# neomycin/bacterial overgrowth continued/part 2



## Pete (Jan 20, 2000)

Well I just got back from Cedar Sinai. As you know from my previous post, I was diagnosed with bacterial overgrowth of the small intestine. I was prescribed an antibiotic called neomycin and my gas disappeared. I know this is a confusing issue when there are people who are posting bad information(ie, Island Girl) I just had a repeat breath test and the neomycin did work. My result was normal. So what did the neomycin acheive for me? Well it decreased gas production from 100 times a day to under 10. It helped my bloating. Wiped out my fatigue. Did absolutley nothing for my burping and reflux. So now what? Well according the the docs at Cedar, they are working on alternatives to antibiotics to keep the overgrowth from reoccurring. They claim that overgrowth reoccurs in about 60 days. Everyone gets reoccurance. So what causes this overgrowth in the first place? Once again unknown but they believe it has to do with your Phase III contractions. Flux can probably explain better than I what Phase III contractions are. Basically it is a motility problem. Well now they gave me erythromycin to help stimulate these Phase III contractions. The normal antibiotic dose is usually 1000 mg a day. A child's dose is 250 mg. For this problem I was prescribed 50mg. A dose for a baby. At this low dose there is no antibiotic effect. It is used simply to speed up these contractions. At this time the use of erthromycin can delay reoccurence of overgrowth usually for 6 to 8 months. At that time another dose of neomycin would be given. So it means antibiotics 2x a year if what they are telling me is right. This is of course until they come up with alternatives. I do believe that these docs at Cedar have figured out how to help treat excess gas and fatigue. He also claims the BO causes diarrhea and constipation. Well that is the scoop. He also said in theory that probiotics can make the matter worse. I will continue to keep everyone informed. Now a question for the fluxster. Flux, as you know I was diagnosed with gastroparesis. 13% emptied after 90 minutes. Well the doc at Cedar felt that my gastroparesis could be caused by PPIS(Prevacid). He had me do a repeat study after 4 days off of my med. I was shocked to see that the result was normal study. Does this make sense to you? Well he switched me from prevacid to zantac 300mg 2x a day. You also asked my peak H2 level on the first breath test. It was 80.Thanks,Pete


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## Pookie's Mom (Dec 21, 2000)

Hi Pete, happy you're doing well with this new treatment







I wasn't paying too much attention to the bacterial subject cause I thought it was strictly for D people...I found it interesting that you mention it is both D and C..also I just got off some antiboitics almost had pnemonia..and I noticed the first week I went from a MAJOR C person to D...my body got use to the antibotics and the D stopped but I also noticed that I feel a lot better this week! My primary care doc did put me on erythromycin a few months ago for 2 weeks for the same reason you're taking it but I didn't notice anything different. I am curious about this bacteria and C now. I hope you continue to improve!!!Pookie


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## flux (Dec 13, 1998)

> quote:I know this is a confusing issue when there are people who are posting bad information(ie, Island Girl)


I wholeheartedly agree.


> quote:My result was normal.


This doesn't prove you had BO believe it or not. Neomycin could conceivably deaden the breath test response in anyone who had any H2-producing bacteria.


> quote:Once again unknown but they believe it has to do with your Phase III contractions.


This is correct, but 1) did they do antroduodenal manometry and find a problem with your Phase III? 2) Usually, they give you erthromycin and see if that induces Phase III. It does in healthy folks but not in those with pseudo-obstructionCould they be testing the a non-IBS crowd? It's hard for me believe because not having Phase III is a motility disorder of mega proportions. It is *not* IBS; it's pseudo-obstruction. People who don't have Phase III usually cannot eat at all and must live on either tube feedings or intravenous feedings.


> quote:He also claims the BO causes diarrhea and constipation.


Constipation I don't get. But it should cause a lot more. Malabsorption for one. And that usually leads to anemia, which leads to fatigue, but I doubt it could fix your fatigue that quickly and were you ever diagnosed with anemia?


> quote:He also said in theory that probiotics can make the matter worse.


Ditto.


> quote:He had me do a repeat study after 4 days off of my med. I was shocked to see that the result was normal study. Does this make sense to you?


First, what exactly was the result numerically? Second, the burping could be related to the esophagus (and LES) and not the stomach. Do you know how well your LES works?


> quote:You also asked my peak H2 level on the first breath test. It was 80.


This is a normal high value in labs who do the test right. Must be your gas was mainly CO2 or you had really bad overgrowth along the whole tract. Do you know what the area under the curve was? [This message has been edited by flux (edited 02-23-2001).]


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## Guest (Feb 24, 2001)

Pete,Thanks so much for the update. Be sure to continue to keep us updated. I am going down in one week for the test/consultation. Unlike you, I don't have a gas problem, so it will be interesting to see how I react to the neomycin (given the test is positive). Good Luck with everything!!!!!!!!!!!!!!!!


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## badfoot (Oct 5, 1999)

Hi PeteThanks for all this info your getting. It's great to hear actual about research as it's happening. A source of hope.I've had IBS C&D since '88. At one time early in my treatment history a GI doc in NY gave me erythromycin to help speed up my motility. It worked to a degree, but eventually the erythromycin was too hard on my stomach (caused pain) and I stopped. I don't remember the dosage, so it may have been higher than yours. Just thought I would pass that on. thanks again and best of luck.


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## Guest (Feb 24, 2001)

Pete-This is wonderful news! I'm glad you're feeling better, and the doctors at Cedars seem to be on the right track to helping you feel better on a permanent basis!I'm having my re-check on Monday. I'm a little nervous because the neomycin did not make me feel any better--I still have all the same symptoms and continued to have them while I was taking the antibiotic. I wonder what will happen next...Best of luck to you!


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## Ugh (Jan 30, 2001)

Hi Pete,thanks for the update. I have a couple of questions for you and flux. First, I was wondering if you had any lower GI problems besides gas (D? C? anything?) and any effect the treatment had on that.My next question is probably more for flux (I've tried to get an answer to this before)... why can't this gas reduction be from the removal of gas causing bacteria in the colon? I know they tested him again for BO, but I still don't see why someone with a bacterial problem in the colon wouldn't also have a gas reduction in response to antibiotics. I'm not sure if the only way to have excessive gas from bacteria is to have that bacteria in the small intestine, does anyone know?As for the probiotics, why would they cause gas if situated in the small intestine? I understand they would cause problems if overgrown in the small intestine, but how would one of those problems be gas if the bacteria don't produce gas?thanks if advance for any info


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## Pete (Jan 20, 2000)

Flux,I don't know the technical responses to most of your questions. What I do know is that I did have an andro manometry. It was only 2 hours so it was a limited study. I believe it said phase 1 and 2 were normal. I believe it was unable to access phase III. The doc at Cedar said that my problem is not obstruction as per a GI series. He requested a repeat andro manometry but I declined. This test is absolutely torture. As far as my gastric emptying goes, I had 2 tests which showed gastroparesis yet my limited andro manometry was normal. Off of the PPI, my result was normal. I believe it said t-1/2 of stomach after 58 minutes. Do you know what that means? Does it mean that 1/2 of my stomach emptied after one hour? I will have to call the doc and see? My LES is not working based on PH probe that showed reflux 24% of time in upright position. Esophageal manometry was normal. The reflux correlated with the belching. I had the fundoplication and it cured the reflux for about 6 months but then the wrap slipped. I had repeat fundo, and once again it slipped after 6 months. The fundo did nothing for the gas while it was working. It just moved it from upper to lower. Now my lower gas is gone for 3 to 4 weeks thanks to neomycin. I tried Cipro, tetracycline, and flagyl in the past. This is the only antibiotic that works(for me at least). So what is your opinion? Do you think the erythromycin is a reasonable treatment option or do you think I would be better off with Imitrex or zelmac(when it comes available). Also if prevacid was delaying my stomach, shouldn't zantac(600mg a day) do the same thing?Your advice is always greatly appreciated.Thanks,Pete


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## KateyKat (Jan 4, 2001)

Ta mucho for keeping us informed Pete, and glad to hear your gas problem hasn't re-emerged .. yet.Like others I remain rather puzzled tho.Reduced phase 3's appear to facilitate development of BO and long term use of low dose erythromycin speeds up these MMC's, so slowing down the build up of BO. Yet CS still appear to expect the BO to return, sooner or later.This would make sense, but still fails to deal with the question of *why* the MMC's are not up to scratch. KKat


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## Pete (Jan 20, 2000)

Kkat,I agree but its a start.


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## flux (Dec 13, 1998)

> quote: why can't this gas reduction be from the removal of gas causing bacteria in the colon?


Oh, it almost certainly was. There is way more bacteria in the colon than in the small bowel, even when bacterially infested.


> quote:I'm not sure if the only way to have excessive gas from bacteria is to have that bacteria in the small intestine, does anyone know?


I actually tend to doubt that BO in the small gut can cause any significant amount of gas from what they specifically produce in the small gut unless it were really badly overgrown.However, what I just realized is they should cause malabsorption and the malabsorbed sugars can cause major gas in the colon.However, I'm still curious to know what the area under the curve was when Pete said his peak H2 was 80. That peak is in the colon and is perfectly normal. No way it could cause 100 passes of gas a day. So my guess: gas must have been mainly CO2 from the colon either from a lot of active CO2 producing bacteria or from having a normal amount of CO2 bacteria feasting on an extra load of sugars from the small intestine that couldn't have digested them properly due to interference of the BO in the small gut.s


> quote:As for the probiotics, why would they cause gas if situated in the small intestine?


Some strains do produce gas, but they would that wherever they are located if given enough to feed on.


> quote: believe it was unable to access phase III.


2 hours is too short a study. Should have been at least 6 hours.


> quote:This test is absolutely torture.


Really? Were they using the clunky water-perfused tubes? I don't trust that method anyway.


> quote:I believe it said t-1/2 of stomach after 58 minutes. Do you know what that means? Does it mean that 1/2 of my stomach emptied after one hour?


Yes, that's it. Sounds good.


> quote: Do you think the erythromycin is a reasonable treatment option or do you think I would be better off with Imitrex or zelmac(when it comes available).


I don't think there is any way to predict how erythromycin should affect the gut. Dose is small and it's similar to neomycin I think. But there is no real proof you have a problem with MMCs. Not having phase III should make mucho ill.Also, baclofen has been tried to fix problems with reflux and there is botox, too.


> quote:Also if prevacid was delaying my stomach, shouldn't zantac(600mg a day) do the same thing?


Zantac (ranitidine) speeds up stomach emptying! See www3.infotrieve.com/medline/infotrieve/detail.asp?med9496+426645+"(ranitidine)+AND+(gastroparesis)"[This message has been edited by flux (edited 02-24-2001).]


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## Pete (Jan 20, 2000)

Flux,How could zantac speed up emptying? Also what is botox? I tried baclofen. It helped a little but not enough to deal with the side effects. Made me groggy. I don't think phase III is not necessarily working, I just believe it is probably not operating 100%. Why else would erythromycin delay recurrence of BO by 5 to 6 months? It obviously has something to do with Phase III. I don't think it could be delaying BO because of it's antibiotic effect, the dose is too small. Flux,why not get try a 10 day dose of neomycin and see for yourself? I realize you may of had a bad experience with antibiotics, but this is the only one that has ever worked. My gas was much worse when I ate sugar. Does this piece of information help your second theory?


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## Pete (Jan 20, 2000)

Flux,One more for you. The zantac doesn't seem to be controlling the acid like prevacid did. Could being off prevacid give me some type of rebound effect, meaning that my body just needs more time?Pete


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## Pete (Jan 20, 2000)

Flux, You are the best source of info. I keep thinking of questions. In your opinion could a problem with Phase III cause reflux/and or burping?


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## KateyKat (Jan 4, 2001)

Pete, you've got me rather worried by saying this as I'm trying to get this test arranged.It seems to me that checking these MMC's is the best thing to do.Is it *really* bad and if so in what way?Pete said:"He requested a repeat andro manometry but I declined. This test is absolutely torture. "KKat


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## flux (Dec 13, 1998)

> quote:How could zantac speed up emptying?


That is just what the drug does. It's a cholinergic agonist (in addition to being an H2 antagonist).


> quote:Also what is botox?


I had the information mangled in my head







It's botulism toxin, but it's used to treat achalasia, not GERD or reflux.


> quote:I tried baclofen. It helped a little but not enough to deal with the side effects. Made me groggy.


Did you ever try titrating the dose? Start it very small, breaking up the tablets if need be. Then working your way up. No guarantees, just an idea to cheat on the side effect problem.


> quote:Why else would erythromycin delay recurrence of BO by 5 to 6 months?


But you haven't tried it yet, so yeah it would do it a person who really had this problem (well, that is the hope) I'd want evidence of a problem with your MMCs before giving it. Say your real problem is the odd case where your bacteria in your colon changed. Probably it won't help that.Another option is octeotride, but again you want a good study before doing that.[quote[My gas was much worse when I ate sugar. Does this piece of information help your second theory?[/quote]Possibly, but nothing beats a good clean study of the MMCs. Also, you could get breath testing done for individual sugars.


> quote:One more for you. The zantac doesn't seem to be controlling the acid like prevacid did.


It probably won't. It cuts back on histamine, not on acid directly. The Prevacid is more potent in that regard.


> quote: In your opinion could a problem with Phase III cause reflux/and or burping?


Perhaps reflux from the duodenum into the stomach, but I don't see that happening at the other end of the stomach. That's got be something to do with esophagus or its sphincters.


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## Ugh (Jan 30, 2001)

> quote:However, what I just realized is they should cause malabsorption and the malabsorbed sugars can cause major gas in the colon.


Ohhhh, okay...now it makes more sense. I was under the impression that the bacteria in the small intestine in BO somehow were directly responsible for the excessive gas (which I understand is a major symptom of BO). So, actually the BO causes *malabsorbtion* which then causes gas. More complicated than I thought.


> quote:Not having phase III should make mucho ill.


I take it this is why doctors don't usually give h2 breath tests to people with IBS like symptoms.flux, when is your editorial on the Cedar's BO treatment coming out? you're behind schedule.


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## KateyKat (Jan 4, 2001)

Speaking about his antro/mano test Pete said:"This test is absolutely torture.And Flux responded:"Really? Were they using the clunky water-perfused tubes? I don't trust that method anyway."Both of u *Please* explain - I'm trying to get this test arranged but am now quite worried about it. The unit that does oeso/mano says you sip water at regular intervals for that one, so would the antro test be any different?What other methods are there, and are these more reliable?ScaredyKKat


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## Ugh (Jan 30, 2001)

KateyKat, if you don't mind me asking, could you please tell me what symptoms you have that led your doctor to suggest having that test done?


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## Pete (Jan 20, 2000)

Katey,Don't worry about it. I shouldn't of said torture, just very uncomfortable. I'm a big sissy though. You'll be fine. It is something you have to do. I will do it again if I have to.Pete


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## flux (Dec 13, 1998)

> quote:I'm trying to get this test arranged but am now quite worried about it. The unit that does oeso/mano says you sip water at regular intervals for that one, so would the antro test be any different? What other methods are there, and are these more reliable?


You have to sip water for the esophageal manometry since the purpose of the test to look at how well it works on swallowing. That's not related to method of recording the pressures. That's either done by water-perfused tubes or solid-state electronic transducer tubes. The former are thick clunky tubes and don't produce good data in my opinion. The others are like thin spaghetti and are more accurate (in my opinion). In all cases, the tube is inserted through your nose and lies behnd your throat for the duration of the test (aka nasogastric tube).


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## KateyKat (Jan 4, 2001)

Oh Pete and Flux, thanks ever so much for the info and reassurance .. if this test can be so helpful with diagnosis then yes I'llovercome my dread.Ugh, I have high levels of gas in my GI tract - amongst other difficulties it severely affects my ability to breathe. Peak Flow of ~100 - should be 450 LPM. My doc didn't suggest it .. I asked about it and he arranged the wrong one ie. oeso/mano + ph Ugh asked:"KateyKat..could you please tell me what symptoms you have that led your doctor to suggest having that test done? "KKat


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## Ugh (Jan 30, 2001)

kateykat said:"amongst other difficulties it severely affects my ability to breathe"I haven't heard of that before, where it affects breathing. I'm a little confused. Do you mean gas as in stomach (belching) gas? I find this thread interesting, so if you can, please explain how your gas interferes with breathing.thanks for any info


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## Kathleen M. (Nov 16, 1999)

The stomach is right under the diaphram, so if the stomach doesn't like the diaphram pushing down on it and it is uncomfortable to breathe fully it could effect the breathing (Peak Flow Value).GERD because it effects the esophagus and that lies next to the trachea can also effect breathing.K.------------------I have no financial, academic, or any other stake in any commercial product mentioned by me.And from the as if IBS isn't enough of a worry file...from New Scientist's Feedback column: photographed on the door of a ladies' loo in the Sequoia National Park in California by reader Liz Masterman: "Please keep door closed to discourage bears from entering."


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## KateyKat (Jan 4, 2001)

Ugh, the gas is in my stomach and small intestines and [just about any other place it can find to go ] .. sort of explosive quantities. My stomach pushes on the diaphragm which in turn pushes up on my lungs. I've seen the results of this demonstrated on chest X-ray.From reading this board I tend to think its possible that my MMC's aren't functioning properly, could be wrong of course, could be a compulsive air swallower, but this is why I want the antro/mano test.Ugh said:I'm a little confused. Do you mean gas as in stomach (belching) gas? I find this thread interesting, so if you can, please explain how your gas interferes with breathing.KKat


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## NickT (Oct 3, 2000)

Pete; I'm curious about the Drs. choice to use Neomycin. Neomycin is enteric coated erythromycin. Erythromycin is used to kill off Chlamydia Pneumonia. Did the Drs. ever explain why they chose Neomycin?


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## flux (Dec 13, 1998)

> quote: Neomycin is enteric coated erythromycin


*No, it's not.*


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## Guest (Mar 1, 2001)

Pete - I took neomycin after taking breathe test at cedars cinai hospital. My lower gas decreased to almost 95% and i feel less gas in my stomach by its size. But working is still a problem for me. How many times per day you take erythromycin(50 mg) and for how long you are going to take them. Thanks!


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## Persistance (Jul 11, 1999)

Forgive me for butting in here, but are we talking about the manometry test to measure esophageal motility? Or duodendal motility -- something else that affects IBS? Because I had the former at Cedars a year ago, and it wasn't that bad at all, particularly once they deaden your nose with lidocaine. Now the 24Hour PH test, where you walk around with a harness through your nose....But I must be talking about something else, because that manometry I had wasn't torture at all.


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## flux (Dec 13, 1998)

> quote:re we talking about the manometry test to measure esophageal motility?


Antroduodenal, not esophageal. The pH test uses a very slender probe.


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## BELLYBLOAT13 (Nov 19, 2014)

hello pete , how long and what was the dose on the neomycin please. IM SO SCARED TO TAKE IT CUZ OF WARNINGS ! I have 500 2x for 2weeks.


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