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Syl, no problem, I have a ton of sibo information in regards to sibo and IBS. But

SIBO didn't pan out really as a "cause" of IBS, but some people can have sibo and IBS.

Bacterial Overgrowth Apparently Not Important in IBS

By David Douglas

NEW YORK (Reuters Health) Jun 04 - An abnormally high number of bacteria in the small intestine does not appear to be a major factor underlying symptoms of irritable bowel syndrome (IBS), Swedish researchers report in the June issue of Gut.

"The data," senior investigator Dr. Magnus Simren told Reuters Health, "do not support an important role for small intestinal bacterial overgrowth, according to commonly used clinical definitions, in IBS."

Dr. Simren and colleagues at Sahlgrenska University Hospital, Gothenburg note that a high prevalence of small intestinal bacterial overgrowth has been reported in patients with IBS, but those results were based on indirect determination using hydrogen breath tests.

They therefore assessed small intestinal bacterial overgrowth by a direct test -- bacterial culture of small-bowel aspirates -- among 162 patients with IBS and 26 healthy controls. Cultures revealed small intestinal bacterial overgrowth in 4% of patients and 4% of controls.

Signs of enteric dysmotility were seen in 86% of patients with overgrowth and in 39% of patients without. Nevertheless, say the investigators, motility alterations could not reliably predict altered small-bowel bacterial flora.

"However," said Dr. Simren, "mildly increased counts of small-bowel bacteria seem to be more common in IBS," but "its clinical relevance remains unclear."

Gut 2007;56:802-808.

also I asked Dr Drossman about the sibo

sorry its in bold type that is how he worte it into the email so I would see it was his answers.

"IT IS AN OVERSTATEMENT TO SAY THEY ARE "IRRITATING" SUBSTANCES AT LEAST
IN THE SENSE OF BEING SOME TYPE OF TOXIN. THEY ARE NATURAL BYPRODUCTS OF
DEGRADATION OF FOOD SUBSTANCES BY BACTERIA WHICH DON'T NORMALLY OCCUR IN
THE SMALL BOWEL. SO WITH INCREASED BACTERIA IN THE SMALL BOWEL, THE
BACTERIA ARE ABLE TO DIGEST SUGARS FOR EXAMPLE PRODUCING H2 AND CO2 FROM
THE SUGARS WHICH ARE GASEOUS BUT WHICH ALSO HAVE OSMOTIC PROPERTIES,
I.E. INCREASED PARTICLES THAT CAUSE SECRETION OF FLUID INTO THE BOWEL
THUS CAUSING DIARRHEA. IT'S THE SAME PRINCIPLE AS USING NON ABSORBABLE
SUGARS LIKE LACTULOSE OR SORBITAL TO TREAT CONSIPATION BY INCREASING
FLUID IN THE BOWEL. IT'S JUST THAT WITHOUT BACTERIA IN THE SMALL BOWEL,
IT DOESN'T HAPPEN AND THE FOOD SUBSTANCES GET ABSORBED. WITH INCREASED
BACTERIA IT COMPETES FOR THE FOOD SUBSTANCES AND PRODUCES THE GAS AND
DIARRHEA."

*This means these are just in the wrong place and not specific or multiple pathogens?*

CORRECT. HOWEVER, THERE IS GROWING INTEREST NOT IN THE AMOUNT OF
BACTERIA BUT THE TYPE OF BACTERIA. CERTAIN BACTERIA CAN CAUSE SOME MILD
INFLAMMATION OF THE BOWEL AND OTHERS PROTECT THE BOWEL FROM THAT
POSSIBILITY. SO THERE IS "GOOD" AND "BAD" BACTERIA. POSSIBLY WHEN PEOPLE
ARE TREATING PRESUMED SIBO (WHICH MIGHT NOT ACTUALLY BE HAPPENNING,
BECAUSE THE TEST MAY BE INACCURATE) ANTIBIOTICS MAY HELP TO GET RID OF
THE BAD BACTERIA AND THAT MAY BE WHY THEY ARE GETTING BETTER. THIS IS
WHY SOME PEOPLE GET BETTER AFTER ANTIBIOTIC TREATMENT. BUT IT CAN ALSO
GO THE OTHER WAY, I.E., ANTIBIOTICS HAVE BEEN SHOWN TO MAKE IBS WORSE AS
WELL. THE OTHER IDEA IS TO USE PROBIOTICS WHICH CONTAIN "GOOD" BACTERIA
(E.G., LACTOBACILLUS OR BIFIDOBACTERIA) WHICH REPLACE THE BAD BACTERIA,
POSSIBLY REDUCE THE INFLAMMATION AND IMPROVE SYMPTOMS. SO THE ISSUE OF
BACTERIA IN THE BOWEL IS MUCH MORE COMPLICATED THAN SIMPLE SIBO, BUT SIBO CAN BE A PART OF THE WHOLE PICTURE (THOUGH NOT THE WHOLE PICTURE FOR IBS).

Dr Drossman

This was at least a year ago and more has been learned on the connections between the two condition. Also people can have sibo without IBS and vise versa.

I have a ton more on all this

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My website on IBS is www.ibshealth.com

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