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Discussion Starter · #1 ·
This is a message of hope for those bothered by IBS symptoms. I am 57 years old and have had a relatively normal digestive system for most of my life (except for some food allergies). This past spring I had to endure some extreme stress related to my work. I was physically and mentally exhausted. I was losing sleep (anxiety) and down most of the time so my doctor prescribed some anti-anxiety medications and an antidepressant. These helped somewhat, but then I began having serious digestion problems. I could not sleep at night because of bloating and excessive gas. Nothing felt right and I could not enjoy eating. With both eating and sleeping affected the quality of life is terrible. I became even more depressed. My GI specialist did an endoscopy and found nothing major wrong with my gut (just reflux). It was his opinion that I had IBS. I resisted this diagnosis and did some research – including reading this forum. I could not stand the idea that I would have to just live with this discomfort (gas, bloating, constipation, etc.). However, to his credit, my doctor did recommend that I read Mark Pimentel’s book (thank God!). Of course, Dr. Pimentel’s theory made sense to me, and I immediately requested a referral to Cedars-Sinai Medical center here in L.A. for the lactulose breath test.The breath test showed that I did, indeed, have a bad case of bacterial overgrowth. The next day my doctor started me on the treatment protocol recommended at the Cedars GI Motility clinic. Now, two-weeks later, I am symptom free, eating normally and sleeping normally. I have regained the quality of life I enjoyed prior to this episode. I am meditating and using other stress reducing techniques (e.g. the Sedona Method of releasing harmful emotions). I am also continuing to take some meds (Cymbalta and Xanax XR) because my job is still excessively stressful. But, I am working on a long term solution to the job stress and will work my way off of the meds. The key message that I wish to share is one of hope- especially for those newly diagnosed. I still do not believe that I had a genuine case of IBS. Rather, I think I got a case of bacterial overgrowth (which may have been related to a stressful life style). If my doctor had not recommended Mark Pimentel’s book I may still be miserable and believing I had a chronic disease that is not well understood and for which there is no real cure. I am so thankful for Dr. Pimentel’s efforts to convince the medical community that at least some forms of IBS may be due to bacterial overgrowth. I hope more doctors learn about this idea and refer their patients for the breath test. If your doctor has not considered it please get Dr. Pimentel’s book “A New IBS Solution” inform him or her.My very best to all of you.
 

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I have a question....Is bacterial overgrowth, which I assume is SIBO, an accepted condition understood by mainstream doctors? Or is it more along the lines of fibromyalgia which some doctors don't believe exists.I wish I had kept a diary but I believe my LG problem took a vacation when I had been on some antibiotics for an infected tooth. And also when I took antibiotics for strep throat, because I have had months where I have been completely free of LG. It seems to be the only explanation.
 

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Discussion Starter · #3 ·
The theme of Dr. Pimentel's book is that it is still controversial and that many mainstream doctors are skeptical. I was fortunate to find one that has an open mind. I have gone out of my way to thank him and to remind him to share successes like mine with his professional colleagues.P
 

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That was my fear.....so would my doctor even know about the breath test for this?I don't want him to think I am making things up by chasing imaginary illnesses. I really need him to believe me and understand this LG situation. In your opinion, would you say a specialist (GI) doctor would have an even more skeptical view of this?The articles I have read on bacterial overgrowth seem to point more in the direction of a naturalpath type of care giver. Can these types of "doctors" (are they even doctors?) prescribe anti biotics? I don't think they can.Any input you have for my questions is appreciated.
 

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If I may answer this question without getting in trouble
SIBO as the cause of IBS (or at least some people's IBS) is still a new thing and in the not widely accepted phase.SIBO in people who have various other diseases or surgeries to the small intestine is widely accepted as a very real thing. When Pimental started this I looked in the medical literature and SIBO has been around for certain illnesses for a very very long time. Only the IBS connection is new and has controversy associated with it. Most doctors believe SIBO happens, just that it is in IBSers is a not completely proven thing.The Wiki for it http://en.wikipedia.org/wiki/Bacterial_overgrowth has most of the various causes of SIBO listed. In all the accepted diseases it is treated with repeated courses of various antibiotics, must like SIBO in IBSers is treated, although it seems that Pimental may be finding it somewhat reversible in IBSers where in people who have a blind loop in the small intestine from a surgery they will never really get rid of it.Naturopathic doctors typically cannot dispense any prescription medications and use herbal remedies or other such treatments. (although you can find holistic MD's that do both)K.
 

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Thank you Kathleen, that makes sense to me.Its good to know then that mainstream doctors will know about SIBO, just maybe not as an accepted cause of IBS. So I could ask my doctor for the breath test for it.Whether or not traditional medicine is still struggling to determine if it is a cause of IBS you would think they would not be reluctant to at least order the test and prescribe the antibiotics if they have been shown to help improve the symptoms of IBS.I will give it a try. My Doc is pretty good about listening, I just wanted to make sure I didn't sound like some kind of hypocondriac.
 

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It is worth asking. The breath tests aren't always available (mostly bigger hospitals have them) but it is at least worth IMO checking in with the doctor to see what they think.We've had some people who've done the antibiotics without the tests because they tend to be a major hospitals and the results are mixed as you don't know who has SIBO and who doesn't and no follow up tests to make sure they used the right antibiotic. However it shows a fair number of doctors are at least willing to try it in case it works.K.
 

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No.H. Pylori is a specific bacteria that lives in the stomach and can cause stomach ulcers in some people who have it. This bacteria is highly specialized and pretty much only lives in the extremely harsh conditions of the stomach that other bacteria cannot survive.SIBO is bacteria that are normally in the mouth or colon that start living in the small intestine which normally keeps itself clear of bacteria. There is no specific bacteria involved (just bacteria that are normal in other locaitons) and those bacteria are a problem because they are in the wrong place not because they cause a disease.K.
 

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Loukas,I am glad you that Pimentel's protocol worked for you and your symptoms were relieved.Would you mind sharing with us what antibiotics you were on initially, for how long, and what dose? Was it Xifaxan or Neomycin or both? And did you go on Erythromycin or Zelnorm after the initial dose of antibiotics?Thanks.
 

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Discussion Starter · #11 ·
It was Xifaxan 200mg and Metronidazole 25mg at the same time for a ten day course. I am not taking Zelnorm.L
 

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after months of bewilderment and confusion by my gi dr and myself, he placed me on 200 mg xifaxan for 10 days. maybe it is sibo, he says, that is causing my chronic constant bloating and constipation.he did not prescribe the metronidazole.
 

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quote:Originally posted by Loukas:It was Xifaxan 200mg and Metronidazole 25mg at the same time for a ten day course. I am not taking Zelnorm.L
Thanks for that info. The Xifaxan is a relatively low dose. Some research shows that symptomatic relief is dose-dependent and higher doses are more likely to bring relief. I am glad to hear you found relief at a relatively low dose.
 

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The letter from Loukas reads suspiciously like an advertisement. I think readers should be wary of posts that so wholeheartedly endorse a named therapist or specific treatment.Andrew May (MD)
 

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FYI"Small Intestinal Bacterial OvergrowthThe presence of a higher than usual population of bacteria in the small intestine (leading to bacterial fermentation of poorly digestible starches and subsequent gas production) has been proposed as a potential etiologic factor in IBS.[71] Pimentel and colleagues have shown that, when measured by the lactose hydrogen breath test (LHBT), small intestinal bacterial overgrowth (SIBO) has been detected in 78% to 84% of patients with IBS.[71,72] However, the accuracy of the LHBT in testing for the presence of SIBO has been questioned.[73] Sensitivity of the LHBT for SIBO has been shown to be as low as 16.7%, and specificity approximately 70%.[74] Additionally, this test may suboptimally assess treatment response.[75] The glucose breath test has been shown to be a more reliable tool,[76] with a 75% sensitivity for SIBO[77] vs 39% with LHBT for the "double-peak" method of SIBO detection.[74] In a recently conducted retrospective study involving review of patient charts for the presence of gastrointestinal-related symptoms (including IBS) in patients who were referred for glucose hydrogen breath tests for SIBO, of 113 patients who met Rome II criteria for IBS, 11% tested positive for SIBO.[78] Thus, results demonstrated that IBS symptoms are often unrelated to the presence of SIBO. Despite the controversy regarding the contribution of SIBO to the underlying pathophysiology of IBS and its symptoms, short-term placebo-controlled clinical studies with select antibiotics, including neomycin and rifaximin, have demonstrated symptom improvement in IBS patients.[61,72,79] Antibiotics may therefore have potential utility in select subgroups of IBS patients in whom SIBO contributes to symptoms. However, the chronic nature of IBS symptoms often leads to the need for long-term treatment. Given the fact that long-term use of antibiotics is generally undesirable, the place of antibiotics in IBS therapy remains to be established.[73]"http://ibsgroup.org/groupee/forums/a/tpc/f...261/m/963105552This is a speculation theory about sibo and IBS."Is there a relationship between IBS and small intestinal bacterial overgrowth?IBS and small intestinal bacterial overgrowth (SIBO)There is a striking similarity between the symptoms of IBS and a condition known as small intestinal bacterial overgrowth (SIBO). The entire gastrointestinal tract, including the small intestine, normally contains bacteria. The number of bacteria is greatest in the colon (at least 1,000,000,000 bacteria per ml of fluid) and much lower in the small intestine (less than 10,000 bacteria per ml of fluid). Moreover, the types of bacteria within the small intestine are different than the types of bacteria within the colon. SIBO refers to a condition in which abnormally large numbers of bacteria (at least 100,000 bacteria per ml of fluid) are present in the small intestine, and the types of bacteria in the small intestine resemble more the bacteria of the colon than the small intestine. The symptoms of SIBO include excess gas, abdominal bloating and distension, diarrhea, and abdominal pain. A small number of patients with SIBO have chronic constipation rather than diarrhea. When the overgrowth is severe and prolonged, the bacteria may interfere with the digestion and/or absorption of food, and deficiencies of vitamins and minerals may develop. Loss of weight also may occur. The symptoms of SIBO tend to be chronic; a typical patient with SIBO can have symptoms that fluctuate in intensity over months, years, or even decades before the diagnosis is made. It has been theorized that SIBO may be responsible for the symptoms in at least some patients with IBS. The estimates run as high as 50% of patients with IBS. Support for the SIBO theory of IBS comes from the observation that many patients with IBS are found to have an abnormal hydrogen breath test, a test used for diagnosing SIBO. In addition, some patients with IBS have improvement of their symptoms after treatment with antibiotics, the primary treatment for SIBO. Moreover, small, scientifically sound studies have shown that treatment with probiotics (“good” bacteria) improves the symptoms of IBS. Although there are several ways in which probiotics may be having their beneficial effect, one way is by affecting the existing bacteria in the small intestine. If this is indeed the mechanism of action, it would support the theory that SIBO is a cause of IBS. Nevertheless, it has not been determined if this is the mechanism of action of probiotics in IBS. 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."http://www.medicinenet.com/irritable_bowel...drome/page6.htmOther ibs centers around the world have not been able to replicate Cedars studies.
 
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