# OK: So exactly what is a normal result and what is a positive result for SIBO



## anmegrl (Jul 4, 2004)

I took the lactulose SIBO test a couple of months ago and finally managed to get the raw data and the summary report. I'm a bit confused on what a positive result is supposed to look like. The interpreting doctor concluded that there was no evidence for SIBO but in his report he also states that my results are suggestive of SIBO. I gave the raw data to a friend of mine (toxicologist) to try to reconcile the report with the data but he was confused with what the report was trying to say as well. I've tried to get more info from the hospital on this but keep hitting dead ends.Should there always be two peaks in positive results - one showing the small intestine bacteria production and one showing the later colonic bacteria production? I thought there should be. In Pimentel's book, he states that if the bacteria levels rise within 90 minutes at 20 ppm or more that is an indication of SIBO. My results do this but I only have one peak . . . at least I think I do - more on this later. Unlike other Hydrogen test procedures I've read about, this hospital (which just happened to be the one who did the study last year disputing Pimentel's association between SIBO and IBS), the measurements were taken every 20 minutes for two hours and then 30 minutes for the last hour - rather than every 15 minutes for three or more hours. The readings are:minutes ppm H30 1 20 2 40 11 60 17 80 46100 62120 98150 73180 27The measurements for CH4 were all 0.In the published study, they considered the test result positive "if it met *any* of the previously published criteria: ( a ) breath H2 of >20 parts per million (ppm), ( b ) increase in breath H2 in <90 min, ( c ) dual H2 peaks (12-ppm increase over baseline with a decrease of ≥5 ppm before 2nd peak), and ( d ) breath CH4 of >1 ppm." I met the criteria for A and B and the report makes a special note that the level reported at 120 minutes is extreme and points towards SIBO. At 120 minutes, the lactulose should be in the colon so I still don't understand why this measurement suggests SIBO unless I have slow transit in which case maybe the test should have continued for another 30 or 40 minutes to see if a 2nd peak would appear. However, the doctor states that there was "normal but slightly rapid orocecal transit." In that situation, my friend thinks it's possible that a 2nd peak was there but the measurement showing the peak was not captured . . . iow, if the measurements were taken every 15 (or maybe even 10) minutes instead of every 20/30 minutes there could have been two peaks. In either case, since my results met previously published criteria why is there a finding of no evidence of SIBO? I can understand if one criteria has been afforded more credence over another but if they accepted different criteria just six months prior to my taking the test and nothing really new has happened with regards to diagnosis why should their opinion differ so much now? Hospital politics?I just wanted to have the test rule out one way or the other so I would not have to waste anymore time wondering if I have SIBO. I hope I don't have to go to the medical center down the street and get their opinion or have to do the test over again.I appreciate any light some of you can shed on this.


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## Moises (May 20, 2000)

anmegrl,I don't think anyone can shed any more light than you already have. The fact is that the research on Pimentel's program thus far is equivocal. We all want black and white answers and they are not forthcoming. I just took the Xifaxan--twice--without any SIBO test. Others have argued, with good reason, that such a course of action is recklessly dangerous. Pimentel argues that Xifaxan passes almost in its entirety through the gut unabsorbed, so the risk of side effects is minimal. It was a risk I was willing to take. It's a risk you need to discuss with your doctor.By the way, I had zero improvement from Xifaxan.Good luck,moises


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## overitnow (Nov 25, 2001)

anmegrl, one of the things Patman has discovered about the function of grape seed flavonoid supplements is that, as part of the plant's defensive system, they help kill off bad bacteria while leaving the good ones alone. The Provex CV might be worth at least trying, if/when you finally decide if SIBO is it.Cheers, Mark


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## anmegrl (Jul 4, 2004)

Thanks for your responses







. I got a second opinion this Monday and the doc said about the same thing you did Moises. It's not black and white but he was more than willing to talk to me at length about SIBO and Pimentel's treatment. That's something considering the other doc refused to hear/speak anything further on the subject. I have the prescription for Rifaximin (he was out of samples) and will start taking it next week. He assured me that the risks were very small and I would most likely not have any side effects. I just happened to stop by the forum to see if I should take probiotics at the same time as Rifaximin or just wait until I finish the course of treatment.Overitnow, I've thought about buying some Provex CV to see if it would help with D. The only thing that helps right now is taking very small doses of Lomotil a day but it shouldn't be used long term and my new doc expressed concerns about me taking it indefinitely. I'm not really comfortable buying supplements on Ebay - that's the only way I could get them. Plus I wanted to exhaust all other "theories" of remedies first (translate: high quality digestive enzymes, goodbelly probiotic drinks, and oleic acid to slow down digestion). I may decide to get it in the next month or two if there's no improvement. Not sure how it could distinguish between "good" and "bad" bacteria or do you mean by location of bacteria, not by type? If I do have a bacteria problem, it's probably due to overgrowth of normal bacteria in the small intestine or colon, not from the presence of pathogenic strands. I'll do some more research on it. Thanks again!


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## anmegrl (Jul 4, 2004)

Thanks for the pm. Found the posts here about Provex CV and finally found the product label so I could look up the ingredients on the Univ. of MD website.I see why it would be effective for D so I will go ahead and get some next week. Should help with bacterial/fungal issues as well so hopefully it may help with BO too if it is an issue.


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## overitnow (Nov 25, 2001)

Presumably you know that it may take a little time to see if it will be helpful, or not. While I "felt" some changes in the first couple of weeks, it wasn't until the end of the second month that I really knew something good was going on. Stay in touch and good luck with it. (Max dosage 1 cap per 35 lbs. I started at about 1 cap per 100 lbs., so there can be some variability there; but then, I was quite slow in my recovery, so dosage may have played a role. "Keep it in the fridge for best results"; but don't sweat it if it is left out.)Cheers,Mark


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