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neomycin/bacterial overgrowth continued/part 2


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#1 Pete

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Posted 24 February 2001 - 12:24 AM

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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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#2 Pookie's Mom

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Posted 24 February 2001 - 12:34 AM

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

#3 flux

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Posted 24 February 2001 - 01:44 AM

quote:
I know this is a confusing issue when there are people who are posting bad information(ie, Island Girl)
I wholeheartedly agree.
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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.
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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.
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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?
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He also said in theory that probiotics can make the matter worse.
Ditto.
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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?
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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).]
I am not a doctor, but utilize sources of information not readily available to the public. Some of this information may contradict what you think you know and some of it may sound harsh, but the information is what it is, and you got it here for free. I am just a messenger. Always consult a real doctor.

#4 Guest_shellygrl_26_*

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Posted 24 February 2001 - 03:06 AM

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!!!!!!!!!!!!!!!!

#5 badfoot

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Posted 24 February 2001 - 04:56 AM

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.

#6 Guest_QueenBee_*

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Posted 24 February 2001 - 04:59 AM

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!

#7 Ugh

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Posted 24 February 2001 - 05:05 AM

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

#8 Pete

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Posted 24 February 2001 - 01:14 PM

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

#9 KateyKat

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Posted 24 February 2001 - 01:24 PM

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

#10 Pete

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Posted 24 February 2001 - 01:48 PM

Kkat,I agree but its a start.

#11 flux

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Posted 24 February 2001 - 04:18 PM

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.
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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
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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.
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believe it was unable to access phase III.
2 hours is too short a study. Should have been at least 6 hours.
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This test is absolutely torture.
Really? Were they using the clunky water-perfused tubes? I don't trust that method anyway.
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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.
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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).]
I am not a doctor, but utilize sources of information not readily available to the public. Some of this information may contradict what you think you know and some of it may sound harsh, but the information is what it is, and you got it here for free. I am just a messenger. Always consult a real doctor.

#12 Pete

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Posted 24 February 2001 - 10:28 PM

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?

#13 Pete

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Posted 24 February 2001 - 10:30 PM

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

#14 Pete

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Posted 24 February 2001 - 10:32 PM

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?

#15 KateyKat

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Posted 24 February 2001 - 10:32 PM

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

#16 flux

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Posted 24 February 2001 - 11:58 PM

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.
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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.
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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.
I am not a doctor, but utilize sources of information not readily available to the public. Some of this information may contradict what you think you know and some of it may sound harsh, but the information is what it is, and you got it here for free. I am just a messenger. Always consult a real doctor.

#17 Ugh

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Posted 25 February 2001 - 12:09 AM

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.

#18 KateyKat

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Posted 25 February 2001 - 10:37 PM

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

#19 Ugh

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Posted 26 February 2001 - 12:44 AM

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?

#20 Pete

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Posted 26 February 2001 - 12:55 AM

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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