# Small Intestinal Bacterial Overgrowth and IBS-C



## boardsjohn (Sep 15, 2007)

I have had IBS with constipation and bloating for years. Now I have been diagnosed with SIBO - Small intestinal bacterial overgrowth syndrome, or Small Bowel Bacterial Overgrowth Syndrome (SBBOS). AND THE FIRST COURSE OF TREATMENT WAS LIKE A MIRACLE.My breath test was positive as below.Time ppmH2 ppmCH4 (f)CO20735 016 009 1.690835 012 015 1.800855 036 019 2.10I was placed on Xifaxin 200 mg three times a day for 14 days with great improvement in my symptoms, especially for the first few days, but total relapse occurred the day after stopping the medication.I have been restarted on Xifaxin 200 tid for another two weeks, which again is helping, but it does not seem like it is going to be curative. I have just found out that 1200mg/day for 12 weeks is the recommended dose and that neomycin, 500mg bid, should also be given since my methane gas test is positive. I REALLY NEED HELP/ADVICE AS THERE SEEMS TO BE SOMETHING IMPORTANT TO THIS SMALL BOWEL BACTERIAL OVERGROWTH SYNDROME. Has anyone been cured of it?I finally feel like I'm on the right track buy my GI doc knows very little about this.Thank you. John


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## 16229 (Jan 28, 2006)

Did you cycle onto probiotics when you came off the antibiotics? The antibiotics can raise some hell in your gut on their own as they kill all the bacteria. It's a good idea to try to introduce some good bacteria when you come off the antibiotics. As to which specific one? That can differ, but it seems to vary among us. You'll see a lot of probiotics recommended on the board. You may want to try Activia to start off with. It's pretty much the same price as other yogurts, tastes pretty good, and can easily be integrated into your normal food budget if that is a concern.


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## Janet Robinson (Sep 21, 2006)

I am exactly like you, I traveled to Philaphia for the test, norm is 10 I was a 18 after 6 hours..I then started probotics and heathers fiber and a herbalife program and my life is normal again.If I can help you feel free to pls email me direct [email protected] I stopped the antib's my problems returned big time. I take 2 probotics, 1 digestive advantage over the counter and herbalife shakes and nutrition. It works.


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## 20070 (Dec 13, 2005)

I was diagnosed with SIBO about a year ago. I was on Cipro for 14 days, I believe it was 500mg. twice a day. The first week was great, the 2nd week was much worse. I had bad D every morning, and was "out of it" and light-headed , and lacked my usual vitality. I stuck it out and am about 80% cured. I still have to watch what I eat, and make smart decisions with food choices, I'm okay with that. "artjunky and janet" are 100% right get on some probiotics, I did right after my treatment, and it really helped! PB8 is a good probiotic that my GI recommends.


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## pamela123 (Jul 25, 2007)

Hi John, Go to the Symbion For Life website and they've got a resource page that gives some information about it. It's an exciting discovery if they can get the cure right. Good luck in your treatment!


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## eric (Jul 8, 1999)

Things to know about all this.One IBS and SIBO are seperate conditions.There is a lot of controversary right now about SIBO and IBS.SIBO is basically a functional disorder like 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/517739The 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=us


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## searching4answers (Mar 4, 2010)

boardsjohn said:


> I have had IBS with constipation and bloating for years. Now I have been diagnosed with SIBO - Small intestinal bacterial overgrowth syndrome, or Small Bowel Bacterial Overgrowth Syndrome (SBBOS). AND THE FIRST COURSE OF TREATMENT WAS LIKE A MIRACLE.My breath test was positive as below.Time ppmH2 ppmCH4 (f)CO20735 016 009 1.690835 012 015 1.800855 036 019 2.10I was placed on Xifaxin 200 mg three times a day for 14 days with great improvement in my symptoms, especially for the first few days, but total relapse occurred the day after stopping the medication.I have been restarted on Xifaxin 200 tid for another two weeks, which again is helping, but it does not seem like it is going to be curative. I have just found out that 1200mg/day for 12 weeks is the recommended dose and that neomycin, 500mg bid, should also be given since my methane gas test is positive. I REALLY NEED HELP/ADVICE AS THERE SEEMS TO BE SOMETHING IMPORTANT TO THIS SMALL BOWEL BACTERIAL OVERGROWTH SYNDROME. Has anyone been cured of it?I finally feel like I'm on the right track buy my GI doc knows very little about this.Thank you. John


IMPORANT: Flagyl. Ask about Flagyl. I have bacteria overgrowth and Flagyl got rid of my leaky gas and sharp pains for now. It's been about 5 days since i've been off Flagyl and then they put me on Miralax to clean me out for about 5 days. It's the strongest of all the medications for bacterial overgrowth and is important that when u take it, u follow the directions or risk developing a antibiotic resistant strain of bacteria. Yes the side effects while on Flagyl will be pretty bad (extreme fatigue, dizziness, and nauseua) but the result is worth it.


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