# Conversation with Dr. Mark Pimentel: Bacteria IBS Study



## Jeffrey Roberts (Apr 15, 1987)

I had a conversation with Dr. Mark Pimentel on Thursday Dec. 14. Dr. Pimentel is the assistant director of the gastrointestinal motility program at Cedars-Sinai Medical Center in Beverly Hills, Calif. The conversation was about the recent study which links intestinal bacteria to irritable bowel syndrome. The conversation helped to clarify the study results.Dr. Pimentel suggests that more than the usual amount of gas in the intestine occurs by either swallowing, in which case there is a valve to release it via burping, or gas builds up by fermentation from bacteria. IBS has symptoms of bloating, D. and C. Even C. people have the occasional D. Bacteria is normally found in the large intestine but not in the small intestine which is primary for digestion of food particles. An overgrowth of bacteria appears to be occuring in 85% of people in the study. It is not a bacterial infection - bacteria is in fact not meant to be there in the small intestine. Some mechanism does not appear to be working for sufferers of IBS. In fact there are normally 6 mechanisms to prevent the build-up of bacteria in the gut. The failure of one of the mechanisms causes problems.The use of an antibiotic to remove the bacteria was tested in the study. Bacteria levels were measured by way of a hydrogen breath test. The absence of hydrogen implied that the bacteria was in check.Neomycin was used as the primary 1st line antibiotic. It was successful in 60% of cases. Flagyl was only successful in 20% of the cases. Some drug resistance occurred during the study. No overgrowth of C. Diff was seen. Relapses occured and were treated with Neomycin again. Relapses seem to occur after 1 or 6 months after initial treatment.There is active research to develop a non-antibiotic treatment. This is expected within 12 months.Dr. Pimentel does not recommend the wide use of antibiotics to control IBS. He feels that you must confirm the presence of bacteria overgrowth with hydrogen breath tests first.This study is based on a study from Japan. It is one of the first to look for a cause of IBS rather than attempting to treat the symptoms.Dr. Pimental will be continuing his study, which has been underway for the last several years, and will be looking for interested individuals to join the study. I will post the study information on the Studies page.Dr. Pimental reported that he has successfully treated 900 IBS patients with antibiotics.Jeff[This message has been edited by Jeffrey Roberts (edited 12-15-2000).]


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## Persistance (Jul 11, 1999)

Jeff, that is fascinating. So that _is_connected with the paper Dr. Edward Share of Cedars Sinai handed me back in April about "his" breath test, and it _wasn't_ as crazy as I thought. But nonetheless, if they're looking for a non-antibiotic solution to this, I'm glad I waited before being tested and treated.


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## Brandi Guidry (Jul 9, 2000)

Jeff,Thanks for posting this very interesting info. This seems to be a major subject on the bb lately. I did my experiment on a gastric and a colon bx on a pt with a history of crohnic D. I did a GMS-silver stain, looking for fungus, and I found none. Of course, these biopsies were randomly selected out of the 500 bx that I process a year. That would be fantastic if Dr. Pimentel could prove that antibiotic would be helpful in treating IBS. Did he say how long before the breath test would be on the market?Jeff, thanks again and please keep us informed if you have any more info concerning this!Brandi


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## trbell (Nov 1, 2000)

great work, Jeff. the wonders of the internet! for those of you in the US with the same insurance problems I have, let me pass along something I'm trying that may work for you. My insurance ends on December 31 as my wife lost her job but I just sent a letter to my primary physician with this info and I will try to see him before the 31st, but incase I can't I also sent the info to the insurance company. Since I do have a diagnosed condition and I am requesting treatment, if I can't get in before the end of the insurance, I think the insurance company will be forced to cover since I am making the effort to get treatment?tom


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## Guest (Dec 15, 2000)

Thanks Jeffrey for he info!roz


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## Guest (Dec 15, 2000)

Thanks also Jeffrey...especially for the quick turn around!


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## rebel (Jul 17, 2000)

Thanks Jeff


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## Guest (Dec 15, 2000)

Brandi - There's already a similar test for detecting ulcers which has been in use for some time. I wonder if this is the same test...


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## HipJan (Apr 9, 1999)

Thanks, Jeff! I will definitely pass this info. along to a couple of doctors of mine in January.


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## echris (Jul 19, 2000)

The hydrogen breath test has been around for a long time. I took it almost 20 years ago. You have to fast after midnight. About 8 am, they give you a glass of lactulose to drink, which no one can digest. Then they have you breathe into a large test tube that is sealed with a cork. You continue to breathe into a different test tube something like every 15 minutes for 4 hours. Then they analyze the contents of the test tubes to construct a curve showing the amount of hydrogen exhaled across time.I did this first with Lactulose, then with Sucrose and Lactose. The tests are done at about weekly intervals to give your GI tract a little time to calm down, if needed. The test may, by now, be a little different, but I suspect that the basic strategy remains the same. If you haven't figured it out yet, if you are IBS - D, as I am, don't plan any activities for the rest of the day because at least the Lactulose will really clean you out. In my case, I was also cleaned out by the sucrose and the Lactose. In fact, if my memory serves me correctly, I believe that the average person gets cleaned out, by the Lactulose, in about 62 minutes, and I mean cleaned out.Of all of the tests that I've had, and I think I've had them all, this was one of the most benign (except, of course, for the thorough cleaning out that I got from it).echris (IBS - D, 24 years and counting)


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## Stace (Sep 20, 2000)

The breath test that detects H. Pylori (the bacteria that causes ulcers) checks for Urea, not Hydrogen.Stacey


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## SteveE (Jan 7, 1999)

I guess I'll wait for the actual study to come out, but I'm tempted to go back to the Dr. who ran the breath test and see about neomycin.Any idea how they arrived at using that particular antibiotic? I'm very curious about that because I saw that it is used for ear infections. After a round of tetracycline once, my IBS got better, but I suddenly got very stuffy ears. As the stuffiness went away, the ibs returned.[This message has been edited by SteveE (edited 12-15-2000).]


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## Guest (Dec 15, 2000)

Thanks Jeff.


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## eric (Jul 8, 1999)

Thanks Jeff, for finding some information out for us. Interesting.------------------ http://www.ibshealth.com/ www.ibsaudioprogram.com


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## eric (Jul 8, 1999)

Just FYI, the bb member Paloma is seeing this doctor and posted on another thread about it.Pete's thread on bacteria.------------------ http://www.ibshealth.com/ www.ibsaudioprogram.com


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## Krissy (Jul 6, 2000)

Thanks for passing the info. Jeff, Krissy


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## Jeffrey Roberts (Apr 15, 1987)

I do not know specifically why Neomycin was chosen although Dr. Pimentel did comment that Neomycin was a good choice because it is poorly absorbed by the liver. I presume this implies fewer side-effects.


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## Bud (May 16, 2000)

Thanks Jeff for this info.


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## Jeffrey Roberts (Apr 15, 1987)

> quote:Hopefully this Public Information Sheet providedby Dr. Mark Pimentel can answer some of your questions about smallintestinal bacterial overgrowth and testing for it. If you have furtherquestions, please refer to the full article available in the AmericanJournal of Gastroenterology, December 2000 issue. Any other medicaltreatment concerns should be directed to your primary care physician orgastroenterologist.Public Information Sheet What is bacterial overgrowth? Bacterial overgrowth is not an infection. The colon normallycontains a large number of bacteria (300-400 different species). However,because the small intestine is where food is absorbed and digested there aremany protective mechanisms to keep it free from bacteria. In the case ofbacterial overgrowth, there is excessive colon type bacteria in the smallintestine. This results in gas, bloating, diarrhea, abdominal pain and inmany cases alternating diarrhea and constipation. What is the association between bacterial overgrowth and IBS? We have recently shown that 78% of subjects with IBS have bacterialovergrowth. When the bacterial overgrowth is eradicated with the appropriateantibiotic, there is a dramatic improvement in symptoms with cure of IBS inalmost 50% of subjects by study definition. How do I diagnose bacterial overgrowth? To diagnose bacterial overgrowth requires a special test called alactulose hydrogen breath test. This involves drinking a syrup of a sugarthat humans cannot digest. Therefore the syrup gradually makes its waythrough the intestine. Because bacteria can digest the sugar, as soon as thesyrup reaches areas of the intestine where there are bacteria, they use itto produce gas. One of the gases they produce is hydrogen. The hydrogen gasis then absorbed through the intestine into the blood and enters yourbreath. The hydrogen gas is not toxic as it is the same gas that would havebeen produced if you had eaten a meal. Breath samples are collected every 15minutes after you drink the syrup. The breath samples are measured on aspecialized device. The time it takes from the time you drink the syrup tothe rise in hydrogen in your breath will determine whether the bacteria isin the small intestine or colon. How do I treat the bacterial overgrowth? This is an important question. It is very important not to useantibiotics without knowing you have bacterial overgrowth. It is thereforevital to get a breath test first. The other important aspect of the breathtest is that many times, antibiotics are given and the symptoms do not goaway. In that instance the repeat breath test often shows that the hydrogenlevels are reduced but not normal. Therefore another antibiotic may berequired to complete the eradication process. The important thing is torealize that taking antibiotics without reason is a problem and can resultin antibiotic resistance. Where do I get help? One problem with this new finding is that there are very few placesable to perform the breath test. If you are in the Los Angeles area and wantthe breath test, we can help but any testing should be under the supervisionof your primary care physician or gastroenterologist. The telephone numberto arrange for the breath test is (310)423-6143. PLEASE, do not call thisnumber for general information as it is for booking tests only.


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## JeanG (Oct 20, 1999)

Thanks for this info, Jeff! I use neomycin drops for my ear infections. Of course, that's not the route they are talking about here.Thanks for keeping us updated.







JeanG


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## eric (Jul 8, 1999)

Thanks Jeff for the information. ------------------ http://www.ibshealth.com/ www.ibsaudioprogram.com


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## Dennis (Jan 13, 1999)

Jeff:Has there been any hydrogen breath testing in Canada? Are there any Doctors/hospitals/clinics that are following through with this type of research?Echris:Can you provide us with the results of your test? Did it suggest that you had an overgrowth of bacteria...and...did they treat you for it? Your post suggests that you are still a sufferer...did you benefit in any way???


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## phyllisfin (Jan 27, 1999)

This sounds extremely interesting. Does anyone know of any doctor/hospital/clinic in the U.S. which offers this hydrogen breath test. I'm trying to get the urea test done here in Sarasota, Florida or vicinity and the doctors look at me as though I don't know what I'm talking about. And I'm not a doctor. Can anyone help??? Thanks. Phyllis


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## Guest (Dec 18, 2000)

I was told by a holistic person that I had "parasites (sp.)" - is that different from bacteria? I didn't take his "test" or medicines.


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## partypooper (Mar 22, 2000)

I wonder if any "natural" antibiotics might help. For instance, I have heard that garlic has antibiotic, antifungal, and antiviral principles. However, it has to be the real thing - not supplements. Anyone ever tried this with success? Or anything else that is a natural substance?


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## Blair (Dec 15, 1998)

I had a D-Xylose test done to detect bateria overgrowth in the small intestine. D-Xylose is a sugar not absorbed by people but bacteria can change it. the test involes drinking D-Xylose ( a sugar ) and then collecting urine for the next 5 hours. The more D-Xylose collected the less bacteria have acted on it. I suppose this test is not specific to what the breath test does as it's not timed the same way.


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## Blair (Dec 15, 1998)

Maybe this is why low carb works? see SCD diet by Elaine Gottschalk. I'd be dead if I didn't modify my diet radicaly to eliminate wheat and cut down on starchy foods; although I'd probably also be dead if I followed the SCD diet to the letter.


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## echris (Jul 19, 2000)

Dennis: I believe that I had the hydrogen breath tests done when they were very new, as part of a workup to see if I was lactose intolerant. The complex sugar was used as the control (because no one can digest it). At the time, the doctor who performed the tests concluded that I was NOT lactose intolerant, although I had explosive diarrhea the evening of the day that I drank the lactose. Obviously, that many years ago (probably 20), they didn't know anything about the current research on bacterial growth in the small intestine.While I don't think I've been a fountain of information, this is all that I really have. echris (IBS - D, 24 years and counting)


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## Island girl (Jul 24, 2000)

Here are some natural antivirals & antibacterials that I've recently tried or ordered. After *much* research on the web, these seem to have been able to help many people when used on a rotation schedule. If you don't rotate their use, the bad bugs build up a resistance.Of course, study up on them if you plan on taking any! And always take a probiotic an hour or so after any of these on an empty stomach.Okay, here are the products(which I'm not endorsing, just putting out there):Maitake ExtractGrapefruit Seed ExtractPau D'Arco(very strong)Caprylic acidUndecylenic acid(reportedly 6 xs more effective than caprylic acid)Black WalnutI've been alternating Pau D'Arco and Maitake over the past 2 weeks. I've had much more active D in the am's, but realize this is my body ridding itself of the built-up toxins. Will try the others when they come in the mail....Garlic will not produce any discernible affects, but I've read it is very good for protecting the bloodstream from getting infected. Kyolic brand is the only product that has studies showing its effectiveness(other than real garlic).And if you haven't read "Breaking the Vicious Cycle-Intestinal Health Through Diet" by E. Gottschall, I highly recommend it. I believe though that the diet needs a bit of a push with antivirals.Happy Researching!IG


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## Guest (Dec 19, 2000)

And what is the only medication I am allergic too?Neomycin!







Ah well!Andy------------------ http://www.dustyspringfield.co.uk/


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