# IBS and SIBO Links



## 23770 (Nov 26, 2005)

New Research is showing that many cases of IBS is the result of SIBO(Small Intestinal Bacteria Overgrowth) and that you can successfully erradicate the problem using anti-biotics.(Most of you in this forum have probably already read these)Here is a link to a thread detailing my Neomycin Trial: http://ibsgroup.org/eve/forums/a/tpc/f/71210261/m/923102902Here is a link to a thread detailing my Rifaximin Trial:http://ibsgroup.org/eve/forums/a/tpc/f/71210261/m/809108081Here are links to some important studies:The Study that started it allEradication of small intestinal bacterial overgrowth reduces symptoms of irritable bowel syndrome-2000Bi-Directional Interplay between Intestinal Flora and MotilityInteractions Between Commensal Bacteria and Gut Sensorimotor Function in Health and Disease-2005Exciting new findings concerning methaneMETHANE, A GAS PRODUCED BY ENTERIC BACTERIA, SLOWS INTESTINAL TRANSIT AND AUGMENTS SMALL INTESTINAL CONTRACTILE ACTIVITY.Methane is linked with IBS-CMethane production during lactulose breath test is associated with gastrointestinal disease presentation.Neomycin to the rescue!Neomycin Improves Constipation in Ibs: Subanalysis Of a Double Blind Randomized Controlled StudySuccessful use of anti-biotics for SIBO/IBSIBS study shows that targeted antibiotics lead to long-lasting improvement in symptoms-2005Every IBSer should have this test doneI'm looking to get it done soon!Lactutose Hydrogen Breath Test for SIBOSpecific Anti-Biotics that you should discuss with your doctorTreatment of IBS based on the theory of small intestinal bacterial overgrowthEven Natural Anti-biotics helpPersonally, I've seen significant reduction of symptons with peppermint and garlicThe treatment of small intestinal bacterial overgrowth with enteric-coated peppermint oil: a case report - Peppermint Oil-2002I orginally posted this topic in the IBS-C forum and didn't notice this information forum or else I would have posted here first.I'm almost 100% sure my IBS-C, which has been debilitating me for the last year, is SIBO related.A year ago I was placed on the drug Anafranil for OCD and experienced Paralytic Ileus as a side effect which is when the intestines go stone dead. I believe that the bacteria in the large intestine took advantage of this window of opportunity and made it's way into the small intestine, proliferated, and has been there ever since.Strangely, after my Anafranil episode, the condition continued. This makes sense if you've read the article "Interactions between commensal bacteria and gut sensorimotor". It seems that the intestinal flora and motility of the intestines depend on each other for proper functioning. I believe that the Anafranil-induced paralytic ileus caused my SIBO and now SIBO is causing me paralytic ileus or IBS-C.The only relief I found was when I followed a holistic approach to treating SIBO which consisted of garlic and peppermint which are natural anti-biotics. I also found Zinc to help my severe burning pain in the stomach that is ulcer-like. Unfortunately this only lasted for so long and lately I've been looking into a more conventional intervention.I just convinced my doctor to put me on Rifaximin which is a nonabsobable anti-biotic which is supposed to stay in the gut and has been involved in the latest studies at Cedars-Sinai hospital. Right now I'm just waiting for him to call it in to the pharmacy. I'll let you know how it goes.


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## eric (Jul 8, 1999)

you have ulcers?Just fyi, but generally in most patients sibo leads to d, but in your case with the cause of your c there might be a reason.


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## gilly (Feb 5, 2001)

thanks for such a good summary post on SIBO Gilly


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## 23770 (Nov 26, 2005)

Hi Eric. I just edited my post to make some corrections. I haven't been diagnosed as having ulcers but I experience burning pain in the stomach that is ulcer-like.Where did you hear that patients with SIBO generally have D?This quote from my link "IBS study shows that targeted antibiotics lead to long-lasting improvement in symptoms" seems to indicate that patients with abnormal breath tests have IBS-C."To show evidence of small intestine bacterial overgrowth, participants in both studies were given a lactulose breath test, which monitors the level of hydrogen and methane (the gases emitted by fermented bacteria) on the breath. In the first study, an abnormal breath methane profile was shown to be 100 percent predictive of constipation-predominant IBS. In the current study, the correlation between the amount of methane and the amount of constipation was confirmed, another key finding."


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## eric (Jul 8, 1999)

> quote:Where did you hear that patients with SIBO generally have D?


From Dr Drossman at one of the chats with the experts."Is this a dramatic new finding? Breath testing when considering a diagnosis of IBS has been around a long time. A preliminary diagnosis of IBS is based on the absence of warning signs for other known diseases, a complete history, and description of specific symptoms (e.g., a symptom pattern consistent with the Rome criteria, which have recently been revised as Rome II). Depending on the presentation, a physical examination and limited laboratory studies are performed before a confident diagnosis of IBS may be made. A breath test is considered if indicated by features in the patient history, or if the screening studies point to another diagnosis. Small intestinal bacterial overgrowth is known to cause symptoms of abdominal pain, bloating, and diarrhea. While similar to IBS, it points to another diagnosis."http://www.aboutibs.org/Publications/bacteria.htmlThere is also this from the last ddwDigestive Disease Week 2005Functional Bowel Disorders -- Clinical Highlights CMESmall Intestinal Bacterial Overgrowth in IBSSmall Intestinal Bacterial Overgrowth in IBSRecurrent abdominal pain associated with bloating and altered bowel function is the typical composite for the pathology described as IBS. However, the symptoms associated with IBS are similar to those associated with small intestinal bacterial overgrowth. Data from one study[10] have suggested a high prevalence of small intestinal bacterial overgrowth in patients with IBS. This study was criticized because of the low accuracy of the lactulose breath test, which was used to define small intestinal bacterial overgrowth. Glucose has become the preferred substrate for hydrogen breath testing. Additional work aimed at clarifying the potential association between small intestinal bacterial overgrowth and IBS was presented during this year's DDW meeting.In this setting, Lupascu and colleagues[11] assessed the prevalence of small intestinal bacterial overgrowth by glucose breath testing in IBS patients vs healthy controls. The study involved patients with IBS as defined by Rome II criteria; an appropriately matched group without IBS served as the control population. The study authors found a significantly increased (P < .05) proportion of patients with small intestinal bacterial overgrowth among patients in the IBS group: 20 of 65 (30.7%) compared with 4 of 102 (3.9%) controls. These findings are consistent with an increasing awareness of a postinfectious IBS syndrome.McCallum and colleagues[12] presented additional evidence on the association of small intestinal bacterial overgrowth with IBS. They evaluated only patients with IBS with diarrhea using the glucose breath test, assessing both H2 and CH4 production as criteria for a positive test. They defined a prevalence rate of small intestinal bacterial overgrowth of 38.5% in their population of 143 patients with IBS with diarrhea. For the breath-test analysis, 74.5% of patients were positive only by H2 analysis, and 23.6% were positive only by the CH4 analysis. These investigators suggest that both the H2 and CH4 analysis should be performed to optimize the interpretation of these breath tests in this population of patients.CommentaryBoth of these studies are provocative in suggesting a high prevalence of small intestinal bacterial overgrowth in IBS. However, there are limitations before these data can be extrapolated to the "world" of IBS. The study by Lupascu and colleagues did not separate patients by subtype of IBS (eg, IBS with diarrhea vs IBS with constipation). There is an emerging body of evidence regarding postinfectious IBS. In these patients, there is a clearly defined start date (ie, symptoms) and the condition is typically more homogeneous (ie, generally IBS with diarrhea). Clearly, we will need prospective randomized controlled trials with identification of the specific patient IBS subtypes to further explore the potential of this association.http://www.medscape.com/viewarticle/506599and he also sent me this email."Dear Shawn Eric, I do feel that the issue of bacterial overgrowth is an important considerations in IBS, and these authors have gone a long way to advance this area of investigation and raise awareness of bacterial overgrowth as a possible player in IBS. It kind of relates to other work being done in the area of post-infectious IBS and altered mucosal immunity in subsets of IBS. However, there is some disagreement within the community with regard to the prevalence in patients with IBS, these authors claiming up to 80% and others finding far less by standard methods. Another issue of concern is that explaining bacterial overgrowth as the cause of so many other aspects of the condition is going beyond the available scientific data. Their work should be considered more in the way of opinion/speculation, rather than accepted dogma within the medical community, and further confirmation is needed. You should keep in mind that all scientists will from time to time try to extend their data into understanding other aspects of a condition, but the checks and balances within medicine lead to common acceptance when there is confirmation from other groups and more conclusive evidence. That has not happenned as of yet but remains an area of interest in the field.Doug"


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## 23770 (Nov 26, 2005)

This quote is from the link "Treatment of IBS based on the theory of Small Intestinal Bacterial Overgrowth" up above."A small number of patients with SIBO have chronic constipation rather than diarrhea."The next quote is from Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome: a double-blind, randomized, placebo-controlled study"LBT gas production was associated with IBS subgroup, such that methane excretion was 100% associated with constipation-predominant IBS."The next quote is fromMethane production during lactulose breath test is associated with gastrointestinal disease presentation."If a breath test was methane positive, this was 100% associated with constipation predominant IBS."In conclusion:Yes, constipation is not seen as often as diarrhea in SIBO, but that doesn't mean it is unheard of. The quote above says that 100% of the methane positive tests conducted was associated with constipation-predominant IBS!!Perhaps hydrogen-producing bacteria is associated with IBS-D and methane-producing bacteria is associated with IBS-C


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## 23770 (Nov 26, 2005)

This link definitely shows that IBS-C can be connected with SIBO.Lower frequency of MMC is found in IBS subjects with abnormal lactulose breath test, suggesting bacterial overgrowth.


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## eric (Jul 8, 1999)

Did you have a breath test done Carmelrob?Have you read this thread?http://ibsgroup.org/eve/forums/a/tpc/f/43110261/m/596105671


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## 23770 (Nov 26, 2005)

I'm going to request one this Wednesday when I see my GI doctor.


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## eric (Jul 8, 1999)

Is the test at Cedar?Good luck with your test.


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## jasonsmith (Aug 1, 2006)

This is interesting. I have IBS-D and the last few times I passed gas, I held up a lighter to the area and the _wind_ just blew the flame out. So NO methane. Hmmmm....


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## eric (Jul 8, 1999)

FYIFrom Medscape General Medicineâ„¢MedGenMed GastroenterologyIBS -- Review and What's NewPosted 07/26/2006Amy Foxx-Orenstein, DO, FACG, FACP Abstract and Introduction"Small Intestinal Bacterial OvergrowthThe presence of a higher than usual population of bacteria in the small intestine (leading to bacterial fermentation of poorly digestible starches and subsequent gas production) has been proposed as a potential etiologic factor in IBS.[71] Pimentel and colleagues have shown that, when measured by the lactose hydrogen breath test (LHBT), small intestinal bacterial overgrowth (SIBO) has been detected in 78% to 84% of patients with IBS.[71,72] However, the accuracy of the LHBT in testing for the presence of SIBO has been questioned.[73] Sensitivity of the LHBT for SIBO has been shown to be as low as 16.7%, and specificity approximately 70%.[74] Additionally, this test may suboptimally assess treatment response.[75] The glucose breath test has been shown to be a more reliable tool,[76] with a 75% sensitivity for SIBO[77] vs 39% with LHBT for the "double-peak" method of SIBO detection.[74] In a recently conducted retrospective study involving review of patient charts for the presence of gastrointestinal-related symptoms (including IBS) in patients who were referred for glucose hydrogen breath tests for SIBO, of 113 patients who met Rome II criteria for IBS, 11% tested positive for SIBO.[78] Thus, results demonstrated that IBS symptoms are often unrelated to the presence of SIBO. Despite the controversy regarding the contribution of SIBO to the underlying pathophysiology of IBS and its symptoms, short-term placebo-controlled clinical studies with select antibiotics, including neomycin and rifaximin, have demonstrated symptom improvement in IBS patients.[61,72,79] Antibiotics may therefore have potential utility in select subgroups of IBS patients in whom SIBO contributes to symptoms. However, the chronic nature of IBS symptoms often leads to the need for long-term treatment. Given the fact that long-term use of antibiotics is generally undesirable, the place of antibiotics in IBS therapy remains to be established.[73]"Abstract and IntroductionMaking a Positive Diagnosis of IBSThe Science of IBSIBS TreatmentsConclusionhttp://www.medscape.com/viewarticle/532089_3


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## 13423 (Jul 22, 2006)

> quote:Originally posted by CarmelRob:I'm going to request one this Wednesday when I see my GI doctor.


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## 13423 (Jul 22, 2006)

can you tell me if you took the Rifaximin and if so how did you do


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## eric (Jul 8, 1999)

FYI Anaerobe. 2003 Feb;9(1):11-4. Links The micro-flora of the small bowel in health and disease.Sullivan A, Tornblom H, Lindberg G, Hammarlund B, Palmgren AC, Einarsson C, Nord CE. Department of Laboratory Medicine, Karolinska Institutet, Huddinge University Hospital, SE-141 86 Huddinge, Stockholm, Sweden.The micro-flora of the proximal jejunum in healthy volunteers was compared with the micro-flora in patients with gastrointestinal symptoms suggestive of spontaneous bacterial overgrowth in the small intestine. Biopsies were taken distally to the ligament of Treitz with a Watson capsule. The samples were diluted and inoculated on selective and non-selective agar plates that were incubated aerobically and anaerobically. No major differences were found in the small jejunum micro-flora in healthy persons or in a heterogenous group of patients with gastrointestinal disorders. Oropharyngeal micro-organisms dominated the micro-flora in all subjects and colonic micro-organisms were found in low numbers in a few subjects from both groups. Streptococcus intermedius and Haemophilus parahaemolyticus were only found in the micro-flora of healthy subjects while Lactobacillus spp. was more frequently found in the samples from patients. Eight of 20 healthy subjects and five of 18 patients met the criterion of small intestinal overgrowth. Emerging evidence suggests that other factors are involved in the pathogenesis of the irritable bowel syndrome complex. There is a need for better understanding of the complicated interactions between the host and the endogenous micro-flora.PMID: 16887682 Aliment Pharmacol Ther. 2005 Dec;22(11-12):1157-60. Links Hydrogen glucose breath test to detect small intestinal bacterial overgrowth: a prevalence case-control study in irritable bowel syndrome.Lupascu A, Gabrielli M, Lauritano EC, Scarpellini E, Santoliquido A, Cammarota G, Flore R, Tondi P, Pola P, Gasbarrini G, Gasbarrini A. Internal Medicine Department, Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy.BACKGROUND: Studies assessing the prevalence of small intestinal bacterial overgrowth in irritable bowel syndrome gave contrasting results. Differences in criteria to define irritable bowel syndrome patients and methods to assess small intestinal bacterial overgrowth may explain different results. Moreover, no data exist on small intestinal bacterial overgrowth prevalence in a significant population of healthy non-irritable bowel syndrome subjects. AIM: To assess the prevalence of small intestinal bacterial overgrowth by glucose breath test in patients with irritable bowel syndrome symptoms with respect to a consistent control group. METHODS: Consecutive patients with irritable bowel syndrome according to Rome II criteria were enrolled. The control population consisted of 102 sex- and age-matched healthy subjects without irritable bowel syndrome symptoms. All subjects underwent glucose breath test. A peak of H2 values >10 p.p.m above the basal value after 50 g of glucose ingestion was considered suggestive of small intestinal bacterial overgrowth. RESULTS: A total of 65 irritable bowel syndrome patients and 102 healthy controls were enrolled. Positivity to glucose breath test was found in 31% of irritable bowel syndrome patients with respect to 4% in the control group, the difference between groups resulting statistically significant (OR: 2.65; 95% CI: 3.5-33.7, P < 0.00001). CONCLUSIONS: The present case-control study showed an epidemiological association between irritable bowel syndrome and small intestinal bacterial overgrowth. Placebo-controlled small intestinal bacterial overgrowth-eradication studies are necessary to clarify the real impact of small intestinal bacterial overgrowth on irritable bowel syndrome symptoms.PMID: 16305730


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