1636 replies to this topic

[ForLyla]

I see. Well that's probably not good. I've been connected to one of the best sibo specialists in the world. We'll see what they can do for me.

[fishinghat]

I am still working on the medical journal articles. A lot of digging to do but I did not forget you.

[ForLyla]

Vitamin c. Ester C in particular. Any affect on absorption?

[fishinghat]

It acidifies the stomach although not as much as regular vitamin C. It is also used in the synthesis of adrenaline. Not an issue for most people but I recommend starting with a small dose. Several research articles recommend 500 mg twice a day during many types of withdrawal but that would be a lot of extra acid.

 

Why the interest in Vitamin C?

[ForLyla]

They say people with sibo can be vitamin c deficient. I've also heard it can act as a prokinetic in high doses. I took 1000mg this morning and 1000mg this evening. I guess that's too much. Maybe I should stay away from it. I need something to aid motility though. My bowels havent functioned since taking the herbals.

[fishinghat]

Still working on your info. I will add Vitamin C to the list of things to check out. Yea, I would stick to 600 mg twice a day. I know that doses of over 1000 mg per day can cause an irregular heart beat in some people.

[fishinghat]

SIBO

Summary of findings.

Abbreviations;
HBT - hydrogen breath test
MBT - methane breath text
LBT - lactulose breath test
GBT - glucose breath test
IBS-D - Irritable bowel syndrome with diarrhea
IBS-C - with constipation.

General
The production of small amounts of hydrogen and/or methane does not normally produce symptoms, whereas the production of higher levels can lead to a wide range of symptoms ranging from functional disorders of the bowel to low level depression. It is possible that excess methane levels may have more health consequences than excess hydrogen levels.

 

Anxiety and Depression
One study found no link between anxiety or depression to sibo but another study found a link between both and sibo. It is logical to assume that anything causing stress to the body would at least exacerbates anxiety if not depression.

Symptoms
H(hydrogen)-Sibo has more nausea associated with it than M(methane)-Sibo.

 

Typical symptoms of SIBO comprises meteorism (Swelling of the abdomen due to gas in the intestinal or peritoneal cavity), enterectasia (enlarged bowel), abdominal discomfort and diarrhea.

 

L(Lactulose )BT (mixed, both hydrogen and methane)+ group had more symptoms of significance hard stools, strain, urgency, and flatus than LBT- group

 

Constipation is more common in methane producers and diarrhea in the hydrogen producers.



Effects
SIBO disturbs digestion and absorption in the alimentary tract, which causes systemic inflammation.

SIBO affects the shape and function of the digestive system and can cause systemic complications (e.g. osteoporosis, macrocytic anemia).

Sibo decreases mucous secretion which protects the lining of the GI tract from acids. Mucous also aides in motility (movement) of material.

There is an association between sibo and vagus nerve dysfunction.
(For details on vagus nerve dysfuntion see https://www.theodyss...rve-dysfunction. Symptoms include nausea, weight loss, weight gain, fast or slow pulse, IBS, depression, anxiety, chronic inflammation, chronic fatigue, heartburn dizziness and /or fainting.)



Risk Factors;

Cystic fibrosis

Obesity

Irritable bowel syndrome

Hypochlorhydria
Chronic liver disease - 355 have sibo (There was no difference among various causes of cirrhosis, such as viral, alcoholic, or idiopathic.)

Congenital and anatomical abnormalities in the digestive tract (e.g. small intestinal obstruction, diverticula, fistulae, surgical blind loop, previous ileo- caecal resections...)

Motility disorder (movement of material in the digestive tract) (eg. scleroderma, autonomic neuropathy in diabetes mellitus, post-radiation enteropathy, small intestinal pseudo-obstruction),

Immunological deficits (weak immune system),

GI surgery

Hypothyroidism

Systemic sclerosis

Moderate alcohol consumption

Multiple Sclerosis
Metabolic bone disease

High blood pressure

Coronary Artery Disease
Deep vein thrombosis
Spinal cord injuries.
Pancreatic carcinoma
Cholangiocarcinoma
Gastroparesis.
Bacterial peritonitis
Non-steroidal anti-inflammatory drugs
High-fat diet

Nonalcoholic fatty liver disease
Probiotics
Metabolic acidosis

Achlorhydria (abnormal condition characterized by the absence of hydrochloric acid in gastric secretions) and

Pancreatic exocrine insufficiency are all risk factors for developing Sibo.


In some patients more than one factor may be involved.

https://www.ehealthm...ial-overgrowth/
Benicar (Olmesartan), a high blood pressure medication has been associated with sibo.
 

[fishinghat]

Diagnostic Methods

The best method for diagnosing SIBO is microbial investigation of jejunal aspirates but this is very uncomfortable to the patient and very expensive. Non-invasive hydrogen and methane breath tests are most commonly used for the diagnosis of SIBO using glucose or lactulose.

Bifidobacterium infantis taken before a LBT will cause a false positive (high methane value). Patients shoiuld not take probiotics before breath tests.

46% had a positive breath test: 24 % positive for hydrogen, 18% were positive for methane, and 4% positive for both gases.

LBT+ patients, 64.7% positive for Hydrogen, 5.9% positive for methane, 29.4% positive for both..

50% had a positive lactulose breath result and 37% had a positive glucose breath result.
Positivity for hydrogen was more common than methane.

66% produced only hydrogen 29% methane only, and 5% both-hydrogen and methane.
In general, a combination of HBT and MBT is the most accurate but still may only be 50% to 70% accurate. GBT is more accurate than LBT.

[fishinghat]

Treatment

Therapy for SIBO must be complex, addressing all causes, symptoms and complications, and fully individualized. It should include treatment of the underlying disease, nutritional support and cyclical gastro-intestinal selective antibiotics. Prognosis is usually serious, determined mostly by the underlying disease that led to SIBO.

a) Rifaximin in a dose of 800 mg per day for 4 weeks: 1) was safe and effective treatment in reducing symptoms in patients with SIBO of multiple etiologies, especially when diarrhea was the dominant symptom; and 2) normalized the GBT in approximately 50% of patients.
 

74% treated with antibiotics reported improvement in more than half of the symptoms within 3 months. In total, 67% of the subjects who tested negative for SIBO, by all criteria, had a favorable response to antibiotics.

c) After antibiotic treatment, 88.7% of those who had diarrhea reported improvement, 63.3% with constipation reported improvement, and 74.3% with baseline bloating experienced improvement.


d) 79.3% with pain or discomfort reported improvement. Of those treated with a rifaximin regimen, 74.2% reported a response to treatment. 71.4% treated with amoxicillin/clavulanate experienced a clinical response.


e) 5/13 of the IBS-P patients receiving rifaximin presented negative LBT results after rifaximin therapy, with lower hydrogen concentration at all the time points and lower methane concentration especially in small intestinal section (80 min).


f) 8 patients with SIBO received rifamixin 800 mg/day. Repeat GBT was normal in 75%, 12.5% normalized according to hydrogen criteria but methane remained positive. Symptoms score improved in 87.5% patients and no adverse events were noted.


g) Case Study - One patient - The treatment approach was multifaceted, involving a low-FODMAP diet, antimicrobial botanical therapy, and homeopathic medicine.

h) Probiotics can help treat sibo, especially in hydrogen BT positive patients but does not prevent the development of sibo.

i) Saccharomyces boulardii, Bifidobacterium lactis, Lactobacillus acidophilus, and Lactobacillus plantarum probiotic showed a 71.3% decrease in symptoms after a 30 day treatment.

j) 63.0% of patients versus 16.3% of controls was tested positive for SIBO. SIBO was associated with proton pump inhibitor (PPI) use. Bifidobacterium triple viable capsule was effective in combating SIBO and was associated with a significant improvement in gastrointestinal symptoms.

[fishinghat]

k) 30 cases suffering from chronic abdominal pain or diarrhea and with a positive hydrogen breath test were randomized in a double-blind manner into two groups: probiotic user and control group. After an initial 3-week aggressive therapy with broad-spectrum antibiotics, a 15-day maintenance antibiotic therapy with lactol was administered for the study group and the same regimen without lactol 9Lactol. Lactol contains a combination of probiotic (Lactobacillus sporogenes) and prebiotic (fructo-oligosaccharides) in a suitable ratio) for the control group. The hydrogen breath test turned negative in 93.3 per cent of those receiving lactol compared to 66.7 per cent of the controls. In all the cases receiving lactol, the abdominal pain disappeared completely. In addition, other GI problems including flatulence, belching and diarrhea significantly improved in the study group.

l) It was shown that those who received (group 1) Rifaximin 400 mg/day for 7 days/month followed by Lactobacillus casei for 7 days more and group 2 antibiotic followed by short chain fructo-oligosaccharides... In group 1, a significant improvement was obtained in 5 out of 6 symptoms, whilst in group 2 in 4 out of 6 symptoms (nausea and number of bowel movements failed to improve). Our preliminary data show a good outcome with sequential antibioticprobiotic/ prebiotic administration in patients with SIBO.

m) Herbal therapy, 17 (46%) had a negative follow-up LBT compared to 23/67 (34%) of rifaximin users (P=.24). Herbal therapies are at least as effective as rifaximin for resolution of SIBO by LBT. Herbals also appear to be as effective as triple antibiotic therapy for SIBO rescue therapy for rifaximin non-responders.


Resistance to treatment

a) 35.2% patients, who had completed up to four eradication therapies, were diagnosed with SIBO by HMBT.

The three sugars used in breath tests all show variations in results but similar with a variation of 6% to 17% positive results. Successful antibiotic therapy with rifaximin could be demonstrated in 86.7% of patients as indicated by normal HMBT results and symptom remission.

c) GBT positivity recurrence rate was high after antibiotic treatment. Older age, history of appendectomy, and chronic use of PPIs were associated with GBT positivity recurrence. Patients with evidence of GBT positivity recurrence showed gastrointestinal symptoms relapse thus suggesting SIBO recurrence.

 

[fishinghat]

Diet
a) The positive rate of LMHBT in IBS-D was significantly higher than that of HC[39.8% (35/88) vs 12.5%(4/28), P=0.005]. IBS-D patients with high fat diet had higher LMHBT positive rate than that of non-high fat diet patients[54.2% (13/24) vs 17.2% (11/64), P=0.001]. Breath methane peak value was positively correlated with the fat proportion of diet (r=0.413, P=0.022).


A comparison of nutritional diversity in patients with SIBO-H2 revealed a lower count base diversity in the groups of dairy products (2.70±1.37 vs 3.19±1.34, p<0.001), vegetables (5.50±2.22 vs 6.29±1.90, p<0.001), fruits (1.54± 1.38 vs 1.99±1.69, p=0.018) in compare with controls. Count base diversity in grains, meats, fishes, fat products, nuts and legumes and sweets did not demonstrate significant differences.

c) Patients resistant to therapy had higher consumption of buckwheat and millet, poultry meat and butter and they were also characterized by a lower consumption of mono- and disaccharides and cottage cheese. Consumption of fruits and vegetables did not have significant differences.

Very little information was found concerning diet in sibo patients.

PPIs

a) 83 participants were tested, of whom 56 were taking PPIs. SIBO was detected in five (8.9%) of the 56 participants taking PPI versus one (3.7%) of the 27 participants in the control group, with a relative risk of 2.4.


48% of SIBO positive patients were receiving PPI therapy compared to 40% of IBS patients with negative GBT.


c) PPI use was not found to be significantly associated with the presence of SIBO as determined by the GHBT.


d) A total of 19 articles met the eligibility criteria for the meta-analysis, reporting on 7055 subjects and our meta-analysis suggests that the use of PPI moderately increases the risk of SIBO,


e) Forty-two patients with GERD were selected. After 8 weeks of PPI treatment, patients complained of bloating, flatulence, abdominal pain and diarrhea in 43%, 17%, 7% and 2%, respectively. After 6 months, the incidence of bowel symptoms further increased and GHBT was found positive in 26% patients. Prolonged PPI treatment may produce bowel symptoms and SIBO; therefore, the strategy of step-down or on-demand PPI therapy should be encouraged in GERD.


f) A significantly higher percentage of patients with SIBO use PPIs than patients without SIBO, indicating a possible association.


g) PPI use statistically was associated with SIBO risk, but only when the diagnosis was made by a highly accurate test (duodenal or jejunal aspirate culture, not breath tests).


h) Results indicate a potential risk of SIBO in chronic PPI users; however, this is not statistically significant.


i) SIBO, assessed by GHBT, occurs significantly more frequently among long term PPI users than patients with IBS or control subjects. High dose therapy with rifaximin eradicated 87%-91% of cases of SIBO in patients who continued PPI therapy.
 

[ForLyla]

Thank you Hat. This is a lot of information and will take a bit of time to go through. I appreciate the work you put into digging up the info. Let me follow up with another post after I've gone through it all.

[fishinghat]

Background Research

https://www.ncbi.nlm...pubmed/29794732
A higher level of nausea was present in the Hydrogen-SIBO group when compared to the Methane-SIBO group.
When analyzing the subtypes, M-SIBO has significantly more delayed movement of bowel material in both the small intestines and colon. when compared to H-SIBO.

https://www.ncbi.nlm...pubmed/25657082
Small intestinal bacterial overgrowth (SIBO) is a disease of great clinical and socioeconomic importance caused by an excessive amount of bacteria in the upper alimentary (GI)tract. Physiological microbiota (good bacteria) are replaced by pathogenic bacteria mainly from large intestine, which is called dysbacteriosis. SIBO disturbs digestion and absorption in the alimentary tract, which seems to cause inflammation. SIBO affects the morphology (shape) and function of the digestive system and causes systemic complications (e.g. osteoporosis, macrocytic anemia). Inflammation interferes with gene expression responsible for producing and secreting mucus, therefore, a correlation between SIBO and cystic fibrosis, irritable bowel syndrome and chronic abdominal pain are postulated. All conditions leading to bacterial growth such as congenital and anatomical abnormalities in the digestive tract, motility disorder (movement of material in the digestive tract) or immunological deficits (weak immune system) are risk factors of SIBO. A typical clinical manifestation of SIBO comprises meteorism, enterectasia, abdominal discomfort and diarrhea.

https://www.ncbi.nlm...pubmed/30627990
Patients with true positive SIBO based on BT breathing test had a higher response rate to antibiotics compared to those with false positive SIBO BT (78.3% vs. 33.3%, p = 0.03).


https://www.ncbi.nlm...pubmed/20572300
Any dysbalance of this complex intestinal microbiome, both qualitative and quantitative, might have serious health consequence for a macro-organism, including small intestinal bacterial overgrowth syndrome (SIBO). SIBO is defined as an increase in the number and/or alteration in the type of bacteria in the upper gastrointestinal tract. There are several endogenous defence mechanisms for preventing bacterial overgrowth: gastric acid secretion, intestinal motility, intact ileo-caecal valve, immunoglobulins within intestinal secretion and bacteriostatic properties of pancreatic and biliary secretion. Aetiology of SIBO is usually complex, associated with disorders of protective antibacterial mechanisms (e.g. achlorhydria, pancreatic exocrine insufficiency, immunodeficiency syndromes), anatomical abnormalities (e.g. small intestinal obstruction, diverticula, fistulae, surgical blind loop, previous ileo-caecal resections) and/or motility disorders (e.g. scleroderma, autonomic neuropathy in diabetes mellitus, post-radiation enteropathy, small intestinal pseudo-obstruction). In some patients more than one factor may be involved. Symptoms related to SIBO are bloating, diarrhoea, malabsorption, weight loss and malnutrition. The gold standard for diagnosing SIBO is still microbial investigation of jejunal aspirates. Non-invasive hydrogen and methane breath tests are most commonly used for the diagnosis of SIBO using glucose or lactulose. Therapy for SIBO must be complex, addressing all causes, symptoms and complications, and fully individualised. It should include treatment of the underlying disease, nutritional support and cyclical gastro-intestinal selective antibiotics. Prognosis is usually serious, determined mostly by the underlying disease that led to SIBO.

https://www.ncbi.nlm...pubmed/29397491
This study found that 2 weeks of Bifidobacterium infantis supplementation affects LBT assessment for SIBO by significantly increasing methane, but not hydrogen, excretion after lactulose administration. Methane levels reached values that would be considered positive for SIBO patients. This study suggests that patients undergoing LBT should discontinue probiotics prior to the test as these supplements may alter the test results.
 

[fishinghat]

https://www.ncbi.nlm...pubmed/31710785
The study compared dietary patterns of patients with resistance to the therapy of SIBO and those who had successful therapy. Results and discussion. Control of the hydrogen content in the exhaled air was performed only in 79 re-appeared patients, 38 (48.9%) of them in 2 months after therapy revealed the presence of SIBO H2>20 ppm. A comparison of the nutrition of these patients showed that patients resistant to therapy had higher consumption of buckwheat (0.41±0.47 vs 0.14±0.35 relative to the rate of consumption of cereals, p<0.001) and millet (0.036±0.11 vs 0.007±0.021, p=0.047), poultry meat (0.80±0.64 vs 0.54±0.62, p=0.01) and butter (0.54±0.24 vs 0.39±0.22, p<0.01). The diet of patients with resistant to SIBO therapy was also сharacterized by a lower consumption of mono- and disaccharides (75.2±32.7 vs 95.5±41.5 g/day; p=0.015) and cottage cheese (0.07±0.08 vs 0.17±0.19, p=0.018). Consumption of fruits and vegetables did not have significant differences. Conclusion. Treatment is ineffective in roughly half the patients with SIBO H2.

https://www.ncbi.nlm...pubmed/27586816
In total, 36/109 (33.0%) patients had a positive H. pylori13C-UBT, and 35/109 (32.1%) patients had a positive glucose HMBT, the latter being indicative of SIBO. Interestingly, individuals with a positive H. pylori13C-UBT were significantly more often associated with a positive glucose HMBT (p=0.002). Cohen's κ measuring agreement between the 13C-UBT and the glucose HMBT was 0.31 (confidence intervals: 0.12-0.50) (p=0.001). Altogether, 19 of 54 (35.2%) patients, who had completed up to four eradication therapies, were diagnosed with SIBO by HMBT.

https://www.ncbi.nlm...pubmed/29118931
In total, 46% had a positive breath test: 18% were positive for methane, 24 % positive for hydrogen and 4% positive for both gases (p=0.014). Also, 50% had a positive lactulose breath result and 37% had a positive glucose breath result (p=0.036). The most common symptom for performing the breath test was bloating and the only clinical symptom that significantly showed a positive glucose breath test was increased gas (p=0.028).
Lactulose breath test was more often positive than glucose breath test. Positivity for hydrogen was more common than methane. Bloating was the most frequently perceived symptom of the patients undergoing the breath test but the only statistically significant clinical symptom for a positive glucose breath test was increased gas. Furthermore, the results showed that there was no significant association between positive breath test result and gender, age, non-celiac gluten sensitivity or celiac disease.

https://www.ncbi.nlm...pubmed/26278025
The LBT positivity (+) indicating the presence of SIBO, gas types, bowel symptom questionnaire, laboratory and radiologic results were surveyed. The LBT+ was (1) an increase in the breath H2 (≥20 ppm) or CH4 (≥10 ppm) over the baseline or (2) a baseline H2 (≥20 ppm) or CH4 (Methane)(≥10 ppm) within 90 min after lactulose load.
LBT+ was significantly higher in the patients (17/36) than in controls (13/49) (47.2% vs. 26.5%, P < 0.05). During LBT, the H2 levels between 0 and 105 min were significantly higher in patients than in controls. Among LBT+ patients, 11 (64.7%), 1 (5.9%), 5 (29.4%) were in the LBT (H2)+, (CH4)+, (mixed)+ groups, respectively. The LBT+ group had significantly higher scores of flatus than those of the LBT- group. Considering the subtypes of LBT, the LBT (mixed)+ group had higher symptom scores of significance or tendency in hard stool, strain, urgency, and flatus than LBT- group The laboratory and radiologic features were not significantly different between LBT+ and LBT- groups.

https://www.ncbi.nlm...pubmed/28646815
The treatment approach was multifaceted, involving a low-FODMAP diet, antimicrobial botanical therapy, and homeopathic medicine. Results • The patient's abdominal pain and bloating resolved with the treatment of the SIBO, although her underlying constipation, which was likely associated with other factors, remained. Conclusions • This case study supports an alternative, multifaceted approach to the treatment of SIBO and commonly associated symptoms.
 

[fishinghat]

https://www.ncbi.nlm...pubmed/23470880
However, there are patients who can suffer from the same spectrum of malabsorption issues but who produce little or no hydrogen, instead producing relatively large amounts of methane. These patients will avoid detection with the traditional breath test for malabsorption based on hydrogen detection. Likewise the hydrogen breath test is an established method for small intestinal bacterial overgrowth (SIBO) diagnoses. Therefore, a number of false negatives would be expected for patients who solely produce methane. Usually patients produce either hydrogen or methane, and only rarely there are significant co-producers, as typically the methane is produced at the expense of hydrogen by microbial conversion of carbon dioxide.
As an example, the hydrogen-based lactose malabsorption test is considered to result in about 5-15% false negatives mainly due to methane production. The production of small amounts of hydrogen and/or methane does not normally produce symptoms, whereas the production of higher levels can lead to a wide range of symptoms ranging from functional disorders of the bowel to low level depression. It is possible that excess methane levels may have more health consequences than excess hydrogen levels.

https://www.ncbi.nlm...pubmed/27135726
One hundred participants (78 women) were included in the analysis. The mean age was 51 years. A total of 15% of participants did not meet any criteria on breath testing for SIBO; 73% had a fasting baseline elevation >10 ppm; and 19% had an increase of >20 ppm above baseline in the first 20 minutes, 48% had a 20-ppm increase in the first 60 minutes, and 32% had a second increase, reflecting a colon peak. Overall, 74% responded to a course of antibiotics, determined by reported improvement in more than half of the symptoms within 3 months. In total, 67% (10/15) of the subjects who tested negative for SIBO, by all criteria, had a favorable response to antibiotics. Among those with positive hydrogen increases, 76.3% with 1 criterion responded, 66.7% with 2 criteria responded, 84.6% with 3 responded, and 76.9% with 4 responded. After antibiotic treatment, 88.7% (47/53) of those who had diarrhea reported improvement, 63.3% (19/30) with constipation reported improvement, and 74.3% (52/70) with baseline bloating experienced improvement. Sixty-five of the 82 patients with pain or discomfort reported improvement (79.3%). Of those treated with a rifaximin regimen, 74.2% (49/66) reported a response to treatment. Twenty of 28 (71.4%) treated with amoxicillin/clavulanate experienced a clinical response.
These data suggest that the response to antibiotic therapy in patients with suspected SIBO is not predicted by carbohydrate SIBO testing results and bring into question the value of such testing.

https://www.ncbi.nlm...pubmed/28789488
To explore the diet features of diarrhea predominant irritable bowel syndrome (IBS-D) with small intestinal bacterial overgrowth (SIBO). IBS-D patients were enrolled in outpatient department of Peking University Third Hospital from March 2015 to April 2016. Healthy volunteers were recruited as controls (HC). All the subjects completed screening examinations, clinical and food investigation, and lactulose methane and hydrogen breath test (LMHBT). The high fat diet is defined as the daily total calories supplying from fat is more than 50%.
Eighty-eight IBS-D patients and 32 HC were finally enrolled. The positive rate of LMHBT in IBS-D was significantly higher than that of HC[39.8% (35/88) vs 12.5%(4/28), P=0.005]. The 28 HC with negative LMHBT were enrolled in the follow-up analysis. (1) The BMI of IBS-P (IBS-D with positive LMHBT) was significantly lower than IBS-N (IBS-D with negative LMHBT) [(21.57±0.54) vs (23.30±0.53)kg/m(2,) P=0.032]. IBS-D patients with SIBO had higher scores of abdominal pain assess. (2) The proportion of dietary protein and carbohydrate in IBS-D was significantly higher than that of HC (14.39% vs 12.22%, P=0.001; 53.94% vs 46.25%, P=0.003, respectively). The proportion of diet fat was significantly higher in IBS-P than IBS-N[(47.19±2.62)% vs (40.74±1.66)%, P=0.038]. (3) The baseline of breath methane in IBS-P was significantly higher than that of in IBS-N[(8.69±0.39) ×10(-6) vs (6.39±0.47) ×10(-6,) P=0.002]. IBS-D patients with high fat diet had higher LMHBT positive rate than that of non-high fat diet patients[54.2% (13/24) vs 17.2% (11/64), P=0.001]. Breath methane peak value was positively correlated with the fat proportion of diet (r=0.413, P=0.022).

 

[fishinghat]

https://www.ncbi.nlm...pubmed/27373356
(1) Eighty-four IBS-D patients and 22 healthy controls were enrolled. The prevalence of SIBO in IBS-D patients was 41.67% (35/84), with 27 (77.14%) only hydrogen-positive, 5 (14.29%) methane-positive, and 3 (8.57%) both methane- and hydrogen-positive. (2) The body mass index (BMI) in the IBS-P group was lower than in the IBS-N group [(21.61±0.57) vs (23.44±0.54) kg/m(2,) P<0.05], the maximum stool frequency was also less than in the IBS-N group [(3.85±0.23) vs (4.88±0.35) times/day, P<0.05]. (3) No significant difference was found in oro-cecal transit time (OCTT) among IBS-P, IBS-N and healthy controls. The hydrogen concentration in small intestinal and colonic sections in breath of the IBS-P group was higher than that of both healthy controls and the IBS-N group, while methane concentration in small intestinal and colonic sections (160 min) was higher than that of the IBS-N group (all P<0.05). (4) There was no linear relationship between mean hydrogen and methane concentrations in LBT among the IBS-P, the IBS-N and healthy control groups (all r<0.35, P>0.05). (5) Totally 13 IBS-P patients received rifaximin therapy, in whom the symptoms of abdomen pain, bloating, fecal consistency, stool frequency, and stool satisfactory were significantly improved after treatment (all P<0.05); 8 IBS-N patients received rifaximin therapy, in whom fecal consistency, stool frequency, and satisfactory were significantly improved (all P<0.05). (6) And 5/13 of the IBS-P patients receiving rifaximin presented negative LBT results after rifaximin therapy, with lower hydrogen concentration at all the time points, especially in colonic section (120 min) [(34.54±7.32) ×10(-6) vs (52.23±9.40) ×10(-6,) P<0.05] and lower methane concentration especially in small intestinal section (80 min) [(8.54±0.95) ×10(-6) vs (11.31±0.94) ×10(-6,) P<0.05].
About 41.67% of the IBS-D patients meeting Rome Ⅲ criteria have SIBO, which can be better screened by combining hydrogen and methane in LBT compared with only hydrogen in LBT. SIBO can affect nutritional status in IBS-D patients. Rifaximin can improve the systematic symptoms of IBS-D patients with SIBO, also reduce hydrogen and methane concentration in breath, while only improving diarrhea in IBS-D patients without SIBO. Some differences in gut microbiota may exist between IBS-D with and without SIBO.

https://www.ncbi.nlm...pubmed/29596112
This research demonstrates an association between sibo and vagus nerve dysfunction.
(For details on vagus nerve dysfuntion see https://www.theodyss...rve-dysfunction. Symptoms include nausea, weight loss, weight gain, fast or slow pulse, IBS, depression, anxiety, chronic inflammation, chronic fatigue, heartburn dizziness and /or fainting.)

https://www.ncbi.nlm...pubmed/27134657
A total of 59 (47.2%) patients presented an early H2/CH4 peak with one or more sugars. Among these, 21 (16.8%), 10 (8.0%) and 7 (5.6%) individuals had a positive HMBT result with either glucose, fructose or sorbitol, respectively. Another 21 (16.8%) patients with a positive glucose HMBT result were also found positive with an early H2/CH4 peak obtained after ingestion of fructose and/or sorbitol. Fair agreement was observed between glucose and fructose (κ = 0.26, p = 0.0018) and between glucose and sorbitol (κ = 0.18, p = 0.0178) HMBT results. Slight agreement was observed between fructose and sorbitol (κ = 0.03, p = 0.6955) HMBT results only. Successful antibiotic therapy with rifaximin could be demonstrated in 26/30 (86.7%) of patients as indicated by normal HMBT results and symptom remission.

https://www.ncbi.nlm...pubmed/28030512
Overall, 83 participants were tested, of whom 56 were taking PPIs. SIBO was detected in five (8.9%) of the 56 participants taking PPI versus one (3.7%) of the 27 participants in the control group (P=0.359), with a relative risk of 2.4 (95% confidence interval: 0.29-19.6).

[fishinghat]

https://www.ncbi.nlm...pubmed/32083825
Оne thousand twenty three patients with suspected SIBО were examined. Hydrogen-methane breath test with lactulose was performed in 973 patients, the results of which identified groups with SIBO-H2 (n=522), with SIBO-CH4 (n=340) and without signs of SIBO (n=108). Data on food intake was collected with 24 h recall from all participants. Dietary diversity was assessed using method of calculation of unique values (count base diversity) for 11 groups of food: cereals, meat and eggs, fish and non-fish seafood, fat containing products, dairy products, nuts, vegetables, fruits and berries, confectionery, drinks, sauces and spices. The pattern of food diversity for each patient was obtained by counting the items in each of the studied food groups. Comparison of the mean values of the number of items in each of the studied food groups was used to compare food diversity in patients with and without SIBО-H2.
A comparison of nutritional diversity in patients with SIBO-H2 revealed a lower count base diversity in the groups of dairy products (2.70±1.37 vs 3.19±1.34, p<0.001), vegetables (5.50±2.22 vs 6.29±1.90, p<0.001), fruits (1.54± 1.38 vs 1.99±1.69, p=0.018) in compare with controls. Count base diversity in grains, meats, fishes, fat products, nuts and legumes and sweets did not demonstrate significant differences.
Significant differences in the diversity of dietary patterns in patients with SIBО were found in dairy products, vegetables and fruits and berries. The obtained data may be used to develop diet for SIBO patients additionally to the treatment and prevention of its relapses.



https://www.ncbi.nlm...pubmed/18217406
93 (46%) had a positive GBT. 68 (73%) of these 93 IBS-diarrhea dominant (IBS-D), 12 (13%) were constipation dominant (IBS-C) and 13 (14%) IBS with alternating bowel pattern. 48% of SIBO positive patients were receiving PPI therapy compared to 40% of IBS patients with negative GBT. 61 (66%) produced only hydrogen, 27 (29%) methane only, and 5 (5%) both-hydrogen and methane. There were more methane producers in IBS-C then IBS-D group (58% vs 28%) while IBS-D had more hydrogen formers (71% vs 42%). 8 patients with SIBO (7F & IM; mean age 55, range 31-85) received rifamixin 800 mg/day. Repeat GBT was normal in 6 (75%), 1 patient (12.5%) normalized according to hydrogen criteria but methane remained positive. Symptoms score improved in 7 (87.5%) patients and no adverse events were noted.
(1) SIBO was present in nearly half of this large cohort of IBS patients based on the results of GBT; (2) Chronic PPI use was not associated with SIBO; (3) Methane formers on the GBT are more likely to be constipated; (4) Rifaximin is effective in treatment of SIBO in IBS and controlled trials are warranted.

https://www.ncbi.nlm...pubmed/22334250
PPI use was not found to be significantly associated with the presence of SIBO as determined by the GHBT.

https://www.ncbi.nlm.../pubmed/9754736
We conclude that the prevalence of SIBO in cirrhotic patients is approximately 35.6% and that it is related to the severity of liver disease. There was no difference among various causes of cirrhosis, such as viral, alcoholic, or idiopathic.


https://www.ncbi.nlm...pubmed/17505166
Rifaximin in a dose of 800 mg per day for 4 weeks: 1) was safe and effective treatment in reducing symptoms in patients with SIBO of multiple etiologies, especially when diarrhea was the dominant symptom; and 2) normalized the GBT in approximately 50% of patients. Data support a future therapeutic role for rifaximin in SIBO.

https://www.ncbi.nlm...pubmed/26371034
Based on the (13)C/H₂ breath test, 314 patients were diagnosed with lactase deficiency, 138 with lactose malabsorption or small bowel bacterial overgrowth (SIBO), and 599 with normal lactose digestion. Additional measurement of CH₄ further improved the accuracy of the test as 16% subjects with normal lactose digestion and no H₂-excretion were found to excrete CH₄. These subjects should have been classified as subjects with lactose malabsorption or SIBO. In conclusion, measuring CH₄-concentrations has an added value to the (13)C/H₂ breath test to identify methanogenic subjects with lactose malabsorption or SIBO.

https://www.ncbi.nlm...pubmed/20962560
LBT from 76 IBS patients, 70 functional bowel disorders (FBD), and 40 controls were examined. LBT was considered positive if (1) baseline breath hydrogen (H₂) >20 parts per million (ppm) or rise of breath H₂ >20 ppm above the baseline in <90 mins, or (2) baseline breath methane (CH₄) >10 ppm or rise of breath CH₄ >10 ppm above the baseline in <90 mins. The subjects were categorized into predominant hydrogen producers (PHP), predominant methane producers (PMP), combined producer, and both negative group based on LBT.
The rate of abnormal LBT in the IBS, FBD, and control group were 44.7%, 41.4%, and 40.0% respectively without significant differences. The rate of PHP or PMP was not significantly different among the IBS, FBD, and control group. When clinical characteristics were analyzed in IBS and FBD according to LBT types, IBS subtypes and symptoms were not significantly different.
LBT was not useful to discriminate IBS/FBD patients from the control. The assessment of SIBO by LBT in IBS should be revalidated in the future.

https://www.ncbi.nlm...pubmed/27379166
Anxiety, depression, and LES scores were similar between the SIBO-positive and SIBO-negative groups.

[fishinghat]

https://www.ncbi.nlm...pubmed/18422970
Anxiety and depression related to sibo.


https://www.ehealthm...ial-overgrowth/
Benicar
https://www.ncbi.nlm...les/PMC6364444/
Olmesartan, an angiotensin receptor blockade class of antihypertensive medication has recently been associated with a seronegative sprue like enteropathy (including sibo).

https://www.ncbi.nlm...pubmed/29915215
Brain fogginess, gas and bloating: a link between SIBO, probiotics and metabolic acidosis.
We describe a syndrome of BF, gas and bloating, possibly related to probiotic use, SIBO, and D-lactic acidosis in a cohort without short bowel. Patients with BF exhibited higher prevalence of SIBO and D-lactic acidosis. Symptoms improved with antibiotics and stopping probiotics.
https://www.ncbi.nlm...pubmed/28267052
Probiotics for Preventing and Treating Small Intestinal Bacterial Overgrowth: A Meta-Analysis and Systematic Review of Current Evidence.
The SIBO decontamination rate was 62.8%. The probiotics group showed a significantly higher SIBO decontamination rate than the nonprobiotic group. Also, the H2 concentration was significantly reduced among probiotic users. Although probiotics produced a marked decrease in the abdominal pain scores, it did not significantly reduce the daily stool frequency. Therefore, the present findings indicated that probiotics supplementation could effectively decontaminate SIBO, decrease H2 concentration, and relieve abdominal pain, but were ineffective in preventing SIBO.

https://www.ncbi.nlm...pubmed/29508268
Effect of a Preparation of Four Probiotics on Symptoms of Patients with Irritable Bowel Syndrome: Association with Intestinal Bacterial Overgrowth.
In this prospective trial, five patients with IBS and SIBO and 21 patients with IBS without SIBO were administered an oral capsule containing Saccharomyces boulardii, Bifidobacterium lactis, Lactobacillus acidophilus, and Lactobacillus plantarum (Lactolevure®) every 12 h for 30 days. SIBO was defined by quantitative culture of the third part of the duodenum.Thirty days after the end of treatment, a 71.3% decrease of the total IBS score was detected in patients with IBS and SIBO compared to 10.6% in those without SIBO

https://www.ncbi.nlm...pubmed/27210778
In our study group, 63.0% of patients versus 16.3% of controls was tested positive for SIBO. SIBO was associated with proton pump inhibitor (PPI) use. Bifidobacterium triple viable capsule was effective in combating SIBO and was associated with a significant improvement in gastrointestinal symptoms.
https://www.ncbi.nlm...pubmed/25579140
Evaluating the efficacy of probiotic on treatment in patients with small intestinal bacterial overgrowth (SIBO)--a pilot study.
In this study, 30 cases suffering from chronic abdominal pain or diarrhoea and with a positive hydrogen breath test were randomized in a double-blind manner into two groups: probiotic drug user and control group. After an initial 3-week aggressive therapy with broad-spectrum antibiotics, a 15-day maintenance antibiotic therapy with lactol was administered for the study group and the same regimen without lactol for the control group. The hydrogen breath test turned negative in 93.3 per cent of those receiving lactol compared to 66.7 per cent of the controls. In all the cases receiving lactol, the abdominal pain disappeared completely ( p =0.002). In addition, other GI problems including flatulence, belching and diarrhoea significantly improved in the study group ( p < 0.05).

https://www.ncbi.nlm...pubmed/23244247
Effect of probiotic or prebiotic supplementation on antibiotic therapy in the small intestinal bacterial overgrowth: a comparative evaluation.
Patients were randomly divided into two groups homogeneous for sex and age: group 1 received Rifaximin 400 mg/day for 7 days/month followed by Lactobacillus casei for 7 days more and group 2 antibiotic followed by short chain fructo-oligosaccharides.
In group 1, a significant improvement was obtained in 5 out of 6 symptoms, whilst in group 2 in 4 out of 6 symptoms (nausea and number of bowel movements failed to improve). Our preliminary data show a good outcome with sequential antibioticprobiotic/ prebiotic administration in patients with SIBO.

[fishinghat]

https://www.ncbi.nlm...pubmed/28789488
High fat diet might be one of the risk factors for IBS-D with SIBO.
https://www.ncbi.nlm...pubmed/30483563
The study is a single-center, cross-sectional study. Enrolled patients (with age > 12 years) were divided into two groups: patients taking PPIs for more than 3 months (Group A) and those taking PPIs with prokinetics for more than 3 months (Group B for various indications. Lactulose breath test (LBT) for OCTT and glucose breath test (GBT) for SIBO were conducted for all patients. The duration and type of PPI used were not associated with the occurrence of SIBO in our study.

https://www.ncbi.nlm...pubmed/28770351
Meta-analysis: proton pump inhibitors moderately increase the risk of small intestinal bacterial overgrowth.
A total of 19 articles met the eligibility criteria for the meta-analysis, reporting on 7055 subjects. The pooled odds ratio showed a statistically significant association between increased risk of SIBO and PPI use. Our meta-analysis suggests that the use of PPI moderately increases the risk of SIBO,
https://www.ncbi.nlm...pubmed/21128930
Effects of long-term PPI treatment on producing bowel symptoms and SIBO.
Forty-two patients with GERD were selected. After 8 weeks of PPI treatment, patients complained of bloating, flatulence, abdominal pain and diarrhoea in 43%, 17%, 7% and 2%, respectively. After 6 months, the incidence of bowel symptoms further increased and GHBT was found positive in 26% patients.
Prolonged PPI treatment may produce bowel symptoms and SIBO; therefore, the strategy of step-down or on-demand PPI therapy should be encouraged in GERD.
https://www.ncbi.nlm...pubmed/25694782
A significantly higher percentage of patients with SIBO use PPIs than patients without SIBO, indicating a possible association. Similar proportions of patients with SIBO improved whether or not they received antibiotic treatment, calling into question the use of this expensive therapy for this disorder.

https://www.ncbi.nlm...pubmed/23270866
PPI use statistically was associated with SIBO risk, but only when the diagnosis was made by a highly accurate test (duodenal or jejunal aspirate culture, not breath tests).

https://www.ncbi.nlm...pubmed/28030512
Results indicate a potential risk of SIBO in chronic PPI users; however, this is not statistically significant.
https://www.ncbi.nlm...pubmed/20060064
SIBO, assessed by GHBT, occurs significantly more frequently among long term PPI users than patients with IBS or control subjects. High dose therapy with rifaximin eradicated 87%-91% of cases of SIBO in patients who continued PPI therapy.
https://www.ncbi.nlm...pubmed/18802998
GBT positivity recurrence rate was high after antibiotic treatment. Older age, history of appendectomy, and chronic use of PPIs were associated with GBT positivity recurrence. Patients with evidence of GBT positivity recurrence showed gastrointestinal symptoms relapse thus suggesting SIBO recurrence.


https://www.ncbi.nlm...pubmed/24891990or
https://www.ncbi.nlm...les/PMC4030608/
Of the 37 patients who received herbal therapy, 17 (46%) had a negative follow-up LBT compared to 23/67 (34%) of rifaximin users (P=.24). Herbal therapies are at least as effective as rifaximin for resolution of SIBO by LBT. Herbals also appear to be as effective as triple antibiotic therapy for SIBO rescue therapy for rifaximin non-responders.
Antibiotic Regimens Used for Small Intestine Bacterial Overgrowth18
Agent Dose Frequency
Amoxicillin-clavulanate 500 mg PO 3 times/day
Cephalexin 250 mg PO 4 times/day
Chloramphenicol 250 mg PO 4 times/day
Ciprofloxacin 500 mg PO twice daily
Doxycycline 100 mg PO twice daily
Metronidazole 250 mg PO 3 times/day
Neomycin 500 mg PO twice daily
Norfloxacin 400 mg PO twice daily
Rifaximin 400 mg PO 3 times/day
Tetracycline 250 mg PO 4 times/day
Trimethoprim- sulfamethoxazole 1 double-strength tablet PO twice daily

Subjects with newly diagnosed SIBO by LBT were given two open-label treatment choices based upon individualized treatment preference; either two 200 mg rifaximin tablets three times daily (TID) or 2 capsules twice daily of the following commercial herbal preparations; Dysbiocide and FC Cidal (Biotics Research Laboratories, Rosenberg, Texas) or Candibactin-AR and Candibactin-BR (Metagenics, Inc, Aliso Viejo, California) for 4 consecutive weeks immediately followed by a repeat LBT.
Table 5
Herbal Preparations for the Treatment of Small Intestine Bacterial Overgrowth
FC Cidal Dysbiocide Candibactin-AR Candibactin-BR
Proprietary blend - 500 mg: 1 capsule Proprietary Blend 950 mg per 2 capsules One Capsule contains: Two Capsules contain:
Tinospora cordifolia (stem) Dill seed Red Thyme oil (thymus vulgaris, providing 30%-50% thymol) 0.2 mL Coptis root and rhizome extract (coptis chinensis, containing berberine) 30 mg
Equisetum arvense (stem) Stemona Sessilifolia powder and extract Oregano Oil (origanum vulgare, providing 55% to 75% carvacrol) 0.1 mL Indian Barberry root extract (berberis aristata, containing berberine) 70 mg
Pau D'Arco (inner bark) Artemisia Absinthium shoots and leaves extract, Sage leaf 5.5:1 extract (salvia officinalis) 75 mg Berberine Sulfate 400 mg • Proprietary 4:1 Extract 300 mg: Coptis root and rhizome (coptis chinensis)
Thymus vulgaris (aerial part) Pulsatilla Chinensis rhizome powder and extract Lemon Balm leaf 5:1 extract (melissa officinalis) 50 mg Chinese Skullcap root (scutellaria baicalensis)
Artemisia dracunculus (leaf) Brucea Javanica powder and extract Philodendron bark (phellodendron chinense)
Sida cordifolia (aerial part) Picrasma Excelsa bark extract Ginger rhizome (zingiber officinale)
Olea europaea (leaf) Acacia Catechu stem extract Chinese Licorice root (glycyrrhiza uralensis)
Hedyotis Diffusa powder and extract Chinese Rhubarb root and rhizome (rheum officinale)
Yarrow leaf and flower extract (achillea millefolium). Chinese Rhubarb root and rhizome (rheum officinale).


 

[fishinghat]

Well those will put you to sleep at night.  lol

 

I was surprised by how inaccurate the tests were, the large number of conditions that can cause sibo and the lack of homeopathic information. Let me know if you have questions.

[ForLyla]

K I finally had a chance to read it all over. I decided to go the elemental diet route as it should have the least amount of side effects. I'm not feeling too badly withdrawal wise the last few days, kind of surprisingly but my acid reflux problem is worse than ever. Just waiting on some key ingredients being shipped in from the U.S. Seeing as the half life of cymbalta is 6 hours, is it reasonable to assume that taking things 6 hours later shouldn't affect it as much?

Do you think severe reflux can cause cancer within a matter of a couple years or does it take much longer?

Thanks FH for your hard work. Much appreciated again.

[fishinghat]

No problem Lyla.  FYI, the half life of Cymbalta is 12 hours.

[invalidusername]

Peak blood level should occur ~3 hours in, so 6 hours should be OK, but obviously the further apart, the less likely an interaction.

 

Keep us posted Lyla...

[ForLyla]

So about 2 weeks ago I tapered 1 bead and a few days ago I tapered another. 2 days ago the heart pounding, insane nightmares, headaches, fatigue and the whole nine yards comes back. I wake up every hour. Guess I need to go back up? How long before I feel better you think? I'm worried that I threw myself into another months long withdrawal syndrome.

I'm so sensitive to any change. I guess from sibo maybe but this is very disappointing. How can tapering 2% be this bad?

[fishinghat]

I think you will remain this sensitive as long as you are fighting the sibo. Going back up one bead is up to you. Just depends on how bad things get. I would suggest in the future maybe dropping 1 bead every month and see how that goes. That is not very fast but at least you could possibly be gaining ground while fighting the sibo.

[ForLyla]

FH I tapered 2 beads over the course of about 2 weeks. I feel absolutely terrible. Not sleeping, heart pounding, anxiety and all the hell is back. I'm going back up today. Will this be a quick reversal you think or have I set myself up for another hellish few months of withdrawal symptoms on top of sibo?

I cant wait to do the elemental diet.

[fishinghat]

Probably a few weeks considering the sibo is probably making you more sensitive. Remember Cymbalta effects serotonin and serotonin manages your digestive tract. I fel so bad for what you are going through and can't wait for the sibo issue to be resolved. Sibo treatment is certainly a challenge that is for sure but w will take it one step at a time.

[ForLyla]

FH I feel like I'm dying. I'm wasting away. Losing weight like crazy. How long can I survive like this with all this chaos on my body and mind? 39 months now of mostly hell.

[fishinghat]

I wish I could answer that Lyla. When do you see the specialist about the sibo?

[ForLyla]

Already seen them. All these specialists are useless. All these months with severe acid reflux and wasting away, I wish I had just started with the elemental diet months ago. It's supposed to work in 85% of cases and if it doesn't work the first time then just do it again. Most people are just too scared to do an all liquid diet for 2 or 3 weeks but that will be a cake walk for me compared to what I've been through. I'd do anything to feel better again.

 

Just worried about how much damage the stress and reflux have done to me so far.