really isn't a process that equates with "trapped" and constipated.K.I wrote to Dr Drossman on this and here is the reply. *Any Idea what those irritating substances are?*sorry its in bold type that is how he worte it into the email so I would see it was his answers."IT IS AN OVERSTATEMENT TO SAY THEY ARE "IRRITATING" SUBSTANCES AT LEAST IN THE SENSE OF BEING SOME TYPE OF TOXIN. THEY ARE NATURAL BYPRODUCTS OF DEGRADATION OF FOOD SUBSTANCES BY BACTERIA WHICH DON'T NORMALLY OCCUR IN THE SMALL BOWEL. SO WITH INCREASED BACTERIA IN THE SMALL BOWEL, THE BACTERIA ARE ABLE TO DIGEST SUGARS FOR EXAMPLE PRODUCING H2 AND CO2 FROM THE SUGARS WHICH ARE GASEOUS BUT WHICH ALSO HAVE OSMOTIC PROPERTIES, I.E. INCREASED PARTICLES THAT CAUSE SECRETION OF FLUID INTO THE BOWEL THUS CAUSING DIARRHEA. IT'S THE SAME PRINCIPLE AS USING NON ABSORBABLE SUGARS LIKE LACTULOSE OR SORBITAL TO TREAT CONSIPATION BY INCREASING FLUID IN THE BOWEL. IT'S JUST THAT WITHOUT BACTERIA IN THE SMALL BOWEL, IT DOESN'T HAPPEN AND THE FOOD SUBSTANCES GET ABSORBED. WITH INCREASED BACTERIA IT COMPETES FOR THE FOOD SUBSTANCES AND PRODUCES THE GAS AND DIARRHEA."*This means these are just in the wrong place and not specific or multiple pathogens?*CORRECT. HOWEVER, THERE IS GROWING INTEREST NOT IN THE AMOUNT OF BACTERIA BUT THE TYPE OF BACTERIA. CERTAIN BACTERIA CAN CAUSE SOME MILD INFLAMMATION OF THE BOWEL AND OTHERS PROTECT THE BOWEL FROM THAT POSSIBILITY. SO THERE IS "GOOD" AND "BAD" BACTERIA. POSSIBLY WHEN PEOPLE ARE TREATING PRESUMED SIBO (WHICH MIGHT NOT ACTUALLY BE HAPPENNING, BECAUSE THE TEST MAY BE INACCURATE) ANTIBIOTICS MAY HELP TO GET RID OF THE BAD BACTERIA AND THAT MAY BE WHY THEY ARE GETTING BETTER. THIS IS WHY SOME PEOPLE GET BETTER AFTER ANTIBIOTIC TREATMENT. BUT IT CAN ALSO GO THE OTHER WAY, I.E., ANTIBIOTICS HAVE BEEN SHOWN TO MAKE IBS WORSE AS WELL. THE OTHER IDEA IS TO USE PROBIOTICS WHICH CONTAIN "GOOD" BACTERIA (E.G., LACTOBACILLUS OR BIFIDOBACTERIA) WHICH REPLACE THE BAD BACTERIA, POSSIBLY REDUCE THE INFLAMMATION AND IMPROVE SYMPTOMS. SO THE ISSUE OF BACTERIA IN THE BOWEL IS MUCH MORE COMPLICATED THAN SIMPLE SIBO, BUT SIBO CAN BE A PART OF THE WHOLE PICTURE (THOUGH NOT THE WHOLE PICTURE FOR IBS).spasmanquoteOSSIBLY REDUCE THE INFLAMMATION So there is inflammation? Spasman, I will go over that when I have some time.Here though there can be transient inflammation for a lot of reasons. Even some medications can cause inflammation. But bacteria can, just like a minor food problem, not enough to give you food poisonming for example, but enough to make you quezy so to speak. Like eating some questionable leftovers out of the fridge say. There is another kind of inflammation in IBS also we have talked about extensively regarding mast cells in IBS, especially in PI and D predominate IBS.It is not completely known however if all IBSers have inflammation. This inflammation also is MACROSCOPIC. I will see if I can find a picture. I know there are some out there. And inflammation cannot be a biological marker in IBS, because it does not always cause pain.There are also other abnormalities that have to be taken into account in the big picture.


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## eric (Jul 8, 1999)

FYIalso I highly recomened read this article whcih you can get from the IFFGD"Gut Bacteria and Irritable Bowel Syndrome By: Eamonn, M. M. Quigley M.D., Alimentary Pharmabiotic Centre, University College Cork, Cork, IrelandBacteria are present in the normal gut (intestines) and in large numbers the lower parts of the intestine. These "normal" bacteria have important functions in life. A variety of factors may disturb the mutually beneficial relationship between the flora and its host, and disease may result. The possibility that gut bacteria could have a role in irritable bowel syndrome (IBS) may surprise some; there is indeed, now quite substantial evidence to support the idea that disturbances in the bacteria that populate the intestine may have a role in at least some patients with IBS. This article presents a discussion of the possible role of bacteria in IBS and various treatment approaches."Do bacteria play a role in IBS?The possibility that gut bacteria could have a role Irritable Bowel Syndrome (IBS) may surprize some; there is indeed, now quite substantial evidence to support the idea that distrubances in the bacteria that populate the intestines may have a role in at least some patients with IBS. What is this evidence? It can be summarized as follows:1. surveys which found that antibiotic use, well known to distrub flora, may predispose individuals to IBS.2. The observation that some individuals may develop IBS suddenly, and for the first time, following an episode of stomach or intestinal infection (gatroenteritis) caused by a bacterial infection.3. recent evidence that a very low level of inflammation may be present in the bowel wall of some IBS patients, a degree of inflammation that could well have resulted from abnormal interactions with bacteria in the gut.4. The Suggestion that IBS maybe Associated with the abnormal presents, , in the small intestines, of types and numbers; a condition termed small bacterial overgrowth (SIBO)>5. Accumaliting evidence to indicate that altering the bacteria in the gut, by antibiotics or probiotics, may improve symptoms in IBS.For some time, various studies have suggested the presence of changes in the kind of colonic flora in IBS patients. The most consistent finding is a relative decrease in the population of one species of 'good' bacteria, bifidobacteria.However, the methods employed in these studies have been subject to question and other studies have not always reproduced these finding. Nevertheless, these changes in the flora, maybe primary or secondary, could lead to the increase of bacterial species that produce more gas and other products of their metabolism. These could CONTRIBUTE to symptoms such as gas, bloating and diarrhea.""We still don't know the exact role bacteria has in IBS. More research is needed."http://www.aboutibs.org/Publications/currentParticipate.htmlI highly encourage others to read the read of this excellent article.


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