# Non Absorbable antibiotics for excessive intestinal gas



## bonniei

Maybe people with serious excessive gas can try this approach if they don't mind trying antibiotics. Found it on MedlineTiTle: Non-absorbable antibiotics for managing intestinal gas production and gas-related symptoms. Author: Di Stefano M , Strocchi A , Malservisi S , Veneto G , Ferrieri A , Corazza GR Source Aliment Pharmacol Ther, 14(8): 1001-8 2000 Aug Abstract: BACKGROUND: Simethicone, activated charcoal and antimicrobial drugs have been used to treat gas-related symptoms with conflicting results. AIM: To study the relationship between gaseous symptoms and colonic gas production and to test the efficacy of rifaximin, a new non-absorbable antimicrobial agent, on these symptoms. METHODS: Intestinal gas production was measured by hydrogen (H2) and methane (CH4) breath testing after lactulose in 21 healthy volunteers and 34 functional patients. Only the 34 functional patients took part in a double-blind, double-dummy controlled trial, receiving, at random, rifaximin (400 mg b.d per 7 days), or activated charcoal (400 mg b.d per 7 days). The following parameters were evaluated at the start of the study and 1 and 10 days after therapy: bloating, abdominal pain, number of flatus episodes, abdominal girth, and cumulative breath H2 excretion. RESULTS: Hydrogen excretion was greater in functional patients than in healthy volunteers. Rifaximin, but not activated charcoal, led to a significant reduction in H2 excretion and overall severity of symptoms. In particular, in patients treated with rifaximin, a significant reduction in the mean number of flatus episodes and of mean abdominal girth was evident. CONCLUSIONS: In patients with gas-related symptoms the colonic production of H2 is increased. Rifaximin significantly reduces this production and the excessive number of flatus episodes.


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## stinky too

bonnie,Thanks for that info.







I can pretty well control the gas with diet but the small amt. that I seem to pass and not realize I do, has a very offensive odor.







This is what I can't find an answer for.







------------------Prayer doesn't change God , it changes the one who prays..C type, with G


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## KateyKat

Bonniei this looks like a little gem u found  Ta mucho.


> quote:CONCLUSIONS: In patients with gas-related symptoms the colonic production of H2 is increased. Rifaximin significantly reduces this production and the excessive number of flatus episodes.


And although excessive gas is *not* an 'IBS' symptom, the study does indirectly address the possible B.O. symptom of gut dysfunction. KKat


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## bonniei

I called my doctor this afternoon and he hadn't heard of the antibiotic. Maybe it is too new or hasn't been launched yet. So maybe our hopes shouldn't be raised. But atleast we have seen a study directly connecting gas and antibiotics. So that is something.Hope for the future. If anyone knows if this antibiotic is available please do post here.If this antibiotic is attacking BO, then since this study was not done over a long term who is to say BO won't come back due to motility dysfunction? I was so excited this morning when I saw the study but now I don't know what to feel about it


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## bonniei

BTW what I meant by "if you don't mind taking antibiotics" is -if you are fully aware of the dangers and don't mind taking antibiotics. Drug resistance, C. diff are the two possible disadvantages of antibiotics which come readily to mind.[This message has been edited by bonniei (edited 04-20-2001).]


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## Ugh

"a significant reduction in the mean number of flatus episodes and of mean abdominal girth was evident."Thanks for the post. That's interesting that they included actual measurement of the abdominal girth. My personal opinion on all this is that the gas reduction is from removal of gas producing bacteria in the colon and not BO. They make a mention of the breath test, but there isn't enough details to know what was going on with that.


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## bonniei

Ugh I read somewhere that this particular antibiotic is not absorbed by the small intestine. So it probably does kill the bacteria in the colon. But I don't know if just because it is not absorbed by the small intestine it doesn't kill the bacteria in the small intestine. Anyone know?


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## KateyKat

Yes Ugh they do say *colonic* gas not small intestinal but they're employing a method similar to that used for BO of small bowel.Actually when u think about it u shouldn't need abx for the colon .. where probiotics should do the job adequately. The problem with the small intestine and probiotics is that you're trying to 'therapeutically' colonise with yet more bacteria that shouldn't be there in the first place.Bonniei, since there shouldn't be much bacteria at all in small intestine, your Q is probably more academic than practical. I suspect this may have been addressed inPete's earlier threads on neomycin/CS.KKat


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## Kathleen M.

I suspect that antibiotics that are not absorbed would be more effective at killing intestinal bacteria regardless of where they are. Absorbtion by the small intestine really only tells you if or how well it gets into the rest of the body. So if you had a sinus infection you would want an antibiotic that is readily absorbed into the blood stream and most of that happens in the small intestine, but for an intestinal infection one that wasn't absorbed might be best as it was not diluted out by being distributed throughout the whole body.K.------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html


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## bonniei

> quote:Bonniei, since there shouldn't be much bacteria at all in small intestine


unless you have BO. The real question is does this antibiotic work because it is taking care of BO in the small intestineor killing the bacteria in the colon.If you don't have BO and it is killing the bacteria in the colon then I agree probiotics are entirely adequate. But this antibiotic option provides another option, one I personally don't likeIf the antibiotic is taking care of the BO, then we have thrashed it out many times before and then this is not a new discovery. Thanks k for the reply because it makes me think the antibiotic may be just taking care of the BO and we are back to square one taking antibiotics endlessly.So all in all so much for the discovery lol. I guess the only good thing I see about the study is it proved antibiotics do take care of the gas problem since we had only Pete's experience to go by so far[This message has been edited by bonniei (edited 04-20-2001).]


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## Ugh

> quote:Yes Ugh they do say *colonic* gas not small


doh! lol, you got me there, I guess I was confused by people mentioning BO in the posts following that post.


> quote:intestinal but they're employing a method similar to that used for BO of small bowel.


Yeah, I wasn't saying it wouldn't work for BO, that's not what I meant to imply. I was questioning the whole BO problem in the first place (in terms of the recent treatments). I tend to think that many people who get relief in some of the BO studies, get that relief from changes in colon bacteria. Just my personal opinion, and that is what I was getting at in my post.


> quote:Actually when u think about it u shouldn't need abx for the colon .. where probiotics should do the job adequately. The problem with the small intestine and probiotics is that you're trying to 'therapeutically' colonise with yet more bacteria that shouldn't be there in the first place.


Well.. hmmm... nobody really seems to know how this works, do they? I've heard competing theories about probiotics slowly displacing gas producing bacteria, or probiotics gaining ground in uninhabited areas... who knows. If that were the case you wouldn't think it'd be necessary to continually take a probiotic, yet people seem to say the benefits go away when they stop taking it. I would think that taking an antibiotic followed by lots of probiotics would be much more effective at populating your colon with that probiotic. I'm not saying it is a good idea, I'm saying if the goal was just to get as much probiotics living in your colon as possible, that would seem to be the most effective way to me.


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## eric

For small bowel BO, if you have been tested and have this problem. This came out before DR P's study.Norfloxacin, Amoxicillin-ClavulanicAcid Treat Diarrhea Related toBacterial Overgrowth WESTPORT, Oct 20 (Reuters Health) - Norfloxacin andamoxicillin-clavulanic acid are effective treatments for chronicdiarrhea due to small-bowel bacterial overgrowth, accordingto a report in the October issue of Gastroenterology.Dr. Alain Attar, of Hopital Lariboisere Saint Lazare in Paris,and multicenter French colleagues studied 10 patients with a3-month history of diarrhea, a predisposition to bacterialovergrowth, and positive results on a glucose ingestionhydrogen breath test.During the first week of the trial, patients received notreatment, and during the second week they received placebo.During the third through fifth weeks they received the followingin random order: norfloxacin 800 mg/day,amoxicillin-clavulanic acid 1,500 mg/day, and Saccharomycesboulardii 1,500 mg/day. Patients kept a daily symptom diarythroughout the study period.Dr. Attar's group determined that norfloxacin andamoxicillin-clavulanic acid significantly reduced stoolfrequency compared with placebo, with reductions of 45% and29%, respectively, in the mean daily number of stools. Theseimprovements were maintained for an average of 6 days."The choice of 7 days of treatment was a compromise designedto avoid drop-out and yet ensure the most efficient length oftherapy," the researchers note. "This does not invalidate theprobiotic agent, which may require administration on a longerperiod."Gastroenterology 1999;117:794-797.------------------Moderator of the Cognitive Behavioral Therapy, Anxiety and Hypnotherapy forumI work with Mike and the IBS Audio Program. www.ibshealth.com www.ibsaudioprogram.com


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## eric

I meant to add this is way different then trying to colonize your digestive system with good bacteria using probiotics.There is something else here. Lets take bloating or distension for example. In some IBSers a normal amount of gas gets caught in between two parts of the colon spasming. For an anology, if you took a long balloon and tightened both ends with your hands this forces the air to the center where the balloon will buldge. So this would not be a bacteria problem, but a problem of normal gas being caught in the middle of the spasm and requires a different approach to treat.------------------Moderator of the Cognitive Behavioral Therapy, Anxiety and Hypnotherapy forumI work with Mike and the IBS Audio Program. www.ibshealth.com www.ibsaudioprogram.com


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## KateyKat

> quote:you wouldn't think it'd be necessary to continually take a probiotic, yet people seem to say the benefits go away when they stop taking it.


I suppose u have to know how to feed em properly to keep em alive .. and the inverse for bad bacteria - ie how to starve em. I hear for example that [for cats] lactobacillus can't use FOS but thrive on beet pulp. Don't know the fermentation indeces for humans tho.KKat


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## bonniei

Thanks for pointing out eric taht normal gas is not a BO problem


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## bonniei

The other intersting thing about the study I just realized is this-They proved Lactulose causes more hydrogen production in people with gas problems compared to healthy volunteers. While lactulose may not be great to test for BO, maybe it does test for gasI found this on the internet. FYI"Salix also is working on a second drug. Rifaximin, a gastrointestinal antibiotic, is in Phase III clinical trials and is scheduled to be launched by late 2002 or early 2003."I also read rifaximin has been used in europe to treat traveller's diarrhea. I suppose it has to be the same rifaximin


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## Ugh

> quote:There is something else here. Lets take bloating or distension for example.


Yeah, that is why I thought it was interesting that they measured it. There is also some evidence that bloating and distension can be caused by the abdominal muscles pushing out in response to some miscommunication/stimulus or whatever. This is sort of an unconscious version of when you actually try to push out your belly with your ab muscles. So that gas doesn't even have to be involved, or, if it is, again could be a normal amount.


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## Tara2

I thought this post was very interesting so I did a little searching on the web to find out more info on this drug. Looks like Rifaximin is being developed by Salix Pharmaceuticals. They have recently completed Phase III trials and plan to file a new Drug Application in the second half of 2001. So it is not available yet but might be soon. Check out the following: http://www.business.com/directory/pharmace...ticals/profile/ http://www.salixltd.com/webpage_templates/...e_name=products Tara


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## abcdefg

Bonniei - Thank you for posting the abstract information. I don't have a firm understanding of the terms used, but about your question whether Rifaximin works in the small intestine? or colon?, in an earlier article, the same authors specifically discuss Rifaximin versus another drug in treating small intestine bacterial overgrowth."Rifaximin versus Chlortetracycline in the short-term treatment of small intestinal bacterial overgrowth " Alimentary Pharmacology and Therapeutics 2000 May; 14(5):551-6


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## bonniei

Tara your post says something similar to my previous post. Thanks for the post.Thanks for referring me to the article abcd.I didn't think of doing a search on Medline for Rifaximin! Go figure! It certainly looks like it works on SIBO. So maybe the antibiotic is just taking care of SIBO. But maybe it works on colonic pathogens too because I think k said it works on the entire tract. I guess I would like a study which says gas is caused by SIBO or alternatively by colonic bacteria(other than the one flux referred to in his previous posts) Because I don't have SIBO if the hydrogen breath test is to be believed and I just want to make sure that colonic bacteria are not the cause of my gas and if it were indeed the cause then I would like to know that rifaximin cures it.Ugh, the study abcd referred to talks about chlortetracycline.And the abstract seems to use tetracycline and chlortetracycline interchangeably and says tetracycline has been the first drug of choice for SIBO. I remember you had a question about that in one of your previous posts. However the study goes on to say "The H2 breath test normalized in 70% of patients after rifaximin and in 27% of patients after chlortetracycline". So I hope all that goes some way towards answering your question about your doctor's suggestion.Rifaximin seems to work on H Pylori too according to Medline. It seems like an interesting antibiotic( with all the dangers of antibiotics of course)[This message has been edited by bonniei (edited 04-21-2001).]


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## bonniei

I jusat realized that k had posted this study about intestinal microflora:TiTle: Alteration of intestinal microflora is associated with reduction in abdominal bloating and pain in patients with irritable bowel syndrome. Author: Nobaek S , Johansson ML , Molin G , AhrnÃ© S , Jeppsson B Source Am J Gastroenterol, 95(5): 1231-8 2000 May Service Fee: $10.75 ; Copyright Royalties: $20.30 Abstract: OBJECTIVE: The influence of the gastrointestinal (GI) microflora in patients with irritable bowel syndrome (IBS) has not been clearly elucidated. This study was undertaken to see if patients with IBS have an imbalance in their normal colonic flora, as some bacterial taxa are more prone to gas production than others. We also wanted to study whether the flora could be altered by exogenous supplementation. In a previous study we have characterized the mucosa-associated lactobacilli in healthy individuals and found some strains with good colonizing ability. Upon colonization, they seemed to reduce gas formation. METHODS: The study comprised 60 patients with IBS and a normal colonoscopy or barium enema. Patients fulfilling the Rome criteria, without a history of malabsorption, and with normal blood tests underwent a sigmoidoscopy with biopsy. They were randomized into two groups, one receiving 400 ml per day of a rose-hip drink containing 5 x 10(7) cfu/ml of Lactobacillus plantarum (DSM 9843) and 0.009 g/ml oat flour, and the other group receiving a plain rose-hip drink, comparable in color, texture, and taste. The administration lasted for 4 wk. The patients recorded their own GI function, starting 2 wk before the study and continuing throughout the study period. Twelve months after the end of the study all patients were asked to complete the same questionnaire regarding their symptomatology as at the start of the study. RESULTS: All patients tolerated the products well. The patients receiving Lb. plantarum had these bacteria on rectal biopsies. There were no major changes of Enterobacteriaceae in either group, before or after the study, but the Enterococci increased in the placebo group and remained unchanged in the test group. Flatulence was rapidly and significantly reduced in the test group compared with the placebo group (number of days with abundant gas production, test group 6.5 before, 3.1 after vs 7.4 before and 5.6 after for the placebo group). Abdominal pain was reduced in both groups. At the 12-month follow-up, patients in the test group maintained a better overall GI function than control patients. There was no difference between the groups regarding bloating. Fifty-nine percent of the test group patients had a continuous intake of fermented products, whereas the corresponding figure for the control patients was 73%. CONCLUSIONS: The results of the study indicate that the administration of Lb. plantarum with known probiotic properties decreased pain and flatulence in patients with IBS. The fiber content of the test solution was minimal and it is unlikely that the fiber content could have had any effect. This type of probiotic therapy warrants further studies in IBS patients. So colonic flora does cause gas. I seem to be reinventing the wheel. I guess I would really like to know that rifaximin cures problems caused by colonic bacteria. I guess they should do a study on people who don't have SIBO and yet have gas and see if rifaximin cures itAnd I guess SIBO does cause malabsorption and hence gas.Reinventing the wheel again. Sorry for thinking things through on the BB. Maybe it will help someone[This message has been edited by bonniei (edited 04-21-2001).][This message has been edited by bonniei (edited 04-21-2001).]


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## Ugh

Bonniei, you're awesome! Thanks for the information on tetracycline, I'm surprised you remembered that post of mine. I will be posting some info about that soon.


> quote:but about your question whether Rifaximin works in the small intestine


I could be wrong here, but I would think it would be hard for an antibiotic to work in just the small intestine while not affecting the colon or vice versa. The only reason I can imagine even wanting an antibiotic like that would be to eliminate SIBO without messing with colon flora...I don't think it would be possible to develop an antibiotic that precise. I think there are just some that work better for the intestine as a whole, as I think somebody already mentioned. Although, I just read their site, and they developed some other drug (not an antibiotic) that they claim only affects the colon. It would be tough though to have an antibiotic hit only the small intestine without the colon, just because of the order of them. I could see maybe the colon and not the small intestine.[This message has been edited by Ugh (edited 04-21-2001).]


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## bonniei

Ugh is right about rifaximin afffecting the whole digestive tract including the colon because I found this"Colonic cleansing by non-absorbable antibiotics and lactitol seems to exert a beneficial effect on the supervening infection of experimental necrotizing pancreatitis. ". So atleast rifaximin seems to work on the colon too.


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## eric

Just for information here. Can J Gastroenterol 1999 Mar;13 Suppl A:50A-65A Related Articles, Books, LinkOut Management of irritable bowel syndrome: novel approaches to the pharmacology of gut motility. Scarpignato C, Pelosini I. Department of Gastroenterology and Hepatology, Faculty of Medicine, University of Nantes, France. scarpi###tin.it Although it is unclear to what extent irritable bowel syndrome (IBS) symptoms represent a normal perception of abnormal function or an abnormal perception of normal function, many believe that IBS constitutes the clinical expression of an underlying motility disorder, affecting primarily the mid- and lower gut. Indeed, transit and contractile abnormalities have been demonstrated with sophisticated techniques in a subset of patients with IBS. As a consequence, drugs affecting gastrointestinal (GI) motility have been widely employed with the aim of correcting the major IBS manifestations, ie, pain and altered bowel function. Unfortunately, no single drug has proven to be effective in treating IBS symptom complex. In addition, the use of some medications has often been associated with unpleasant side effects. Therefore, the search for a truly effective and safe drug to control motility disturbances in IBS continues. Several classes of drugs look promising and are under evaluation. Among the motor-inhibiting drugs, gut selective muscarinic antagonists (such as zamifenacin and darifenacin), neurokinin2 antagonists (such as MEN-10627 and MEN-11420), beta3-adrenoreceptor agonists (eg, SR-58611A) and GI-selective calcium channel blockers (eg, pinaverium bromide and octylonium) are able to decrease painful contractile activity in the gut (antispasmodic effect), without significantly affecting other body functions. Novel mechanisms to stimulate GI motility and transit include blockade of cholecystokinin (CCK)A receptors and stimulation of motilin receptors. Loxiglumide (and its dextroisomer, dexloxiglumide) is the only CCKA receptor antagonist that is being evaluated clinically. This drug accelerates gastric emptying and colonic transit, thereby increasing the number of bowel movements in patients with chronic constipation. It is also able to reduce visceral perception. Erythromycin and related 14-member macrolide compounds inhibit the binding of motilin to its receptors on GI smooth muscle and, therefore, act as motilin agonists. This antibiotic accelerates gastric emptying and shortens orocecal transit time. In the large bowel a significant decrease in transit is observed only in the right colon, which suggests a shift in fecal distribution. Several 'motilinomimetics' have been synthesized. Their development depends on the lack of antimicrobial activity and the absence of fading of the prokinetic effect during prolonged administration. 5-hydroxytryptamine (5-HT)4 agonists with significant pharmacological effects on the mid- and distal gut (such as prucalopride and tegaserod) are available for human use. These 'enterokinetic' compounds are useful for treating constipation-predominant IBS patients. 5-HT3 receptor antagonists also possess a number of interesting pharmacological properties that may make them suitable for treatment of IBS. Besides decreasing colonic sensitivity to distension, these drugs prolong intestinal transit and may be particularly useful in diarrhea-predominant IBS. Finally, when administered in small pulsed doses, octreotide, besides reducing the perception of rectal distension, accelerates intestinal transit, although other evidence disputes such an effect. Publication Types: Review Review, academic Eur J Gastroenterol Hepatol 1998 Jan;10(1):59-62 Related Articles, Books, LinkOut Antibiotic use, childhood affluence and irritable bowel syndrome (IBS). Mendall MA, Kumar D. Mayday Hospital, Thornton Health, Surrey, UK. BACKGROUND: Antibiotics cause well defined short-lived disturbances in bowel habit. There is evidence to suggest that antibiotics may play a role in the pathogenesis of IBS. Atopy has been associated with small household size in childhood and could also play a role in IBS. We conducted a survey examining the relation of drug use and other epidemiological correlates of IBS. SETTING: General practice health screening clinic. SUBJECTS AND METHODS: 421 subjects (46% male, mean age 47 years (range 18-80 years) attending a general practice health screening clinic were interviewed by a research nurse and completed a previously validated questionnaire. Symptoms of IBS were said to be present if abdominal pain with 2 or more Manning criteria symptoms occurred more than once per month over the previous 6 months. RESULTS: 48 subjects had symptoms of IBS. The following were strongly related to its presence: antibiotic use [adjusted OR 3.70 (1.80-7.60)], female sex and childhood living density < 1 person per room [OR 3.47 (1.57-7.64)], manual father's occupation [OR 0.35 (0.16-0.76)]. The use of NSAIDS, H2 antagonists or other types of medication was not greater in this group. CONCLUSION: Antibiotic use is associated with IBS. The association with antibiotic use requires testing in prospective studies. Privileged childhood living conditions were also an important risk factor which is consistent with an allergic aetiology for IBS. PMID: 9512954 [PubMed - indexed for MEDLINE] J Pediatr Gastroenterol Nutr 1998 Sep;27(3):323-32 Related Articles, Books, LinkOut Use of probiotics in childhood gastrointestinal disorders. Vanderhoof JA, Young RJ. Department of Pediatrics, University of Nebraska, Omaha, USA. Probiotics appear to be useful in the prevention or treatment of several gastrointestinal disorders, including infectious diarrhea, antibiotic diarrhea, and traveler's diarrhea. Results of preliminary human and animal studies suggest that patients with inflammatory diseases, and even irritable bowel syndrome, may benefit from probiotic therapy. Probiotics represent an exciting therapeutic advance, although much investigation must be undertaken before their role in gastroenterology is clearly delineated. Questions related to probiotic origin, survivability, and adherence are all important considerations for further study. More important, each probiotic proposed must be studied individually and extensively to determine its efficacy and safety in each disorder for which its use may be considered. Publication Types: Review Review, academic Erythromycin, seems to have properties for constipation. Maybe K, can explain it, as I am not totally sure about it. The first abstract mentions some of these properties.Also, there is eveidence of anti-biotics in the pathogenesis of IBS in the first place.------------------Moderator of the Cognitive Behavioral Therapy, Anxiety and Hypnotherapy forumI work with Mike and the IBS Audio Program. www.ibshealth.com www.ibsaudioprogram.com


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## bonniei

Erythromycin speeds up gut movements by facilitating motilin receptors to fire off nerve impulses .Thus it helps to relieve constipation.It is interesting that antibiotics predispose one to IBS. Be warned everyoneWhat I found curious was that priviliged childhood living conditions also does that. Were we all rich?


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## KateyKat

I realise this thread is about the use of particular abx for SIBO, but there's some interesting studies posted by KMottus here: www.ibsgroup.org/ubb/Forum1/HTML/019867.html Probiotics for BO?Well, according to these studies taking probiotics for SIBO may be therapeutic after all!So, instead of looking for particular abx, I am quite excited by my newly thought-through concept that each bad bacterium may have a corresponding [good] probiotic which joins battle - y'know the unity and struggle of opposites. Some of my cat nutrition info refers to which fibre good and bad bacteria enjoy (in cats} but:1] if we take the fibre + probiotic that the good bacteria thrives on then we may simulaneously starve the bad bacteria into submission.2] if we know the fermentation indeces for each type of fibre + its corresponding probiotic then we can target a particular probiotic against a particular bad bacteria thereby increasing the chance of successful elimination of unwanted gas producing baddies.So no need to think about taking abx and risking harm to the entire ecology while laying the foundation for opportunistic bacteria to get a foothold.Does this make sense .. or have I finally cracked LOLKKat


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## Ugh

> quote:Also, there is eveidence of anti-biotics in the pathogenesis of IBS in the first place.


Well, I'm living proof of this. However, there is something about that conclusion I wonder about. Usually, if someone is on antibiotics, they are ill...so how do they know that the illness isn't responsible for the IBS, and not the antibiotics?


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## bonniei

> quote:So no need to think about taking abx


sounds like a plan. I have already got culturelle. It is lying in my refrigerator as I write. I am going to take it as soon as I do the colonic flora test this week. I am getting more and more convinced that probiotics are the wave of the future and will replace antibiotics like Katey Kat says.Whoever told Pete that probiotics can make things worse for SIBO was probably spouting off a theory with no basis in fact.This whole experience of figuring out if probiotics are good has been like pulling teeth. I, for one, am willing to put it to rest.


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## KateyKat

> quote:I am going to take it as soon as I do the colonic flora test this week.


Tell us more .. please CuriouslyKKat


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## bonniei

There is nothin more to say really. The only thing I know about the test is it checks the composition of the colonic flora from a stool sample. It is done in the States by a place known as The Great Smokies Lab. The test will be some time(up to me) next week but my meeting with my Gastro is on May 16th.Will post the test results especially if it is positive


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## abcdefg

Good luck with your test and probiotics. I previously didn't know where to find Culturelle. I have had improvement with PB8 which has lactobacillus plantarum mentioned in the S. Nobaek study listed above.I wondered if anyone had any experience, positive or negative, with a 30-40 day approach that combines acidolphilus, a less-restricted version of candida diet, an antifungal such as nutribiotic, and betaine hydrochloride and preacidified calcium. At the end of the 30-40 days, a normal diet was slowly resumed and a good multivitamin/mineral supplement was stressed.The idea seemed to be to make someone a"bad host" for bacterial overgrowth and recolonizing with "good" bacteria through acidolphilus.The betaine hcl/calcium were included for people who were not producing enough stomach acid which in turn helped foster continuing overgrowth.The article also stated that self-treatment was not recommended at all, but no matter what,never undertake such a program without informing your doctor as you may have other health problems/conditions.There were several degrees listed after the author's name A.A.,D.C.,N.D. Does anyone know what these mean?Thank you!


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## bonniei

> quote:The idea seemed to be to make someone a"bad host" for bacterial overgrowth


The way I understand the candida diet is you restrict carbohydrates which are usually the food for bacteria which makes sense.'Cos you starve the bad bacteria and they die and you populate the colon with good bacteria. The only problem with this approach as I see it is it is a temporary fix only b'cos if you have a gut motility disorder which causes SIBO(small intestine bacterial overgrowth), since the underlying motility disorder is not fixed the BO will come back. But maybe a worthwhile approach if the colonic bacteria were causing the problemDon't know what the degrees mean I am afraid


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## abcdefg

I guess I am wondering if antibiotics, which I would like to try if my test 05/01 is positive, are an incomplete, and as a result temporary, fix because while they kill the current overgrowth, do they correct the environment that permitted the overgrowth in the first place.So I need to know the root cause of the overgrowth, motility problems, etc. before going further.Thank you. That is a big help. I am a little nervous about the breath test.


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## bonniei

Where are you doing the test abcd. And are they using glucose or lactulose. Why are you nervous? Hopefully you will find the cause and that is half the battle won. Unfortunately if it you have BO and a motility problem , the way it is now you will have to take a low dose of erythromycin long term. It could be a problem of low gastric acidity and then I don't know what the solution is. Anyway good luck.


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## Kathleen M.

> quote: There were several degrees listed after the author's name A.A.,D.C.,N.D. Does anyone know what these mean?


A.A. Associates of arts is the only thing I can think of. Usually a 2 year degree from a community college.D.C. Doctor of Chiropracty.N.D. Naturopathic Doctor.K.------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html


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## Pete

If you have SIBO then the small intestine should be sterile. By adding probiotics you are filling your body with more bacteria that would have the opportunity to rise up into the small intestine. I am not saying probiotics are bad if you have SIBO. In theory though they could make the problem worse. These good bugs also produce gas. I sure wish flux was still around to give his scientific opinion.Pete


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## Kathleen M.

Pete, I did a search of the scientific literature and it pretty much comes to the consensus that probiotics if anything should be helpful in SIBO, the one study where they weren't helpful, the didn't make things worse.The thread was referenced once in this thread, but here it is again http://www.ibsgroup.org/ubb/Forum1/HTML/019867.html in case you missed it.K.------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html [This message has been edited by kmottus (edited 04-23-2001).]


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## KateyKat

> quote:If you have SIBO then the small intestine should be sterile.


Yep, we've been here before, but I think there are opinions that this is not the case. I can't go on keep quoting feline bifidogenics .. there must be info re humans .. tho only parts of the cat's small intestine must be clean - other parts *need*bacteria.


> quote:I sure wish flux was still around to give his scientific opinion.


Will second that .. especially since he was one who posted about sterility in the small intestine.KKatSeeking accurate info ...


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## Ugh

Thanks Kmottus for the studies you posted. On a positive note, the one study where they didn't work involved a strain "Lactobacillus fermentum KLD" which I've never seen sold as a probiotic. So perhaps that could have affected the results.Also, I thought the following was interesting from one of the studies:"The principle of using harmless bacteria for conquering pathogens has been used for many years." Maybe I'm just getting hung up on semantics, but I thought it was interesting that they didn't call probiotics "good" bacteria, but just "harmless". That suggests that the aim isn't so much to populate your intestine with good bacteria, but just populate it with harmless bacteria that will keep out harmful bacteria. Maybe that's more accurate than the idea that probiotic manufacturers seem to put out there, I don't know. Nothing major, but there does seem to be a difference.


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## bonniei

Pete I have the greatest regard for your doc and what he has done for youThe problem is believing in a theory in the presence of studies to the contrary. Perhaps your doc was not aware of the study?


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## Guest

Just to add to the discussion, I visited the doctor this past week for an ear infection. He gave me an antibiotic called Augmentin. I was pleasantly surprised when my IBS changed dramatically. Gas was gone. No rectal burning, no urgency. I did however have very liquid stools but that helped reduce the pain of my hemorrhoids.Am wondering if this colonic flora you have discussed was the cause. Do you remember the story of the doctor who used antibiotics for ulcers? They thought he was unbalanced, but he was proven right.Anyone else had a similar experience of relief when taking antibiotics for something else?


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## Kathleen M.

Generally antibiotics make some people better for the duration, make some people much much worse sometimes for much longer than the duration, and for few people don't do anything when they take them for other conditions.K.------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html


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## bonniei

Augmentin could have worked on either the SIBO or colonic flora or Hpylori. These are the three potential things I could think right off. Or maybe on some other infection. Please discuss it with your doc and let him follow it up.


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## Ugh

I'm beginning to think that all IBS cases that involve unrelenting excessive gas that has been present for years should recieve antibiotics to see if it helps.


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## KateyKat

> quote:I'm beginning to think that all IBS cases that involve unrelenting excessive gas that has been present for years should recieve antibiotics to see if it helps.


GAS - aka How Do You Know .. Is it Real .. as in excessive volume OR Imaginary .. as in altered peception?Is it Trapped Gas from Muscle Spasm OR Excessive Gas from Bacteria?KKat


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## bonniei

LOL Katey Kat, you forgot one thing. Is it from the atmosphere?


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## KateyKat

Alright then .. try this:GAS - aka How Do You Know .. Is it Real .. as in lotsa OR Imaginary .. as in altered peception of bitsa?Is it Lotsa Gas from Questionable Sources Or Bitsa Trapped Gas from Muscle Spasm?Opposing sources - opposing treatmentsKKat


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## Ugh

> quote:GAS - aka How Do You Know .. Is it Real .. as in lotsa OR Imaginary .. as in altered peception of bitsa?Is it Lotsa Gas from Questionable Sources Or Bitsa Trapped Gas from Muscle Spasm?Opposing sources - opposing treatments


Because I keep detailed records...as strange as that may sound. I got sick of hearing that "a lot of people with IBS think they have excessive gas when in fact it's normal" and that somehow that automatically meant I could not suffer from excessive gas. I did a systematic process where I used an elimination diet, etc (I will post more about this soon). I tested myself, so I know it is not from air swallowing. I know it is bacterial in nature. Sixty farts in 4 hours is excessive in my book, and while I didn't tape a bag to my butt to check the volume, I can assure you they are not tiny releases which are the result of some kind of spasms of trapped gas. I have kept records for months since reading this board to find out as much about my problem as possible.Anyway, I posted a list of possible root causes of excessive gas in a recent post, so please be aware that I don't claim to have excessive gas just because I "feel" like I have excessive gas.Well, I just reread my post and realized you were probably just wondering how in general someone would know they have excessive gas. Obviously nothing is 100% accurate, however, as I mentioned above, you can narrow down possibilities if you have the patience to keep records, etc. For example, air swallowing is extremely simple to test for as a cause. I'm amazed that anyone who complains about excessive gas wouldn't take the time to test for this and follow it up with an elimination diet. [This message has been edited by Ugh (edited 04-23-2001).]


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## Pete

Ugh,Why are you holding off taking an antibiotic? Get a prescription for neomycin or an antibiotic in the penicillin family. These are the most effective for SIBO which I am 99% sure you have


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## eric

This is interesting FYI,Am J Gastroenterol 2001 Apr;96(4):1139-42 Abdominal wall muscle activity in irritable bowel syndrome with bloating. McManis PG, Newall D, Talley NJ. Department of Medicine, University of Sydney, Nepean Hospital, NSW, Australia. OBJECTIVE: Recurrent episodes of bloating and visible abdominal distension are common and distressing in irritable bowel syndrome, but the mechanisms are unknown. Patients often note that the distension is most pronounced in the upright posture, suggesting that the bloating may be the result of a decrease or absence of the normal rise in electromyograph activity in the abdominal wall muscles when standing. There are no reports of noninvasive electromyograph recordings of abdominal wall muscles in irritable bowel syndrome. We examined the hypothesis that abdominal distension is the result of relaxation of anterior abdominal wall musculature. METHODS: Studies were performed on patients with irritable bowel syndrome and a history of visible distension (n = 11, mean age 48.6 yr, body mass index 24.8) and normal volunteers (n = 13, mean age 39.9 yr, body mass index 24.6). Surface recordings of muscle activity were made while subjects were lying, performing voluntary contraction of the abdominal wall, and standing. The examiners were blind as to the clinical status of the subjects. RESULTS: There were no differences in abdominal wall muscle activity (by electromyograph voltage) when comparing patients with irritable bowel syndrome to normal volunteers (e.g., relaxed lower abdomen supine mean electromyograph voltage in irritable bowel syndrome was 14.0 vs 14.6 in controls, p = 0.7, and relaxed lower abdomen standing in irritable bowel syndrome was 29.6 vs 25.2 in controls, p = 0.4). There was increased activity in both groups when contracting the muscles and when standing. CONCLUSIONS: Patterns of abdominal wall muscle activity do not differ between normal subjects and patients with irritable bowel syndrome. However, there is a clear increase in muscle activity in the standing position. Episodic distension is unlikely to be due to permanent anterior abdominal muscle weakness or a persistent inability of the muscles to activate with standing in irritable bowel syndrome. PMID: 11316160 ------------------Moderator of the Cognitive Behavioral Therapy, Anxiety and Hypnotherapy forumI work with Mike and the IBS Audio Program. www.ibshealth.com www.ibsaudioprogram.com


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## moms777

Pete,What was the mg. of neomycin and how many times a day should you take it?


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## KateyKat

> quote:Well, I just reread my post and realized you were probably just wondering how in general someone would know they have excessive gas.


Yep, was just trying to clarify the different scenarios  KKat[This message has been edited by KateyKat (edited 04-24-2001).]


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## Ugh

Pete, I just replied to another of your posts, but I have now tried an antibiotic, with positive results.On a side note, about the SIBO and probiotic question. I was reading a book about studies Doctors have conducted concerning probiotics. One of the Doctors mentioned during a question and answer session that he thought that probiotics might be helpful in preventing a SIBO from reoccurring. He thought if you could get probiotic bacteria in the small intestine it might stop a bacteria like e.coli from growing there. Who knows, but I thought I'd pass that along. Nobody mentioned that probiotics could cause SIBO. It makes logical sense to me since they use a breath test to determine if you have BO. If there was such a thing as SIBO of "good" bacteria, would a breath test work? From what I've read it wouldn't, but maybe I'm wrong. The other thing I found interesting in this book was just how quickly bacteria in the colon return during and following antibiotics. It's pretty amazing how little antibiotics seem to affect them a lot of the time, and also how quickly they can adapt to them. You can really see how it could be tough to eliminate harmful bacteria from the digestive tract.


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## Kathleen M.

There are several studies that have been done in people with SIBO (particularly in dialysis patients--it seems like certain conditions make SIBO happen more often than in normal people). And most of the studies showed that probiotics were helpful and one found they didn't do anything.It appears the thinking in the medical literature is that if there are probiotic bacteria around they tend to prevent other bacteria from growing really well, a couple of alternative med sites seemed to implicate a lack of probiotic bacteria as a possible cause of SIBO.K.------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html


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## bonniei

Tell us more about your experience with antibiotics, Ugh. I assume you took them without a breath test. Are you going to be looking into underlying motility disorders etc or was this a one time shot at antibiotics?


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## moms777

Kmottus, In your opinion, do you think it would be wise to take the probiotics along with neomycin? I have a one week supply (of neomycin) and I intended to keep on taking Culturelle once a day as I have been for months. Now I'm wondering about it. What do you think?


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## Ugh

bonniei,I took tetracycline for 7 days. I wouldn't say I was cured, but I was as close to it as I've ever been. My IBS never goes away, I have no days where it isn't present, so it was interesting that the tetracycline changed that. In terms of what it did, my gas went way down. It wasn't eliminated, but it came close. Interestingly the bad smelling gas was completely eliminated. I don't recall which bacteria are responsible for the odor in gas, but I can only assume they were killed off in great amounts. My stools became formed. There was a total elimination of mucous. I think that is significant because I have read that colitis may be caused by a bacteria. It could be that the some sort bacteria related irritation caused the mucous in the first place. Of course, I'm only guessing. I'm just glad I tried the tetracycline. Unfortunately the relief ended soon after the antibiotics. I have an appointment with a Doctor and plan on trying more antibiotics.


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## Kathleen M.

I'm not sure of the particular specifity of neomycin (not all antibiotics kill all bacteri) so it's hard to say. I think it's pretty braod spectrum (its the stuff in the antibacterial creams you put on your skin).On the one hand it might just kill it all off and so it's a waste. Or it could be one of the species that it doesn't kill and then you'd be giving it a leg up. On another hand taking it during may increase the risk of having some bacteria only get exposed to a partial dose (which is what often start resistance, only getting winged rather than killed by the antibiotic).Probably the most conservitive course would be to lay off the culturelle for the duration, but I'm not really sure if there is any particular risk that would be involved.K.------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html


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## bonniei

Good luck ugh. I am glad it worked for you, especially on the odor causing bacteria. Keep us posted on your experiences.


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## moms777

Thanks for your opinion, Kmottus. I appreciate your input. I'll be starting the antibiotic in a few days. I hope it helps me!


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## eric

This seems to fit here somewhat and at least for info.Br J Nutr 2001 Mar;85 Suppl 1:S23-30 Related Articles, Books Beneficial health effects of low-digestible carbohydrate consumption. Scheppach W, Luehrs H, Menzel T. Department of Medicine, University of Wuerzburg, Germany. w.scheppach###medizin.uni-wuerzburg.de Low-digestible carbohydrates represent a class of enzyme-resistant saccharides that have specific effects on the human gastrointestinal tract. in the small bowel, they affect nutrient digestion and absorption, glucose and lipid metabolism and protect against known risk factors of cardiovascular disease. In the colon they are mainly degraded by anaerobic bacteria in a process called fermentation. As a consequence, faecal nitrogen excretion is enhanced, which is used clinically to prevent or treat hepatic encephalopathy. Low-digestible carbohydrates are trophic to the epithelia of the ileum and colon, which helps to avoid bacterial translocation. Short-chain fatty acids are important fermentation products and are evaluated as new therapeutics in acute colitis. They are considered in the primary prevention of colorectal cancer. The bifidogenic effect of fructo-oligosaccharides merits further attention, Unfermented carbohydrates increase faecal bulk and play a role in the treatment of chronic functional constipation, symptomatic diverticulosis and, possibly, the irritable bowel syndrome. In conclusion, low-digestible carbohydrates may play a role in the maintenance of human digestive health. However, the strength of evidence differs between disease entities. Publication Types:  Review Review, tutorial PMID: 11321025------------------Moderator of the Cognitive Behavioral Therapy, Anxiety and Hypnotherapy forumI work with Mike and the IBS Audio Program. www.ibshealth.com www.ibsaudioprogram.com


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## Ugh

> quoterobably the most conservitive course would be to lay off the culturelle for the duration, but I'm not really sure if there is any particular risk that would be involved.


Kmottus, I was wondering if you read an article posted a little while back about bacteria sharing their resistant components with other bacteria? It relates to what you were saying and I'm wondering what your thoughts are on that.Okay, I just found the post: http://www.ibsgroup.org/ubb/Forum1/HTML/018086.html It's a little different than I thought, but still related.[This message has been edited by Ugh (edited 04-26-2001).]


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## KateyKat

Going back to Eric's msg of 24th here, sorry must have missed its significance:*Abdominal wall muscle activity in irritable bowel syndrome with bloating.*


> quote:CONCLUSIONSatterns of abdominal wall muscle activity do not differ between normal subjects and patients with irritable bowel syndrome. However, there is a clear increase in muscle activity in the standing position. Episodicdistension is unlikely to be due to permanent anterior abdominal muscle weakness or a persistent inability of the muscles to activate with standing in irritable bowel syndrome.


I just wonder if anyone can clarify something here for me. A few years ago I had exploratory abdo surgery and the doc said he found I had "lax abdo tissue". Prior to circumstances that lead the need for this op. I'd had a very trim tum w/ very strong abdo muscles.Sooo am wondering, *if* there was lax or weak abdo wall muscle could this possibly give rise to IBS like symptoms of gut dysfunction along with distension? Would anyone care to speculate on this?KKat[This message has been edited by KateyKat (edited 04-26-2001).]


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## Kathleen M.

In general, antibiotics are to be avoided as much as possible. The more antibiotics you take the greater the risk for creating resistant bacteria in your body.If you have to take antibiotics, take them properly. Take the whole prescription (unless there is some side effect that means you need to stop treatment now); take all the pills on schedule. Not finishing the prescription is a great way to make sure you have 1/2 dead bacteria that can develop resistance. Not completing the treatment for diseases like TB which requires months of antibiotic treatment is one of the reasons that TB is rapidly becoming resistant. Just because you feel better doesn't mean all the bacteria are all dead, the could just be wounded.Resistance is caused by genes. Genes on bacteria live either in the chromosome or on plasmids (little circles of DNA). Plasmids are quite frequently transmitted between bacteria, even of widely different species, although chromosomal DNA can also be transfered.If you have antibiotic resistanct bacteria living in your gut they can transfer that resistance to other bacteria including pathogens. Also because we don't all wash our hands as well as we should the resistant bacteria can get passed on from one person to another, so it can be both an individual and a population problem.Most antibiotics are on the market about a year or so before resistant strains of bacteria start becoming a problem in the clinic. As a population, the more an antibiotic is taken the faster the resistance occurs. This is why there are some antibiotics they generally don't use until all else fails as they are trying to extend the usuable lifetime of the drug. This is also the concerns with widespread chronic use of antibiotics in animal feed, creating resistant bacteria where the genes get transferred into a human pathogen.K.------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html


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## abcdefg

The discussion posted on this topic has been very helpful. I just had a lactulose hydrogen breath test at Jefferson (PA). The doctor was very nice. Positive after second reading so dr sent me home. Seeing gastroenterologist Thursday to also request an helicobater?? pylori test before going further. Thanks again !!!


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## bonniei

Good luck abcd!You may want to read Pete's thread on neomycin or on Cedars Sinai if you want to understand your situation more


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## flux

> quote:Sixty farts in 4 hours is excessive in my book


I'd agree with that.


> quote:These are the most effective for SIBO which I am 99% sure you have


I do not agree with that.


> quote:There are several studies that have been done in people with SIBO (particularly in dialysis patients--it seems like certain conditions make SIBO happen more often than in normal people). And most of the studies showed that probiotics were helpful


What study showed it to be helpful? That strikes me as odd.


> quote:In your opinion, do you think it would be wise to take the probiotics along with neomycin?


I'm not so sure it's wise to take neomycin. If one is treating SIBO (which it is not likely to be affecting those reading this), it is probably not that wise at least in terms of treating the SIBO.


> quote:Sooo am wondering, *if* there was lax or weak abdo wall muscle could this possibly give rise to IBS like symptoms of gut dysfunction along with distension?


I haven't read this particular study (I don't read everything:-() so I am wondering about it conclusion: it certainly puts a wrinkle into the idea that bloating is not intestinally related. I don't think that weak abdominal muscle tone could give rise to abdominal symptoms. You can your organs to move about just by jumping up and down. Anyone who exercises vigorously is going to have that, but is that going to give them IBS?


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## Kathleen M.

Hey flux--I did some searching on probiotics in SIBO--particuarly as there was some debate about them being a bad thing, and wanted to see if there was ANY data out there.see http://www.ibsgroup.org/ubb/Forum1/HTML/019867.html For the studies I found. There may be more, but I looked at quite a few articles and found these ones.K.------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.My story and what worked for me in greatly easing my IBS: http://www.ibsgroup.org/ubb/Forum17/HTML/000015.html


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## abcdefg

Just had the helicobacter pylori C14-Urea Breath test (was postive on Lactulose Hydrogen Breath Test). Starting combination of amoxicillin (7 days) and flagyl (14 days).After antibiotics over, will be taking enteric lactobacillus.


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## stinky too

42 days, Just wondering if your IBS gas etc. is still gone or has it come back??------------------Prayer doesn't change God , it changes the one who prays..C type, with G


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