# SIBO



## eric (Jul 8, 1999)

This is from 2000http://www.mindbodydigestive.com/themindb1...owth.html#Print


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## Rick (never give up) (Oct 7, 2005)

Thanks eric, I hope I had met you before, all this information you are providing is very useful.This specific article aligns with my own belief that antibiotics should be the last resort. In the end that's why I jumped right into the Vivonex.It also helps me put my feet on the ground with respect to my own expectations once I'm done with the Vivonex, but most importantly, it reassures that perhaps I'm finally in the right track.I'm compiling all the information you had posted so that in a couple of weeks maybe I'll start a post where I'll try to correlate and analyze all the data by adding my own experiences.Understanding IBS may not help me get rid of it by my own, but it is a VERY powerful stimulant for my psyche, and like I said before in my Vivonex thread, I think the psychological part plays a decisive roll in how you deal with IBS and perhaps how to overcome it. Thanks again.


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## Nanobug (Nov 7, 2006)

I did Xifaxan for 10 days recently and I've been doing very well. My IBS-D with *ALL* it's associated symptoms are *GONE*. I don't know whether this will last or not but to suggest (like eric does) that the SIBO hypothesis is simply wrong is at the very least silly.


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## eric (Jul 8, 1999)

Rick send me an email and I will send you some brand new information on SIBO and IBS that is really worth reading. Nanobug, why is there major controvesy over SIBO and IBS right now?Also because you have not read all the information in regards to IBS and SIBO and in fact did not want to read it so your really only looking at one side of the picture here. There is a condition for sure called IBS and one for sure called SIBO. Are they the same conditions cause by the same mechanisms? On a lot of these post your seeing SIBO and IBS used together as if they were and that has not been established yet for sure. As a matter of fact the best testing for sibo has even been established for sure and it looks like the lactulose method is not the best method to do the testing in the first place.In IBS research there is a lot sibo has not explained yet in regards to IBS, right now its only speculation.In state of the art IBS research they have found a lot of abnormalities.


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## eric (Jul 8, 1999)

BACTERIAL OVERGROWTH IN IBShttp://www.ei-resource.org/articles/ibs-art06.asp


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## Rick (never give up) (Oct 7, 2005)

Hi nanobug,First of all, let me tell you that I'm really happy for you cause it seems that the antbiotic protocol worked for you







I think that the idea eric was trying to transmit is not that SIBO is not IBS as an absolute statement, but rather that the best scientific studies are still controvertial, and stating SIBO as a single cause for IBS is risky.So again, my point still stands. IBS may be a common name to a diverse set of illnesses that share similar symptoms. Perhaps yours (I pray for that) was caused by SIBO and the imbalance it creates and endures overall your GI track. But someone else reading this posts shall be carefull before jumping into antibiotics, at least that's my opinion.Two years of IBS (and hundreds of dollars scammed) had made me cautious.







Let us know how are you doing. Knowing that at least one member in this forum got cured by Pimentel's antibiotic protocol will give hope and will also let others, like me, to gather more information.Be well.


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## Nanobug (Nov 7, 2006)

> quote:Nanobug, why is there major controvesy over SIBO and IBS right now?


For the same reason Barry J. Marshall and J. Robin Warren were ridiculed a few years ago for suggesting ulcers were mainly caused by bacteria (Helicobacter Pylori): the "experts" got pissed.


> quote:Also because you have not read all the information in regards to IBS and SIBO


How the heck do you know what I've read or not? Isn't it just a little bit too presumptuous on your part to think you are some kind of Illuminati around here? I've been battling this freaking disease for 20 years; give me some credit, please!


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## Nanobug (Nov 7, 2006)

> quote:First of all, let me tell you that I'm really happy for you cause it seems that the antbiotic protocol worked for you


Well, I appreciate that, thanks. However, I think it's way to early to sing victory just yet.I also would like to wish you success in your Vivonex endeavor. If for some reason I go back to my old IBS-D ways, the thing to try will be Vivonex Plus.


> quote:I think that the idea eric was trying to transmit is not that SIBO is not IBS as an absolute statement


That's not what comes across, at least seen from here. What I see is an attempt to discredit the SIBO hypothesis. And I think this is a disservice to people who could benefit from exploring this hypothesis with their doctors.


> quote:But someone else reading this posts shall be carefull before jumping into antibiotics


Well, I personally adopt a different viewpoint. If nothing else works, if there are no other options, why not try antibiotics? Although antibiotics have some risks, the potential rewards far exceed them. That's my perspective, at least.


> quote:Two years of IBS (and hundreds of dollars scammed) had made me cautious.


In my case, 20 miserable years of IBS-D and thousands of dollars spent made me adventurous.







It comes a time when one has very little to lose. The only line I draw is whether there is any kind of scientific support or not. And the SIBO hypothesis, although not firmly established, had enough behind it to warrant my attention.


> quote:Let us know how are you doing


Yes, it is my intention to continue to provide updates using my "The Skin Rashes" thread.I'm also following with a great deal of attention your updates and do hope, excuse me, *expect* the Vivonex protocol to do wonders for you!


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## eric (Jul 8, 1999)

"For the same reason Barry J. Marshall and J. Robin Warren were ridiculed a few years ago for suggesting ulcers were mainly caused by bacteria (Helicobacter Pylori): the "experts" got pissed."That's not the reason.The reason is no other center has replicated the studies, as well as the method used to diagnoses SIBO, among many other clinical reasons in regards to IBS, such as rectal ballon studies in IBS."experts" got pissed." What experts? And whats the connection does that have to what were talking about here?Only certain experts are worthy? What ones are those?Dr Gershon is the father of neurogastroenterolgy and discovered the role of serotonin in the gi tract and the complexities of the enteric nervous system or brain in the gut. It was a huge discovery seldom mentioned in regards to IBS, even though it directly is involved in IBS and has extensive research behind it in regards to motility in IBS, the d, c and d/c and to pain in IBS. I have had IBS for over thrity five years and I applogize for the last comment, but it was somewhat based on your previous comments of not wanting to read other expert opinions on the relationship of sibo and IBS. As we both have IBS or gi problems I am sure we can hopefully work together and look at all the reaserch.I am personally concern right now people are taking antibiotics for IBS without being tested for sibo using the best methods.I am also concerned with the press and there role in presenting sibo and IBS without some better checks and balances.I am not against in anyway testing and treating SIBO if a person has it.I am intested as anyone if SIBO is commorbid with IBS, how it could cause chronic pain and the sensation of incomplete evacuation? I am interest in FMRI and PET scans and what they are learning in IBS and what relationship it has to both sibo and IBS.I am interested in Post Infectious IBS and its role in IBS and in SIBO?I am interested in malabsorbtion in sibo but not in IBS and what's that about?I am very interested in an sibo study of the general population? and a lot more, but I am concerned right now about somethings. Hence why all the infromation is useful, especially the expert opinions. There are some extremely good doctors working on IBS all over the world.I am glad your feeling better and hope it lasts. Was the antibiotic the only thing you took or have you already started taking 5HTP and has there been any other things you have changed?What test did you have for sibo to be diagnosed with it?What were your major symptoms?


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## Moises (May 20, 2000)

Eric,I have voiced concern a couple of times now about the Pimentel's advocacy of antibiotics. You are right that the press is really picking up on rifaximin. And I believe Pimentel's rifaximin studies are financed by the drug's manufacturer.I personally tried the rifaximin and had no benefit and no known harm, other than the cost in dollars.But Pimentel has published results of the elemental diet that have extremely high rates of improvement. I happen to be in the midst of testing that diet as I write this. I have no idea if I will benefit from it. But if his success rates can be replicated, I don't see any reason to throw the baby out with the bathwater. That is, maybe it is not wise to use Pimentel's rifaximin protocol widely. But it might make sense for those who suffer from IBS to test more widely the effectiveness of an elemental diet.Of course, if the elemental diet is effective, that does not necessarily mean that Pimentel's explanation of why it is effective is correct. But if we had the data that the elemental diet significantly benefits people with IBS, that would be a big move in the right direction.


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## eric (Jul 8, 1999)

> quote:But Pimentel has published results of the elemental diet that have extremely high rates of improvement.


I don't believe I have seen these? Can you post a link or where to find that information? One thing is for sure, other centers and bigger groups as well as different centers, need to replicate Cedars studies. This is also very focused research and it needs to be incorporated into the braoder perscpetives and picture of IBS and that has not been done yet. The testing really needs to be defined as well as the what test is the most accurate for testing SIBO.Is SIBO more commen in women, like IBS?Can people without IBS have SIBO and to me it looks like they can?There is a lot of work to be done. I know I am being slightly skeptical. This is pretty new research and I hope people read all the information and of course work with their doctors. I also believe the last study the press seemed to play it up and the actual effectiveness of the treatment, a lot did not improve in that study really. What did might in part be explained just by the antibiotic killing bacteria and lessening gas and hence less pressure on sensitve nerves. The sensivitve nerves need to be explained I think. Have you ever read all these?http://www.iffgd.org/symposium2005report.htmlhttp://www.iffgd.org/symposium2003report.htmlhttp://www.iffgd.org/symposium2001.htmlhttp://www.aboutibs.org/Publications/symposium.htmlThe complexities are major really and its also amazing in a lot of ways the progress as well. I hope you find success with the diet and it works for you. When I think diet and IBS other then trigger foods, I often think nutrition is major.


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## Moises (May 20, 2000)

> quote:Originally posted by eric:
> 
> 
> > quote:But Pimentel has published results of the elemental diet that have extremely high rates of improvement.
> ...


 link to Pimentel's Elemental Diet Study link to many Pimentel abstracts


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## easybeinggreen (Nov 26, 2007)

I have been on Rifaximin for 6 days and ALL of my IBS symptoms are also GONE. Does it really last?? This is a miracle....all these "hundreds" of years I have been suffering and watching my entire health go down the drain. My father had all of my same symptoms...too bad he had to die of colon cancer before finding out about Rifaximin. What I really would like to find out is how long will the treatment last? I found one site only that said it lasts for 10 weeks. Also do I understand the medication flyer correctly in that for those that Rifaximin works, they are genetically pre-disposed? I can only liken it to Peptic ulcers being cured with antibiotics. My dad had a Peptic ulcer, too. I see my doctor next, Dec 27th. Also, the script has a refill, so that worries me....just remission? Sorry to be rambling, but I am doing the HAPPY DANCE while I am typing this...EACH day I fell better....no more leaky gut syndrome. Amazing.


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## Moises (May 20, 2000)

easy,Good for you! Please read Pimentel's book. If you would like to last a long time without needing medication again, you should follow his diet.moises


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## eric (Jul 8, 1999)

Moises. that is a 2004 study, I wonder where they are at now, since I don't see more on it?Have you been following the newer IBS and sibo material?People can have sibo and can have IBS or sibo and IBS, but the intial speculation that sibo causes IBS is not working out to well.One thing is to find an accurate test to begin with.The lactulose test was not a very accurate test."Curr Gastroenterol Rep. 2007 Oct;9(5):373-7.Evaluation of small bowel bacterial overgrowth.Schiller LR.Digestive Health Associates of Texas, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, USA. [email protected] bowel bacterial overgrowth historically has been associated with malabsorption syndrome attributed to deconjugation of bile acids in the upper small intestine. Recent reports raise the possibility that bacterial overgrowth may be a cause of watery diarrhea or irritable bowel syndrome. Quantitative culture of jejunal contents has been the gold standard for diagnosis, but a variety of indirect tests have been developed (and mostly discarded) over the years in an attempt to facilitate the diagnosis of small bowel bacterial overgrowth. These include breath tests and biochemical tests based on bacterial metabolism of various substrates. Problems with these indirect tests include rapid transit, which may cause substrate to reach the luxuriant bacterial flora in the colon, producing false positives and vagaries of the tests themselves, which may produce falsely negative results. The perfect test for small bowel bacterial overgrowth is yet to be devised.PMID: 17991337 alsoGut. 2007 Jun;56(6):802-8. Epub 2006 Dec 5. LinksSmall intestinal bacterial overgrowth in patients with irritable bowel syndrome.Posserud I, Stotzer PO, Björnsson ES, Abrahamsson H, Simrén M.Department of Internal Medicine, Sahlgrenska University Hospital, 41345 Göteborg, Sweden.BACKGROUND: Small intestinal bacterial overgrowth (SIBO) has been proposed to be common in irritable bowel syndrome (IBS), with altered small-bowel motility as a possible predisposing factor. AIM: To assess the prevalence of SIBO, by culture of small-bowel aspirate, and its correlation to symptoms and motility in IBS. METHODS: *162 patients with IBS who underwent small-bowel manometry and culture of jejunal aspirate were included.* Cultures from 26 healthy subjects served as controls. Two definitions of altered flora were used: the standard definition of SIBO (>/=10(5) colonic bacteria/ml), and mildly increased counts of small-bowel bacteria (>/=95th centile in controls). RESULTS: SIBO (as per standard definition)* was found in 4% of both patients and controls. *Signs of enteric dysmotility were seen in 86% of patients with SIBO and in 39% of patients without SIBO (p = 0.02). Patients with SIBO had fewer phase III activities (activity fronts) than patients without SIBO (p = 0.08), but otherwise no differences in motility parameters were seen. Mildly increased bacterial counts (>/=5x10(3)/ml) were more common in patients with IBS than in controls (43% vs 12%; p = 0.002), but this was unrelated to small intestinal motility. No correlation between bacterial alterations and symptom pattern was observed. CONCLUSIONS: *The data do not support an important role for SIBO according to commonly used clinical definitions, in IBS.* However, mildly increased counts of small-bowel bacteria seem to be more common in IBS, and needs further investigation. Motility alterations could not reliably predict altered small-bowel bacterial flora.PMID: 17148502 Gastroenterol Clin North Am. 2007 Sep;36(3):735-48. LinksBacteria: a new player in gastrointestinal motility disorders-infections, bacterial overgrowth, and probiotics.Quigley EM.Department of Medicine, Alimentary Pharmabiotic Centre, University College Cork, Clinical Sciences Building, Cork University Hospital, Cork, Ireland.Irritable bowel syndrome (IBS) may result from a dysfunctional interaction between the indigenous flora and the intestinal mucosa, which in turn leads to immune activation in the colonic mucosa. *Some propose that bacterial overgrowth is a common causative factor in the pathogenesis of symptoms in IBS; others point to evidence suggesting that the cause stems from more subtle qualitative changes in the colonic flora. Bacterial overgrowth will probably prove not to be a major factor in what will eventually be defined as IBS.* Nevertheless, short-term therapy with either antibiotics or probiotics seems to reduce symptoms among IBS patients. However, in the long term, safety issues will favor the probiotic approach; results of long-term studies with these agents are eagerly awaited.PMID: 17950446 Curr Opin Gastroenterol. 2006 Nov;22(6):669-73. LinksBacterial overgrowth as a cause of irritable bowel syndrome.Riordan SM, Kim R.Gastrointestinal and Liver Unit and University of New South Wales, Sydney, NSW, Australia. [email protected] OF REVIEW: To review recently published studies investigating any association between gut flora and symptoms of irritable bowel syndrome. RECENT FINDINGS: Experimental studies demonstrate associations between gut flora, gut motility, mucosal inflammation and visceral hypersensitivity. Scientific bases for possible benefits of selected probiotics on irritable bowel symptoms have been identified. Disturbances in viable counts of fecal flora have been demonstrated in patients with irritable bowel syndrome. *Results of studies based on breath tests are conflicting as to whether the prevalence of small intestinal bacterial overgrowth is increased in this group. Nonetheless, a longitudinal analysis based on bacteriological assessments of serial small intestinal aspirates suggests that this entity should be considered in patients with irritable bowel symptoms, *especially in the setting of predisposition to bacterial overgrowth. Clinical trials of probiotic treatment for irritable bowel syndrome have yielded conflicting results. SUMMARY: Recent studies provide increasing support for the concept that disturbances in gut flora occur in patients with irritable bowel syndrome and that such abnormalities may contribute to irritable bowel syndrome-type symptoms. The relative importance of disturbed gut flora to symptom pathogenesis, along with the therapeutic potential of modulation of the gut flora for amelioration of irritable bowel syndrome symptoms, however, remains to be fully defined.PMID: 17053447 IFFGD Watch these video interviews with Dr Eammon Quigley to learn about Gut Flora, Probiotics, and Antibiotics,http://www.ibsgroup.org/forums/index.php?showtopic=91663 These are the rest of the videos from the symposiumhttp://www.aboutibs.org/site/learning-center/video-corner/Moises, have you ever heard of Dr Eammon Quigley before?


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