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Researchers at Cedars-Sinai Medical Center in Los Angeles think they may have identified the cause of this mysterious and very common condition, and found an effective way to treat it. The Cedars-Sinai researchers found that 78% of the IBS patients they tested had what they called small intestinal bacterial overgrowth (SIBO), a condition in which excessive amounts of bacteria are present in the small intestine.The researchers treated the patients who tested positive for SIBO with a 10-day course of antibiotics. Tests at the end of that time found that 25 of 47 patients had no bacterial overgrowth present, and that 12 of them had no IBS symptoms, while the symptoms were "significantly reduced" in the other 13. The symptoms were also reduced in the patients in which some SIBO was still detected, suggesting that if treatment had been continued until it was completely eliminated, perhaps with an alternative antibiotic, better results would have been obtained.
 

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Hi Paul, this is from July 2003 re: SIBO~"The bacterial species in the small intestine in SIBO closely resemble the 300�400 species normally found in the colon. Although anatomic abnormalities and severe intestinal dysmotility are often considered to be requisite for the development of SIBO, recent discoveries linking SIBO to patients with irritable bowel syndrome suggest otherwise(3)." *(3) is a 2003 study publ'd in the Am J Gastroenterology http://www.healthsystem.virginia.edu/inter...idelArticle.pdf
 

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Hi Paul, this is from July 2003 re: SIBO~"The bacterial species in the small intestine in SIBO closely resemble the 300�400 species normally found in the colon. Although anatomic abnormalities and severe intestinal dysmotility are often considered to be requisite for the development of SIBO, recent discoveries linking SIBO to patients with irritable bowel syndrome suggest otherwise(3)." *(3) is a 2003 study publ'd in the Am J Gastroenterology http://www.healthsystem.virginia.edu/inter...idelArticle.pdf
 

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paul: The study that you are mentioning is old news (2000), however there was a followup study done in (2003) that was better designed.Relevant Abstracts:Eradication of Small Intestinal Bacterial Overgrowth Reduces Symptoms of Irritable Bowel Syndrome (2000) http://www-east.elsevier.com/ajg/issues/9512/ajg3368fla.htm Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome: a double-blind, randomized, placebo-controlled study. (2003) http://www.ncbi.nlm.nih.gov/entrez/query.f...2&dopt=Abstract A 14-day elemental diet is highly effective in normalizing the lactulose breath test. (2004)Pimentel M, Constantino T, Kong Y, Bajwa M, Rezaei A, Park S. http://www.ncbi.nlm.nih.gov/entrez/query.f...t_uids=14992438 Dr Mark Pimentel and his colleagues are the only researchers at this time that are studying SIBO extensively and its relationship to IBS. Other IBS researchers like Dr Douglas Drossman have blown off this breakthrough as nothing significant in the understanding of IBS. However Pimentel addressed the limitations of the first study that Drossman critiques, so they are moot now.
quote:GI Motility ResearchCedars-Sinai's GI Motility Program is conducting leading-edge research in several areas, including irritable bowel syndrome (IBS), small intestinal bacterial overgrowth (SIBO) and motility of the esophagus, stomach and small intestine, as well as studies of movements and controlling mechanisms of the small intestine.Dr. Mark Pimentel's research interests lie in the field of IBS as it relates to bacteria in the small intestine. Recent findings suggest a very high prevalence of SIBO (a condition in which there is an inappropriate quantity of bacteria in the small intestine). This relationship has resulted in further research demonstrating that the elimination of these bacteria results in the most dramatic improvement in IBS symptoms ever published. As such, the demand for breath testing to rule out SIBO has increased. Follow-up research on this topic has resulted in finding some of the moving problems of the intestine possibly responsible for this development of bacteria. Furthermore, treatments to prevent the recurrence of the bacteria and the IBS symptoms have been developed and have been found to be very effective.We are currently conducting clinical studies related to SIBO. We are recruiting subjects with IBS, normal subjects and controls. For more information on how to participate in these studies, please contact our research office at (310) 423-3792. http://www.cedars-sinai.edu/2645.html
It's important to realize that one major finding needs to be corroborated among other researchers and retested to separate other variables to refine our knowledge.In scientific research, it is important to follow these general rules:
  • Wherever possible there must be independent confirmation of the facts
  • Encourage substantive debate on the evidence by knowledgeable proponents of all points of view.
  • Arguments from authority carry little weight (in science there are no "authorities").
  • Spin more than one hypothesis - don't simply run with the first idea that caught your fancy.
  • Try not to get overly attached to a hypothesis just because it's yours.
  • Quantify, wherever possible.
  • If there is a chain of argument every link in the chain must work.
  • "Occam's razor" - if there are two hypothesis that explain the data equally well choose the simpler.
  • Ask whether the hypothesis can, at least in principle, be falsified (shown to be false by some unambiguous test). In other words, it is testable? Can others duplicate the experiment and get the same result?Additional issues are:
  • Conduct control experiments - especially "double blind" experiments where the person taking measurements is not aware of the test and control subjects.
  • Check for confounding factors - separate the variables.adapted from Carl Sagan's Baloney Detection Kit in the book Demon Haunted World
eric:
quote:ITs old now, and SIBO is not IBS.
Of course, SIBO isn't IBS, but it hasn't been ruled out as a cause of IBS. The cause of IBS is still not known.
quote:ButThis is a responce from the Rome, commitee chairman. http://www.med.unc.edu/wrkunits/2depts/med...rowthandibs.htm
This is old news. These objections were soundly refuted in the followup study.Limitation #2: The 2003 study was a placebo-controlled double-blinded study. Similar results were observed in the 2000 study.Limitation #3: The 2003 study followed up on almost all of the patients. If I remember correctly, there was only 2 patients that didn't not come back for follow up breath testing.Limitation #4: The study was well designed and used a single antibiotic (neomycin sulfate).
quote:IBS PublicationsAnother look at bacteria and IBSBy Douglas A. Drossman, M.D. http://www.aboutibs.org/Publications/bacteria.html
Same old news.Talissa: Thanks for the interesting article. Bookmarked.
skinny[edit] oops misspelled Tal's nickname. heh
 

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paul: The study that you are mentioning is old news (2000), however there was a followup study done in (2003) that was better designed.Relevant Abstracts:Eradication of Small Intestinal Bacterial Overgrowth Reduces Symptoms of Irritable Bowel Syndrome (2000) http://www-east.elsevier.com/ajg/issues/9512/ajg3368fla.htm Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome: a double-blind, randomized, placebo-controlled study. (2003) http://www.ncbi.nlm.nih.gov/entrez/query.f...2&dopt=Abstract A 14-day elemental diet is highly effective in normalizing the lactulose breath test. (2004)Pimentel M, Constantino T, Kong Y, Bajwa M, Rezaei A, Park S. http://www.ncbi.nlm.nih.gov/entrez/query.f...t_uids=14992438 Dr Mark Pimentel and his colleagues are the only researchers at this time that are studying SIBO extensively and its relationship to IBS. Other IBS researchers like Dr Douglas Drossman have blown off this breakthrough as nothing significant in the understanding of IBS. However Pimentel addressed the limitations of the first study that Drossman critiques, so they are moot now.
quote:GI Motility ResearchCedars-Sinai's GI Motility Program is conducting leading-edge research in several areas, including irritable bowel syndrome (IBS), small intestinal bacterial overgrowth (SIBO) and motility of the esophagus, stomach and small intestine, as well as studies of movements and controlling mechanisms of the small intestine.Dr. Mark Pimentel's research interests lie in the field of IBS as it relates to bacteria in the small intestine. Recent findings suggest a very high prevalence of SIBO (a condition in which there is an inappropriate quantity of bacteria in the small intestine). This relationship has resulted in further research demonstrating that the elimination of these bacteria results in the most dramatic improvement in IBS symptoms ever published. As such, the demand for breath testing to rule out SIBO has increased. Follow-up research on this topic has resulted in finding some of the moving problems of the intestine possibly responsible for this development of bacteria. Furthermore, treatments to prevent the recurrence of the bacteria and the IBS symptoms have been developed and have been found to be very effective.We are currently conducting clinical studies related to SIBO. We are recruiting subjects with IBS, normal subjects and controls. For more information on how to participate in these studies, please contact our research office at (310) 423-3792. http://www.cedars-sinai.edu/2645.html
It's important to realize that one major finding needs to be corroborated among other researchers and retested to separate other variables to refine our knowledge.In scientific research, it is important to follow these general rules:
  • Wherever possible there must be independent confirmation of the facts
  • Encourage substantive debate on the evidence by knowledgeable proponents of all points of view.
  • Arguments from authority carry little weight (in science there are no "authorities").
  • Spin more than one hypothesis - don't simply run with the first idea that caught your fancy.
  • Try not to get overly attached to a hypothesis just because it's yours.
  • Quantify, wherever possible.
  • If there is a chain of argument every link in the chain must work.
  • "Occam's razor" - if there are two hypothesis that explain the data equally well choose the simpler.
  • Ask whether the hypothesis can, at least in principle, be falsified (shown to be false by some unambiguous test). In other words, it is testable? Can others duplicate the experiment and get the same result?Additional issues are:
  • Conduct control experiments - especially "double blind" experiments where the person taking measurements is not aware of the test and control subjects.
  • Check for confounding factors - separate the variables.adapted from Carl Sagan's Baloney Detection Kit in the book Demon Haunted World
eric:
quote:ITs old now, and SIBO is not IBS.
Of course, SIBO isn't IBS, but it hasn't been ruled out as a cause of IBS. The cause of IBS is still not known.
quote:ButThis is a responce from the Rome, commitee chairman. http://www.med.unc.edu/wrkunits/2depts/med...rowthandibs.htm
This is old news. These objections were soundly refuted in the followup study.Limitation #2: The 2003 study was a placebo-controlled double-blinded study. Similar results were observed in the 2000 study.Limitation #3: The 2003 study followed up on almost all of the patients. If I remember correctly, there was only 2 patients that didn't not come back for follow up breath testing.Limitation #4: The study was well designed and used a single antibiotic (neomycin sulfate).
quote:IBS PublicationsAnother look at bacteria and IBSBy Douglas A. Drossman, M.D. http://www.aboutibs.org/Publications/bacteria.html
Same old news.Talissa: Thanks for the interesting article. Bookmarked.
skinny[edit] oops misspelled Tal's nickname. heh
 

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Skinny,This"This relationship has resulted in further research demonstrating that the elimination of these bacteria results in the most dramatic improvement in IBS symptoms ever published"Is this from the 2004 this study? Is this the most dramtic improvements ever published in IBS?"36.1% improvement in bowel symptoms"What is the cluster of symptoms to diagnose IBS?What are the symptoms to diagnose SIBO?
 

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Skinny,This"This relationship has resulted in further research demonstrating that the elimination of these bacteria results in the most dramatic improvement in IBS symptoms ever published"Is this from the 2004 this study? Is this the most dramtic improvements ever published in IBS?"36.1% improvement in bowel symptoms"What is the cluster of symptoms to diagnose IBS?What are the symptoms to diagnose SIBO?
 

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quote:"This relationship has resulted in further research demonstrating that the elimination of these bacteria results in the most dramatic improvement in IBS symptoms ever published"Is this from the 2004 this study? Is this the most dramtic improvements ever published in IBS?
The 2004 study is dramatic but dramatic would be a subjective word. The results of the study indicate that the improvement of symptoms in the number of subjects were pretty darn significant.
quote:"36.1% improvement in bowel symptoms"
Eric, what are you talking about? The 2004 abstract states: "On chart review, subjects who successfully normalized their breath test had a 66.4 � 36.1% improvement in bowel symptoms..." Do you know what this means?
quote:What is the cluster of symptoms to diagnose IBS?
Rome II Diagnostic Criteria(a system for diagnosing functional gastrointestinal disorders based on symptoms) for IBS is as follows:At least 12 weeks or more, which need not be consecutive, in the preceding 12 months of abdominal discomfort or pain that is accompanied by at least two of the following features:1) It is relieved with defecation, and/or2) Onset is associated with a change in frequency of stool, and/or3) Onset is associated with a change in form (appearance) of stool.Other symptoms that are not essential but support the diagnosis of IBS: * Abnormal stool frequency (greater than 3 bowel movements/day or less than 3 bowel movements/week); * Abnormal stool form (lumpy/hard or loose/watery stool); * Abnormal stool passage (straining, urgency, or feeling of incomplete evacuation); * Passage of mucus; * Bloating or feeling of abdominal distension.
quote:What are the symptoms to diagnose SIBO?
If you have IBS symptoms, you may have SIBO. It's best diagnosed with the lactulose breath test which is not the most foolproof, but it's the best we have at the moment.skinny
 

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quote:"This relationship has resulted in further research demonstrating that the elimination of these bacteria results in the most dramatic improvement in IBS symptoms ever published"Is this from the 2004 this study? Is this the most dramtic improvements ever published in IBS?
The 2004 study is dramatic but dramatic would be a subjective word. The results of the study indicate that the improvement of symptoms in the number of subjects were pretty darn significant.
quote:"36.1% improvement in bowel symptoms"
Eric, what are you talking about? The 2004 abstract states: "On chart review, subjects who successfully normalized their breath test had a 66.4 � 36.1% improvement in bowel symptoms..." Do you know what this means?
quote:What is the cluster of symptoms to diagnose IBS?
Rome II Diagnostic Criteria(a system for diagnosing functional gastrointestinal disorders based on symptoms) for IBS is as follows:At least 12 weeks or more, which need not be consecutive, in the preceding 12 months of abdominal discomfort or pain that is accompanied by at least two of the following features:1) It is relieved with defecation, and/or2) Onset is associated with a change in frequency of stool, and/or3) Onset is associated with a change in form (appearance) of stool.Other symptoms that are not essential but support the diagnosis of IBS: * Abnormal stool frequency (greater than 3 bowel movements/day or less than 3 bowel movements/week); * Abnormal stool form (lumpy/hard or loose/watery stool); * Abnormal stool passage (straining, urgency, or feeling of incomplete evacuation); * Passage of mucus; * Bloating or feeling of abdominal distension.
quote:What are the symptoms to diagnose SIBO?
If you have IBS symptoms, you may have SIBO. It's best diagnosed with the lactulose breath test which is not the most foolproof, but it's the best we have at the moment.skinny
 

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Skinny, I 'll come back to this and a few things. One it looks like they took IBS patients with SIBO once again. What bowel sysmptoms all of them?with regards to this,"This relationship has resulted in further research demonstrating that the elimination of these bacteria results in the most dramatic improvement in IBS symptoms ever published"Also what about this?Why Consider Hypnosis Treatment for IBS?"It is one of the most successful treatment approaches for chronic IBS. The response rate to treatment is 80% and better in most published studies to date. " http://www.ibshypnosis.com/whyhypnosis.html In more then one study?and "One concern over the use of hypnotherapy is the possibility that patients might relapse once a course of treatment has been completed. We have recently addressed this question with a study on the long-term follow up of patients attending the unit. This has shown that after a period of between one and five years, 83% of responders remained well with 59% requiring no further medication at all. Patients also took much less time off work and consulted the medical profession less often. ""Following the success in patients with IBS, we have recently looked at the use of hypnotherapy in functional dyspepsia, which is a closely related condition resulting in primarily upper gastrointestinal symptoms. Again, compared with controls, the hypnotherapy patients showed substantial improvements in both symptoms and quality of life. One of the most striking outcomes of this particular study was that, after a follow up of one year, not one patient in the hypnotherapy group required any further medication compared with 82% and 90% of subjects in the 2 control groups. Similar trends to those observed in the IBS studies were seen for a reduction in medical consultations and time off work. " http://www.aboutibs.org/Publications/hypnosis.html The on the2004 study, they already did this"Consecutive subjects with IBS and abnormal LBT suggesting the presence of bacterial overgrowth"Also, for how long did they remain well, months, years? Did they still nesd treatments?They still looked for sibo symptoms in there patients also, maybe people with IBS and SIBO?This also doesn't seem to be a controled study? But maybe I am missing it.
 

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Skinny, I 'll come back to this and a few things. One it looks like they took IBS patients with SIBO once again. What bowel sysmptoms all of them?with regards to this,"This relationship has resulted in further research demonstrating that the elimination of these bacteria results in the most dramatic improvement in IBS symptoms ever published"Also what about this?Why Consider Hypnosis Treatment for IBS?"It is one of the most successful treatment approaches for chronic IBS. The response rate to treatment is 80% and better in most published studies to date. " http://www.ibshypnosis.com/whyhypnosis.html In more then one study?and "One concern over the use of hypnotherapy is the possibility that patients might relapse once a course of treatment has been completed. We have recently addressed this question with a study on the long-term follow up of patients attending the unit. This has shown that after a period of between one and five years, 83% of responders remained well with 59% requiring no further medication at all. Patients also took much less time off work and consulted the medical profession less often. ""Following the success in patients with IBS, we have recently looked at the use of hypnotherapy in functional dyspepsia, which is a closely related condition resulting in primarily upper gastrointestinal symptoms. Again, compared with controls, the hypnotherapy patients showed substantial improvements in both symptoms and quality of life. One of the most striking outcomes of this particular study was that, after a follow up of one year, not one patient in the hypnotherapy group required any further medication compared with 82% and 90% of subjects in the 2 control groups. Similar trends to those observed in the IBS studies were seen for a reduction in medical consultations and time off work. " http://www.aboutibs.org/Publications/hypnosis.html The on the2004 study, they already did this"Consecutive subjects with IBS and abnormal LBT suggesting the presence of bacterial overgrowth"Also, for how long did they remain well, months, years? Did they still nesd treatments?They still looked for sibo symptoms in there patients also, maybe people with IBS and SIBO?This also doesn't seem to be a controled study? But maybe I am missing it.
 

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Not to mention"The problem is that most IBS treatment research has not examined how non-IBS symptoms change. Non-IBS symptoms have also not been a focus of standard IBS treatment.An exception to this is psychological treatment trials for IBS, which sometimes have included general physical symptom questionnaires among the measures of treatment effects. We therefore know from our two studies of hypnosis treatment for IBS(22) as well as from research in England(23) that hypnosis treatment for IBS regularly improves non-GI symptoms substantially in addition to beneficial effects on bowel symptoms." http://www.med.unc.edu/medicine/fgidc/beyond_the_bowel.htm
 

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Not to mention"The problem is that most IBS treatment research has not examined how non-IBS symptoms change. Non-IBS symptoms have also not been a focus of standard IBS treatment.An exception to this is psychological treatment trials for IBS, which sometimes have included general physical symptom questionnaires among the measures of treatment effects. We therefore know from our two studies of hypnosis treatment for IBS(22) as well as from research in England(23) that hypnosis treatment for IBS regularly improves non-GI symptoms substantially in addition to beneficial effects on bowel symptoms." http://www.med.unc.edu/medicine/fgidc/beyond_the_bowel.htm
 

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skinny, I will post some more on all this, but this study from 2004 from Pimentel, says A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing.Pimentel M, Wallace D, Hallegua D, Chow E, Kong Y, Park S, Lin HC.GI Motility Program, Divisions of Gastroenterology and Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, CSMC Burns & Allen Research Institute, Los Angeles, California 90048, USA."CONCLUSIONS: An abnormal lactulose breath test is more common in fibromyalgia than IBS. In contrast with IBS, the degree of abnormality on breath test is greater in subjects with fibromyalgia and correlates with somatic pain."This oneDig Dis Sci. 2002 Dec;47(12):2639-43. Related Articles, Links Lower frequency of MMC is found in IBS subjects with abnormal lactulose breath test, suggesting bacterial overgrowth."We have recently described an association between irritable bowel syndrome (IBS) and abnormal lactulose breath test, suggesting small intestinal bacterial overgrowth (SIBO). However, the mechanism by which SIBO develops in IBS is unknown."an association, wording is important.Develops in IBS, suggest I take it to mean, that they maybe looking at sibo and IBS patients, if you had both and treated the sibo, your IBS might improve,, that would seem logical at least to me.On the aboutibs website from the iffgd, they have this also."Small bowel bacterial overgrowthToo many bacteria in the upper part of the small intestine may lead to symptoms of bloating, pain, and diarrhea. Symptoms occur immediately after eating because the bacteria in the intestine begin to consume the food in the small intestine before it can be absorbed. Small bowel bacterial overgrowth is a result of abnormal motility in the small intestine. "
 

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skinny, I will post some more on all this, but this study from 2004 from Pimentel, says A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing.Pimentel M, Wallace D, Hallegua D, Chow E, Kong Y, Park S, Lin HC.GI Motility Program, Divisions of Gastroenterology and Rheumatology, Department of Medicine, Cedars-Sinai Medical Center, CSMC Burns & Allen Research Institute, Los Angeles, California 90048, USA."CONCLUSIONS: An abnormal lactulose breath test is more common in fibromyalgia than IBS. In contrast with IBS, the degree of abnormality on breath test is greater in subjects with fibromyalgia and correlates with somatic pain."This oneDig Dis Sci. 2002 Dec;47(12):2639-43. Related Articles, Links Lower frequency of MMC is found in IBS subjects with abnormal lactulose breath test, suggesting bacterial overgrowth."We have recently described an association between irritable bowel syndrome (IBS) and abnormal lactulose breath test, suggesting small intestinal bacterial overgrowth (SIBO). However, the mechanism by which SIBO develops in IBS is unknown."an association, wording is important.Develops in IBS, suggest I take it to mean, that they maybe looking at sibo and IBS patients, if you had both and treated the sibo, your IBS might improve,, that would seem logical at least to me.On the aboutibs website from the iffgd, they have this also."Small bowel bacterial overgrowthToo many bacteria in the upper part of the small intestine may lead to symptoms of bloating, pain, and diarrhea. Symptoms occur immediately after eating because the bacteria in the intestine begin to consume the food in the small intestine before it can be absorbed. Small bowel bacterial overgrowth is a result of abnormal motility in the small intestine. "
 

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also, I have not read this yet, and if you don't receive it I highly recommend getting it. Its extremely up to date and has a ton of info in them. That an the IFFGD Digestive health Matters.The UNC's digest.In the new edition."Lactose Intolerance and Small Bacterial Overgrowth in IBS""Probiotic Bacteria in Patients with IBS? ""Winter 2003 - 2004 DigestTreatments of IBSDoes Desipramine Dose Matter in the Treatment of Functional Bowel Disorders? Lactose Intolerance and Small Bacterial Overgrowth in IBSAsk the Expert - Is there a clinical use for Probiotic Bacteria in Patients with IBS? Parents' Thoughts and Worries About Recurrent Abdominal PainRole of Physician Assistant Patient Symposium Advancing the Treatment of Fecal and Urinary Incontinence through Research Center bids farewell to Carlar Blackman " http://www.med.unc.edu/wrkunits/2depts/med...gidc/digest.htm IFFGD Digestive Health Matters http://www.aboutibs.org/Publications/currentParticipate.html
 
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