# Neomycin for IBS-D?



## Kamikazee (Jul 31, 2007)

Does Neomycin work for treating IBS-D or is it just for constipation? I heard it works either way but its more effective for constipation is this true? I also read that Rifamixin yielded a 70% decrease in symptons when neomycin only yielded 30% what do you guys think is it worth a shot. Has anybody else tried this need input so I can push on the issue thanks.After going through several doctors, and a specialist who where not very open minded, saying the usual that ibs is caused by stress nothing we can do to help, take fiber, blah, blah, after having several months of being discouraged and afraid to try again I decided I was determined to talk to somebody who would at least hear me out. So my mother referred me to a wonderful lady that I saw last Thursday, who is a friend from church and is a nurse practitioner. She listened to every word I said and is willing to try my ideas, after we go through the basics, yeah can you believe that the doctors didn't even do basic tests like, gluten test, lactose intolerance test nothing. They jumped me straight ahead to x-ray, colonoscopy, and a parasite test. Which where all negative(Not to mention I am now a 21 year old with hemroids). So anyways she said she would be willing to try my ideas meaning breath test, and maybe some antibiotics. She wont do rifaximin because of the side effects and there hard for her to get, but she says neomycin is very easy to get, and the side effects aren't as severe so she said she would be willing to try that. I should her Dr. Pimental's book and she wanted to read it to have a better understanding of where I'm coming from, and I told her how long I would have to take neomycin and that scared her a little bit, but she said she is still willing to try it. Seeing how they use it to prep the day before for procedures. I'm very excited I hope I get somewhere because I know its possible. I've experience it before. Thanks for all the help!


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## eric (Jul 8, 1999)

Kamikazee.First of IBS is a seperate condition then SIBO, this is important in treating either of them. Its important also to understand what leads to SIBO. SIBO is a functional disorder like IBS.There is a lot of controversary right now about SIBO and IBS.Small intestinal bacterial overgrowth (SIBO) is also known as small bowel bacterial overgrowth (SBBO).What causes small intestinal bacterial overgrowth? The gastrointestinal tract is a continuous muscular tube through which digesting food is transported on its way to the colon. The coordinated activity of the muscles of the stomach and small intestine propels the food from the stomach, through the small intestine, and into the colon. Even when there is no food in the small intestine, muscular activity sweeps through the small intestine from the stomach to the colon. *The muscular activity that sweeps through the small intestine is important for the digestion of food, but it also is important because it sweeps bacteria out of the small intestine and thereby limits the numbers of bacteria in the small intestine. Anything that interferes with the progression of normal muscular activity through the small intestine can result in SIBO. Simply stated, any condition that interferes with muscular activity in the small intestine allows the bacteria to stay longer and multiply in the small intestine. The lack of muscular activity also may allow bacteria to spread backwards from the colon and into the small intestine. *Many conditions are associated with SIBO. A few are common. Neurologic and muscular diseases can alter the normal activity of the intestinal muscles. Diabetes mellitus damages the nerves that control the intestinal muscles. Scleroderma damages the intestinal muscles directly. In both cases, abnormal muscular activity in the small intestine allows SIBO to develop. Partial or intermittent obstruction of the small intestine interferes with the transport of food and bacteria through the small intestine and can result in SIBO. Causes of obstruction leading to SIBO include adhesions (scarring) from previous surgery and Crohn's disease. Diverticuli (out-pouchings) of the small intestine that allow bacteria to multiply inside diverticuli." http://www.medicinenet.com/small_intestina...wth/article.htmLately there has been an association with IBS and sibo, although there is a lot of controvery about how many IBSers might have SIBO. It does not look like at this time IBS is caused by SIBO.The link below uses a better testing method.Excess bacteria don't influence bowel disease http://www.ibsgroup.org/forums/index.php?showtopic=87815It can mimick some IBS symptoms however, but a lot of things can.This is some expert info on it.I wrote to Dr Drossman on this and here is the reply. *Any Idea what those irritating substances are?*sorry its in bold type that is how he worte it into the email so I would see it was his answers.*"IT IS AN OVERSTATEMENT TO SAY THEY ARE "IRRITATING" SUBSTANCES AT LEAST IN THE SENSE OF BEING SOME TYPE OF TOXIN. THEY ARE NATURAL BYPRODUCTS OF DEGRADATION OF FOOD SUBSTANCES BY BACTERIA WHICH DON'T NORMALLY OCCUR IN THE SMALL BOWEL. SO WITH INCREASED BACTERIA IN THE SMALL BOWEL, THE BACTERIA ARE ABLE TO DIGEST SUGARS FOR EXAMPLE PRODUCING H2 AND CO2 FROM THE SUGARS WHICH ARE GASEOUS BUT WHICH ALSO HAVE OSMOTIC PROPERTIES, I.E. INCREASED PARTICLES THAT CAUSE SECRETION OF FLUID INTO THE BOWEL THUS CAUSING DIARRHEA. IT'S THE SAME PRINCIPLE AS USING NON ABSORBABLE SUGARS LIKE LACTULOSE OR SORBITAL TO TREAT CONSIPATION BY INCREASING FLUID IN THE BOWEL. IT'S JUST THAT WITHOUT BACTERIA IN THE SMALL BOWEL, IT DOESN'T HAPPEN AND THE FOOD SUBSTANCES GET ABSORBED. WITH INCREASED BACTERIA IT COMPETES FOR THE FOOD SUBSTANCES AND PRODUCES THE GAS AND DIARRHEA."**This means these are just in the wrong place and not specific or multiple pathogens?**CORRECT. HOWEVER, THERE IS GROWING INTEREST NOT IN THE AMOUNT OF BACTERIA BUT THE TYPE OF BACTERIA. CERTAIN BACTERIA CAN CAUSE SOME MILD INFLAMMATION OF THE BOWEL AND OTHERS PROTECT THE BOWEL FROM THAT POSSIBILITY. SO THERE IS "GOOD" AND "BAD" BACTERIA. POSSIBLY WHEN PEOPLE ARE TREATING PRESUMED SIBO (WHICH MIGHT NOT ACTUALLY BE HAPPENNING, BECAUSE THE TEST MAY BE INACCURATE) ANTIBIOTICS MAY HELP TO GET RID OF THE BAD BACTERIA AND THAT MAY BE WHY THEY ARE GETTING BETTER. THIS IS WHY SOME PEOPLE GET BETTER AFTER ANTIBIOTIC TREATMENT. BUT IT CAN ALSO GO THE OTHER WAY, I.E., ANTIBIOTICS HAVE BEEN SHOWN TO MAKE IBS WORSE AS WELL. THE OTHER IDEA IS TO USE PROBIOTICS WHICH CONTAIN "GOOD" BACTERIA (E.G., LACTOBACILLUS OR BIFIDOBACTERIA) WHICH REPLACE THE BAD BACTERIA, POSSIBLY REDUCE THE INFLAMMATION AND IMPROVE SYMPTOMS. SO THE ISSUE OF BACTERIA IN THE BOWEL IS MUCH MORE COMPLICATED THAN SIMPLE SIBO, BUT SIBO CAN BE A PART OF THE WHOLE PICTURE (THOUGH NOT THE WHOLE PICTURE FOR IBS). *alsoNew Updates in Chronic Constipation and Irritable Bowel Syndrome *"Another diagnostic test that has increasingly gained interest in this setting is the breath test to detect small intestinal bacterial overgrowth (SIBO). It has been proposed that many IBS patients have symptoms due to the presence of SIBO, as measured by the lactulose breath test, which has been detected in as much as 78% to 84% of patients.[39,40] Harris and colleagues[41] presented a retrospective chart review assessing the presence of GI symptoms, in particular those associated with IBS, in patients referred for glucose hydrogen breath tests for SIBO. They predicted that lactulose breath testing overpredicted the actual prevalence of SIBO in IBS. Glucose hydrogen breath testing has a sensitivity of 75% for SIBO[42] compared with the sensitivity of 39% with lactulose breath testing for the "double-peak" phenomenon characteristic of SIBO.[43] There has been considerable debate regarding the accuracy of the lactulose breath test compared with small bowel aspirates to detect the number of bacteria, which has been considered the gold standard for diagnosing SIBO.[*44] Of the 182 patient charts reviewed, 113 patients (88 women; mean age, 58 years) met the Rome II criteria for IBS (IBS-D, 56%; IBS-C, 32%; and IBS-A, 12%).[41] Only 11% of these patients had a positive breath test for SIBO. *The study authors concluded that etiologic factors other than SIBO are likely involved in the pathophysiology of IBS.* Despite the standard use of the Rome II diagnostic criteria for IBS, the prevalence of SIBO in these patients appears to vary widely depending on the patient population and type of methodology used."With growing evidence of increased colonic mucosal immune markers, the efficacy of antibiotics for the treatment of SIBO, and of probiotics for the treatment of patients with IBS symptoms, the postulated mechanism of altered bacterial-mucosal interactions playing a role in IBS appears conceivable. Pimental and colleagues[68] presented a 2-center, randomized, placebo-controlled trial assessing the efficacy of a 10-day course of the nonabsorbable broad-spectrum antibiotic rifaximin* at a dose of 400 mg peroral thrice daily. A 7-day stool diary, questionnaires, and lactulose breath test for SIBO were administered before and after treatment. The primary efficacy end point was global improvement in IBS, with clinical responders defined as having > 50% improvement overall. Forty-three patients were randomized to rifaximin and 43 to placebo. The intention-to-treat analysis demonstrated a 37.7 ± 5.8% overall improvement with rifaximin compared with 23.4 ± 4.3% with placebo (P < .05). Rifaximin was also associated with a significantly higher responder rate of 37% compared with 16% for placebo. Patients with diarrhea showed a greater clinical response with rifaximin (49%) than placebo (23%), but patients with constipation did not demonstrate such a response.http://www.medscape.com/viewarticle/517739Really the main improvement when you get down to it was bloating and not d or c or d/c or pain.The Need to Define The Target of Antibiotic Therapy in IBS Patients: Small Bowel or Colonic Flora?http://www.annals.org/cgi/eletters/145/8/557You should also read this belowTreatment for Bacterial Overgrowth in the Irritable Bowel Syndromehttp://216.109.125.130/search/cache?ei=UTF...=1&.intl=usThese things are all important.When they tested you for IBS did they do blood and stool work? At your age they no longer have to do as many tests to diagnose IBS, especially if they gave you a colonoscopy. I also have to say there may be other reasons besides SIBO you might find some relief with antibiotics.It is also really important not to self diagnose yourself as that is the leading cause of Misdiagnoses.


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## eric (Jul 8, 1999)

Have you ever read this IBS diagnose thread?http://www.ibsgroup.org/forums/index.php?showtopic=65559


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## Kamikazee (Jul 31, 2007)

Thanks for the help, but now I have a new obstacle which will be posted in a new thread.


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