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Discussion Starter · #1 ·
Well what the studies say is that IBS is SIBO related in 65-80% of the cases. If you are reluctant to take antibiotics try lactuloseThe paper "Culture-proven small intestinal bacterial overgrowth as a cause of irritable bowel syndrome: response to lactulose but not broadspectrum antibiotics." reports the case of someone who had all the normal tests negative except the culture. I don't think they did the lactulose test on him. However this is a novel treatment of this person with lactulose.20 g of lactulose b.d for four weeks. Apparently the culture normalized in one case. The theory is that lactulose is metabolized to short chain fatty acids and this acidifies the lumen and discourages the growth of bacteria. They call it "targeted" antibacterial therapy. Just FYI.If your doc wants the dettails they can be found in the article belowJ Gastroenterol. 2005 Jul;40(7):767-8. Related Articles, Links Culture-proven small intestinal bacterial overgrowth as a cause of irritable bowel syndrome: response to lactulose but not broadspectrum antibiotics.Kurtovic J, Segal I, Riordan SM.Gastrointestinal and Liver Unit, The Prince of Wales Hospital, Barker Street, Randwick, 2031, New South Wales, Australia.PMID: 16082596 [PubMed - in process]
 

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I have been extremely unconfortable with Lactulose by the end of the day of my test.I only specululate that my test are positive but i can't imagine 4 weeks on it.Glucose give bloat but Lactulose give twice the bloat.Weird enough,at first i felt fine but when Lactulose reach the lower bowel,it get stuck.NO LAXATIVE action from Lactulose from my bowel view.Flux,i think it help the motility of the upper tract but it slows down the colon.
 

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Discussion Starter · #3 ·
I know lactulose causes a lot of gas in people. That would be a disadvantage but if one has never tried lactulose it might be worth a shot. BTW it takes four weeks of lactulose to normailize the culture and then you have to keep taking lactulose for maintenance.
 

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I don't know but look like BO is the new white horse for the naturopath.
 

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"Well what the studies say is that IBS is SIBO related in 65-80% of the cases."How many studies say that?What does SIBO related mean, in regards to IBS?
 

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Bonniei, I was going through my email and found this from Dr Drossman.This is what I asked, and this was a little while back, not recently per se.from me"Hi Dr Drossman, I know your super busy at the moment, well all the time. > But I have one really quick very important question.> > There is a debate still on SIBO and IBS going on. I personally somehow > feel Dr Pimentel, doesn't seem to be looking at or mentioning the bigger > IBS picture, just my personal opion though.> > Can SIBO cause ALL the symptoms IBS can? I feel personally it may not, but someone > reading DR Pimentel's work said they think it can. Can you help clarify this > briefly for me if you have a second.> > Thanks, looking forward to Rome 3 and hope your doing well."From Dr Drossman"Dear Shawn, I do feel that the issue of bacterial overgrowth is an important considerations in IBS, and these authors have gone a long way to advance this area of investigation and raise awareness of bacterial overgrowth as a possible player in IBS. It kind of relates to other work being done in the area of post-infectious IBS and altered mucosal immunity in subsets of IBS. However, there is some disagreement within the community with regard to the prevalence in patients with IBS, these authors claiming up to 80% and others finding far less by standard methods. Another issue of concern is that explaining bacterial overgrowth as the cause of so many other aspects of the condition is going beyond the available scientific data. Their work should be considered more in the way of opinion/speculation, rather than accepted dogma within the medical community, and further confirmation is needed. You should keep in mind that all scientists will from time to time try to extend their data into understanding other aspects of a condition, but the checks and balances within medicine lead to common acceptance when there is confirmation from other groups and more conclusive evidence. That has not happenned as of yet but remains an area of interest in the field.Doug"
 

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Discussion Starter · #11 ·
eric,
quote:eek:riginally posted by ericThe brain gut axis incorporates all abnormalities and influneces
It does not explain the nearly universal symptom of postprandial bloating(especially distension), the physical evidence of increased intestinal gas that is localized to the small intestine, the effect of probiotics on bloating, This is from the "SIBO: A framework for understanding IBS"paper. What is your reply to this? You answer this and then I will answer your questions.
 

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The Brain gut axis is how everyone's bodies physically work!!! The brain gut axis is not a theory!!!The "especially distension" your talking about might have to do with abdominal muscle wall tone, there is research on that for one. However there is an increase in serotonin after eating that may cause postprandial symptoms. Second"Neurotransmitter ImbalanceNinety-five percent of serotonin is in the GI tract, within enterochromaffin cells, neurons, mast cells, and smooth muscle cells. When released by enterochromaffin cells, serotonin stimulates extrinsic vagal afferent nerve fibers and intrinsic enteric afferent nerve fibers, resulting in such physiologic responses as intestinal secretion and the peristaltic reflex and in such symptoms as nausea, vomiting, abdominal pain, and bloating.15 Preliminary evidence suggests that patients with IBS have increased serotonin levels in plasma and in the rectosigmoid colon.16,17 Other neurotransmitters that may play a role in IBS include calcitonin gene-related peptide, nitric oxide, and vasoactive intestinal peptide"http://www.clevelandclinicmeded.com/diseas...tro/ibs/ibs.htmFYIMedscapeExpert Commentary -- Bloating, Distension, and the Irritable Bowel SyndromeDefinition of Bloating and DistensionThe Epidemiology of BloatingThe Relationship Between Bloating and DistensionThe Pathophysiology of BloatingHow to Manage Patients With BloatingConclusionhttp://www.medscape.com/viewarticle/483079Visceral Sensations and Brain-Gut MechanismsBy: Emeran A. Mayer, M.D., Professor of Medicine, Physiology and Psychiatry; Director, Center for Neurovisceral Sciences & Women's Health, David Geffen School of Medicine at UCLA"The most common symptoms of IBS patients are related to altered perception of sensations arising from the GI tract, and frequently from sites outside the GI tract, such as the genitourinary system or the musculoskeletal system. Sensations of bloating, fullness, gas, incomplete rectal evacuation and crampy abdominal pain are the most common symptoms patients experience. Numerous reports have demonstrated that a significant percentage of FBD patients (about 60%) rate experimental distensions of the colon as uncomfortable at lower distension volumes or pressures when compared to healthy control subjects. This finding of an increased perception of visceral signals ("visceral hypersensitivity") has been demonstrated during balloon distension tests of the respective part of the GI tract regardless of where their primary symptoms are â€" the esophagus, the stomach, or the lower abdomen. In contrast to the current emphasis on mechanisms that may result in sensitization of visceral afferent pathways in the gut, it may well be that alterations in the way the nervous system normally suppresses the perception of the great majority of sensory activity arising from our viscera are essential for the typical symptom constellation of IBS and other functional GI disorders to develop.""However, in patients with FBD, this inhibitory mechanism appears to be compromised. For example, people with IBS commonly experience a persistent sensation of excessive gas, even though carefully designed studies have failed to demonstrate alterations in the gas content of the bowel which correlate with symptoms of bloating. A sensation of incomplete evacuation will make a person try to go to the bathroom many times during the day, even though the rectum is virtually empty. Persons with functional heartburn experience a burning sensation in the esophagus, without abnormal amounts of refluxed acid, and persons with dyspepsia will experience a constant sensation of gastric fullness even though their stomachs are nearly empty. "http://www.aboutibs.org/Publications/VisceralSensations.html
 

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This is the model your confusing with the physical working in every human. The brain gut axis.
Which incorporates genetics, psychosocial factors, physiology, all which contribute to and influence IBS.
 

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This is probably a stupid question, but where do you get lactulose? And if someone was to try this treatment, how much per day do you need to take, and how often?Is there any way you can post the actual study, or email it?
 

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Discussion Starter · #16 ·
The dose is 20 g b.d. for fourweeks and if it works got to take it for the rest of your life. If you give me your e-mail I can send it to you. I purchased it so I can give it to you on the condition that you don't post the article on the web. If you want to post portions of it, please paraphrase it. A doc will have to prescribe it.
 

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"Brain-gut does NOT explain it!!!!" Are you 100 percent proof positive sure about that? Or is it just your opinion?"The Pathophysiology of BloatingGas-Related MechanismsPatients and some physicians believe that excessive quantities of intestinal gas are the reason for bloating and/or distension. However, studies attempting to measure gas volumes have not consistently supported this theory. One such study, by Lasser and colleagues,[26] using a gas washout technique, found no differences in gas volumes between patients with bloating and their volunteer counterparts; several more recent studies using labeled sulfurhexafluoride have supported this finding.[27] Using CT scanning to estimate gas volumes, Maxton and colleagues[21] also found no definitive evidence of excess gas in IBS patients, despite demonstrating increased lateral abdominal profiles in these patients. In contrast, Koide and coworkers[28] used plain abdominal radiographs to show that gas volumes were greater in patients with IBS compared with controls. In another study, King and colleagues[29] found that although patients with IBS produced more hydrogen, total gas production was not significantly increased. Thus, the balance of evidence is against excessive gas being the sole cause of abdominal distension.An alternative approach to determining whether bloating/distension is related to excessive amounts of intestinal gas is to assess whether attempting to modify gas volumes alters the severity of these complaints. One such study administered lactulose, a fermentable fiber (psyllium), and a nonfermentable fiber (methylcellulose) to healthy volunteers. Although lactulose ingestion resulted in an increase in flatus, all 3 materials resulted in an increase in bloating. Gas production as measured by breath hydrogen concentrations only increased following lactulose. This interesting study suggests that whereas gaseous symptoms (ie, passage of flatus) are probably related to an increase in gas production, bloating may not be.[30] Another approach to altering gas production is the modification of colonic flora. Two studies found that treatment with antibiotics improved gastrointestinal symptoms other than bloating in patients with IBS thought to have bacterial overgrowth,[31,32] and another reported similar results in patients with functional gastrointestinal disorders without bacterial overgrowth.[33] Other studies using probiotics have also failed to demonstrate any improvement in bloating, although one study did report an improvement in flatus production.[34,35] Taken together, these studies also suggest that excessive quantities of intestinal gas may be associated with gas-related complaints (flatus volume and frequency), although not necessarily be related to the symptom of bloating.Accumulating evidence from the Barcelona group, headed by Professors Azpiroz and Malegalada, has suggestedthat while gas volumes may be normal in bloated patients, intestinal gas handling is abnormal.""Following a study validating their "gas challenge" technique (the gas challenge test involves infusing gas at 12 mL/min into the subject's jejunum, while recording symptoms, abdominal girth, and gas volumes) in healthy volunteers,[36] Serra and colleagues[27] found that during jejunal gas infusion, 18 of 20 IBS patients retained gas, had distention, or developed abdominal symptoms, whereas 16 of 20 healthy volunteers failed to do so. These changes could be augmented by enteral infusion of lipid, providing one possible rationale as to why bloating frequently worsens in the postprandial period.[37"http://www.medscape.com/viewarticle/483079_4Sensation of bloating and visible abdominal distension in patients with irritable bowel syndrome." CONCLUSIONS: Bloating and visible abdominal distension may arise from two distinct but interrelated physiological processes. Although the sensation of bloating may be related to enhanced sensitivity to visceral afferent stimulation, abdominal distension in more severely affected patients may be related to triggering of a visceromotor reflex affecting the tone of abdominal wall muscles."http://www.ncbi.nlm.nih.gov/entrez/query.f...947&query_hl=11A good percentage of IBSers find that bloating and distension worsen as the day progresses also and"including progressive worsening of symptoms during the day, and relief by passing stool or gas. Both bloating and distension worsened when other abdominal symptoms worsened. Abdominal distension was associated with greater symptom severity and less diurnal variation in symptoms, and was less often perceived as associated with food intake."The brain gut axis could explain abdominal bloating and distension.
 

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Discussion Starter · #18 ·
quote:The brain gut axis could explain abdominal bloating and distension.
Is that your opinion? I am going by Pimentel's opinion and all that I have read on it.Where does it say so?. tell me in three sentences or less. I am not going to read totally irrelevant hundred pages. And yes I am familiar with the Barcelona group's work. I correspond with them. By the way Koide et al's studies which have been replicated have shown excessive gas in the small intestine.
 

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alter serotonin dysregulation can lead to altered motility and hence alter intestinal gas transportation and hence cause bloating and distension as well as sensations of these sysmptoms that are then processed in the brain via the neurotransmitter serotonin.However other problems and conditions can cause bloating and distension.You should also read thisApproach to the IBS Patient With Significant Persistent Abdominal Distension?http://216.109.125.130/search/cache?p=abdo...&icp=1&.intl=usThe brain gut axis is involved in bloating and distension with "anxiety-associated aerophagia" for example. And yes I already know SIBO can cause this so you know, I know.But you are also only looking at abdmonial bloating and distension and there is much much more to IBS then those symptoms.But what I really want to know is how many studies have shown this and from how many different groups."Well what the studies say is that IBS is SIBO related in 65-80% of the cases."What does "related" mean, the cause or a consequence?
 

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"ConclusionBloating and distension may occasionally occur in apparently healthy individuals, but are much more common in patients with functional gastrointestinal disorders. Although it has been suggested that the term "bloating" should be used to describe how the patient feels, whereas the term "distension" is reserved for an actual increase in girth, it is important to appreciate that the 2 phenomena may not be precisely the same. Despite the prevalence of these symptoms, the pathophysiology is only just beginning to be discerned and is likely to be much more complex than attributable to just the accumulation of excessive quantities of gas. Until the underlying mechanisms are better understood, treatment will remain challenging; however, modification of diet, use of antidepressants, psychological therapies, or tegaserod may lead to improvement."http://www.medscape.com/viewarticle/483079_printWhy is zelnorm used to help SIBO as a treatment? A drug for IBS and serotonin dysregulation in the brain gut axis?Why does HT help bloating and distension.How many normal people have bloating and distension?
 
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