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Discussion Starter · #1 ·
I talked to my Dr friday about the breath test. She said it is all a gimmick for the ones with the machine to get rich. She does not do them BUT she would give me a round of antibiotics to try if I really thought this is what is wrong with me. I told her I was on 10 days of antibiotics several times and also on Z-pac too for sinus infections ,etc. SHe siad if I had what they were testing for that the antibiotics I was on would of gotten rid of it. She asked if the antibiotics make my D better or worse. I told her worse. She said yes it does most people.Does this sound right to you guys? Makes sense to me. I think.Oh well have a good dayKat
 

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It's a breath test that's used to diagnose S.I.B.O. (small intestinal bacterial overgrowth).I don't know exactly how many of us IBSers they say are suffering from SIBO (someone else would definitely be better suited answering this question).. but it's worth getting checked out if you want the test done.Read about it down in the SIBO forums.
 

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No It doesnt sound right to me,although i'm not claiming to be an expert.Dr Pimentels theory is very convincing and I'm sure the breath tests are not a gimmick.You should have the tests before having random antibiotics,because you need to follow up with erythromycin or zelnorm to keep the bacteria out of the small intestine.Is your doctor a specialist?it sounds as if she doesnt know much about this and doesnt want to admit it!Sorry but I have met a lot of doctors like that!Gilly
 

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Discussion Starter · #6 ·
Yes Grant SIBO. I should of put that in there. THANKS.Gilly, yes she is a GI specialists. I never did talk to my last Dr about the breath tests. BUT to me it makes sense. If you take 10 days of antibiotics for something else would it not get rid of this bacteria too? Zelnorm, that is for IBS-C. Not IBS-D. Did not know it was for bacteria just thought it was to make things move better and help with C.I might check in to things moreThanks
 

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I'm pretty sure you use the antibiotics recommended by Pimental because certain antibiotics are used for certain bacteria.I was taking doxycycline for a year (acne) and it's (from what I remember)often used to treat someone who has been exposed to anthrax... If that's what it was (can't remember), I wasn't too thrilled about becoming "used" to it, when all that stuff after 9/11 was happening.Not all antibiotics work for all bacteria. There's got to be some reason he recommends specific antibiotics. Someone like Kathleen or Flux would probably answer that question with a lot of science behind it, and not just a "word of mouth" response.
 

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According to pimentels book rifamixin(xifaxan) is the best antibiotic for d., neomycin for c..They are not absorbed from the gut so are more effective.Others can work but are not as effective.Zelnorm(although for IBS C. usually ) is thought by Pimentel in a very low dose to encourage the "cleansing waves" in the small intestine and so may stop the SIBO coming back.The book also has a diet to follow(low carbs,some sugars etc.)Gilly
 

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It's simple microbiology. You put one type of bug in a petri dish, you try different types of antibiotics, you see what kills it--and what *doesn't.* It's the same reason antibiotics are given for anything--particular antibiotics for particular types of bugs. For c-diff, for instance, [*not* one of the bugs implicated in SIBO but something you can get in the *colon* if *other* antibiotics kill off your normal colonic flora--which situation can, btw, make diarrhea worse; if you spike fevers at night too it's usually c-diff] *only* flagyl/metronidazole and vancomycin work. Vanco works here *because* it's not well-absorbed from the colon; it stays there.So an added plus is that certain antibiotics do stay in the gut, and rifaximin is another one.Pimentel could not *afford* to publish in the gastro *journals* he does [ya can say anything in a book] if he had not checked to see which types of bugs were popping up and which antibiotics would be ineffective. My GI doc is an older, conservative guy, and *he* likes the breath test and standard antibiotics. But it *is* new enough that OSU, a teaching hospital, doesn't give it. And my PCP, whom they *brought* here to teach diagnostics, is all about the test. Let me just say that in personal experience a lot of things that are new are pooh-poohed. I can tell you from personal experience that a lot of things in med school are taught by memorization/check the box/match the numbers. The people who like to do that and don't like to *think* instead, who don't like change, and who aren't all about continuing education, are often the ones doing the pooh-poohing. There's an excellent article just now on the SIBO site. And it also mentions the cleansing wave, and studies that show many IBSers have distorted or altered cleansing waves. [Meaning to look up that reference and see how they measured that...] Gilly's right, that is what the zelnorm is for: to keep the bugs from moving back 'north' once the drugs stomp 'em out of the small intestine. Article has a great description of the wave, too.
 

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One of the problems is that not all the bacteria that live in the intestines are all that easy to grow in a petri dish to test (some do not like oxygen at all so require special handling that is done in very few labs around the country). We have only really cultured a very small percentage of what lives in there in the lab so I don't know how much information you would get from the small percentage of the stuff in there we can actually culture.My sense is he chose antibiotics that are not well absorbed into the body to try to focus the bacterial killing to inside the gut. Rather than kill everything, everywhere. The antibiotics he use are in the papers he published in journals not just the book even if you can't really grow everything that lives in there to test the antibiotics against in the lab. The breath test results alone can demonstrate if you did anything in the actual human being, which usually trumps what happens in a dish in the lab any day.Neomycin is IIRC pretty broad specturm, which is why it is in a lot of the antibacterial creams for wound healing. It kills a fair range of stuff. I know the other one gets some specific bacteria, and I don't know how broad of a spectrum it is, but it does do the say in the intestines thing which again is why I think it was chosen.There are some legitimate issues with some of his work in the journals, but there is with just about anything anyone publishes.
 

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quote:pimentel could not *afford* to publish in the gastro *journals* he does [ya can say anything in a book] if he had not checked to see which types of bugs were popping up
Actually, he didn't.
quote:and studies that show many IBSers have distorted or altered cleansing waves. [Meaning to look up that reference and see how they measured that...]
Actually, Pimental showed that, but for whatever odd reason, it wasn't measured the same way in the controls and patients. In other studies, many healthy people have "distorted" or "altered" cleaning waves, so it's not clear if has any real significance to IBS.
 

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I seriously believe a person should be tested for sibo before they take antibiotics.FYIIs there a relationship between IBS and small intestinal bacterial overgrowth?"Although the theory that SIBO causes IBS is tantalizing and there is much anecdotal information that supports it, the rigorous scientific studies that are necessary to prove or disprove the theory have just begun. Nevertheless, many physicians have already begun to treat patients with IBS for SIBO. In addition, a lack of rigorous scientific studies demonstrating benefit from antibiotics and probiotics has not stopped physicians from using them for treating patients.""Although it has been hypothesized that IBS may be caused by intestinal bacteria, specifically by small intestinal bacterial overgrowth, there is little rigorous scientific support for the hypothesis. "http://www.medicinenet.com/irritable_bowel...drome/page7.htm"The most popular theory is that patients with irritable bowel syndrome have a subtle abnormality in the function of their intestinal muscles that allows SIBO to occur." http://www.medicinenet.com/small_intestina...rowth/page5.htm
 

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I did the test, but the results were borderline, and my GI was not convinced that I had SIBO. The only way to decide would be to re-test, but I have not taken that offer up. He also said that I could take augmentin, but that's a lottery, as far as I'm concerned. I might get improvement, but maybe it would aggravate my symptoms.
 

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I didn't mean to imply that there had been a lot of culturing/petri dish testing of intestinal bacteria; I meant to imply that it's the same *principle.* For instance, certain things work on gram-positive bacteria, other things on gram-negative, other things on other criteria...And while they may not know *specifics* as to *which* bacterium, they do have general gists on 'these types live here' so have some idea what would and wouldn't work.Plus, as Kathleen says, again the advantage of the gut-limited antibiotic not killing everything, everywhere. That's interesting about the motility thing. [that was from a different article] Now I'm curious. D'you have a reference, Flux? Would like to go read it...I consider the Zelnorm more of a shot in the dark--to move stuff out of the small bowel and keep it out, till the 'normal' stuff is established--than the antibiotics. Thanks for updating me, you guys! Much appreciated.
 

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quote:Actually, Pimental showed that, but for whatever odd reason, it wasn't measured the same way in the controls and patients. In other studies, many healthy people have "distorted" or "altered" cleaning waves, so it's not clear if has any real significance to IBS.
Flux, thanks for the abstract! But I don't see the second part here--that it wasn't measured *the same way* in controls vs. patients. Is that somewhere else in the article, or in another one? It looks to me like they used the same method on everyone, from the abstract.And yeah, you're right about the 'different' waves in normals. Does call it into question.Thanks for keeping me honest! :) Seriously.
 

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quote:But I don't see the second part here--that it wasn't measured *the same way*
You’re right that the abstract is not clear on it (and I think it should have been). The methods section explains it. I think the controls were done as part of the actual study and they use electronic manometry. The IBS data was actually extracted from retrospective data using water-perfused manometry.
 
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