I spoke with one of the doctors at Cedars-Sinai today, and asked again about probiotics and fiber. Her response was that in their clinical experience, patients with IBS caused by SIBO already have a predisposition to bacterial overgrowth. Introduction of large amounts of bacteria, even if it is healthy bacteria in the case of probiotics, can easily contribute to overgrowth in these patients. She said that most of their patients who take probiotics report that it makes their symptoms worse, not better.
It's a similar story with fiber, though she believes it's not as potentially harmful for SIBO patients. If the fiber actually helps move stool through the intestines, then it is effective of course. But in many cases she's observed, the fiber does not increase motility and provides bacteria with a perfect source of food... leading to bacterial overgrowth and symptoms associated with fermentation (gas, bloating, etc.)
So that's their point of view. Based on the ineffectiveness of the treatment I just went through (antibiotics followed by Zelnorm, which works in 90% of their researched trials), her diagnosis is that although SIBO may have been contributing to my problems, it probably wasn't the cause.
She wants me to come back down there and have more tests: endoscopy with biopsy to rule out possible GI pathogens and infections, colonic motility/scintigraphic test (to determine if constipation is caused by nerve problem or muscle weakness), antroduodenal manometry (measure pressures in stomach and small intestine before and after eating) and a colonoscopy.
I still haven't been able to have a BM without an enema or HUGE doses of magnesium and vitamin C - both of which cause incredible amounts of pain, cramping, gas and bloating for the next 24-36 hours. I get to choose between the extreme discomfort and malaise that comes with constipation, or, the excruciating pain and discomfort that come with the use of harsh laxatives. So fun!!!
The doctor recommended MOM and castor oil as the least harmful laxatives. Perhaps I'll try these.
Chris
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Re: This doesn't completely make sense...
