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Doc prescribed Xifaxin without testing for SIBO

Xifaxin Bloating Pain Constipation SIBO

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#1 Ouch34

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Posted 04 April 2016 - 01:18 PM

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Hello, I'm new to this website. I was diagnosed with IBS 12 years ago (age 20) and after that initial flare, have managed pretty well over the past 12 years. Nothing that didn't resolve itself in a matter of hours or a day at most. About 6-9 months ago I started having pain daily, sometimes so excruciating I'd be doubled over and have to stay home from work. Also lots of bloating and constipation. After several months of natural attempts to rid myself of the pain (peppermint tea, extra fiber and water, pepto, tums), i decided to go to the GI doc. As soon as I mentioned IBS she said that she doesn't want to do a colonoscopy right away, but wants to do all non invasive tests first. Blood test all good aside from low vitamin D which I'm told is normal for my age and gender. Stool sample came back negative. Then she prescribed Xifaxin 550mg for 21days, but without ever testing for SIBO. When I asked about it she said something about the test lasting 2 hours and how she'd rather just treat it. I had to call several times and the script took one month to fill. She was skeptical to give me pain meds but finally agreed to Librax which helps but now i have finished the Xifaxin and stopped the Librax and within one day all symptoms came back. I'm guessing that any help during the antibiotics was actually due to the Librax. I'm annoyed that there doesn't seem to be an answer. Is there a chance it's not IBS? I already take an SNRI and have been in therapy for a long time. The pain and bloating are daily and I'm at a loss! But what I really want to know is if anyone's doc has ordered Xifaxin without doing a SIBO test. Should I go to a different doc? I'm due for the two week post antibiotic follow up next week. Thanks in advance!

#2 Ouch34

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Posted 04 April 2016 - 01:21 PM

I should also add that after the initial rectal exam with this doc, two days later I had bright red blood on the stool. I called right away and she called back and dismissed it as anything to worry about. I haven't had bleeding since. Should I push for a colonoscopy?

#3 APR

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Posted 06 April 2016 - 03:00 AM

I wondered about the whole issue of SIBO testing, since neither gastro doctor I've been to showed any interest in testing for SIBO.

 

I thought that Xifraxan was explictly approved for treatment of IBS-D.  On the other hand, [correct me if I'm wrong] I thought I read an article indicating that there was some evidence that Xifraxan can also be effective in treating IBS-C.  So, should people with IBS-C consider asking their doctors for a course of Xifraxan, if they haven't gotten enough relief from diet changes or other treatments?

 

I find all of this a bit confusing.  Xifraxan could be effective for IBS-C, even though it's not approved for that form of IBS.  What is the reason that Xifraxan is only approved for IBS-D?  Of course, it is fairly common for doctors to engage in off label prescribing (e.g., prescribing a medication for something other than what it was explicitly approved by the FDA for).

 

This reminds me of how Amitiza is approved for women with IBS-C, but not men with IBS-C, but doctors will prescribe it to men with IBS-C.  In that case, the reason it was only approved for women with IBS was because the research study demonstrating its efficacy did not include enough men to make a conclusive judgment of its efficacy in men--from what I understand, the reason for including much fewer men than women in the study was because more women suffer from IBS than men, not because of any indication that Amitiza would be less effective in men.  BTW, that seems like a ridiculous reason to include so few men, as IBS isn't exactly a rarity in men; the statistic I saw was that approximately twice as many women suffer from IBS as men.  That is a major gender difference, but it's not like breast cancer where 90+% of breast cancer patients are women.







Also tagged with one or more of these keywords: Xifaxin, Bloating, Pain, Constipation, SIBO


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