Irritable Bowel Linked To Gut Bacteria, Definitively
#367531 - 05/30/12 04:34 AM
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Looks like Pimentel may be right after all.
http://www.medicalnewstoday.com/articles/245874.php
Cheers.
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ibs-d (pseudo)with pain and bloating
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but I wish they would address this aspect:
"They found that more than a third of the patients with IBS had SIBO, compared with only 10% of those without IBS. Of patients with diarrhea-predominant form of IBS, 60% had SIBO, compared to just over 27% without the diarrhea form."
It sounds like a subset of people diagnosed with IBS actually have bacterial overgrowth instead, and should be treated for that. They don't address at all the 40-70% of people with IBS in their study who did NOT test positive for bacterial overgrowth.
To me, this just says that there is yet another GI disorder (SIBO) that is being misdiagnosed as IBS. I can't conclude that it means that IBS actually is bacterial overgrowth across the board. The study itself refutes that.
I hope they follow up on this.
- H
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it says "Of the initial 320 subjects, 112 were IBS sufferers; 35 patients (31.2%) had IBS-D; 19 patients (16.9%) had IBSC; and 58 patients (51.8%) had IBS-A."
518 patients were screened and 320 subjects were enrolled if the met the inclusion criteria stated as "Inclusion criteria were: (a) age C18 years, and (b) clinical indication for outpatient upper GI tract endoscopy." There were a variety exclusion criteria including such things as recent antibiotic use, HIV and hypothyroidism. In other words, individuals were not enrolled solely because they had IBS or SIBO. They were enrolled because they were having an endoscopy.
"Before undergoing upper GI tract endoscopy, patients were asked to provide replies to a specific questionnaire trying to disclose the presence of IBS." The ROME II criteria was used to diagnosis enrolled individuals for IBS.
"Of the initial 320 subjects, 112 were IBS sufferers; 35 patients (31.2%) had IBS-D; 19 patients (16.9%) had IBSC; and 58 patients (51.8%) had IBS-A. Reasons for upper GI tract endoscopy among IBS patients were dyspepsia in 75 patients (66.9%), anemia in 24 patients (21.4%) and change of bowel frequency in nine patients (8.0%); the remaining patients had a list of other uncommon complaints."
During the endoscopy fluid samples were taken from 3rd part of the duodenum and cultured. "The most common bacterial species isolated from the duodenal aspirate of the 62 atients with SIBO were Escherichia coli (n = 23; 37.1%), Enterococcus spp (n = 20; 32.3%), Klebsiella pneumoniae (n = 15; 24.2%), Proteus mirabilis (n = 4; 6.5%), Acinetobacter baumannii (n = 3; 4.8%), Citrobacter freundii (n = 3; 4.8%), Serratia marscecens (n = 3; 4.8%), Staphylococcus aureus (n = 2; 2.9%), Pseudomonas putida (n = 2; 2.9%), Pasteurella multocida (n = 2; 2.9%) and Enterobacter aerogenes (n = 1; 1.6%)."
"Among these IBS subjects, 42 (37.5%) met the applied definition for SIBO." So of the 360 enrolled individuals 112 had IBS according to the ROME criteria and 37.5% of these meet the definition of SIBO. And "The frequency of SIBO was much greater among patients with IBS-D. More precisely, 33.8% of patients with SIBO were sufferers of IBS-D compared with 5.4% of patients without SIBO (P\0.0001) (Table 1)."
"Examining the relationship between SIBO and IBS, among the 62 patients with SIBO, 42 had IBS (67.7%). This was greater than the 258 patients without SIBO, whereby only 70 had IBS (27.1%) (Mantel–Haenszel common odds ratio estimate: 5.64; 95% CI 3.09–10.27; P\0.0001)."
This is not "definitive" evidence that bacteria can play a role in IBS. Given no methodological errors it is strong evidence that in a subset of individuals diagnosed with IBS using the ROME II criteria, particularly those with IBS-D, that bacteria likely plays a role.
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of an IBS diagnosis before they even apply the Rome Criteria. Same as screening out people with celiac, Crohn's, diverticulitis, etc. It sounds like SIBO is just another treatable gut disorder that can masquerade as IBS.
Not sure why they're trying to frame it as if IBS is actually bacterial overgrowth. I look at the study and get a different conclusion.
- H
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Your approach assumes that SIBO and IBS are not intertwined. It possible they co-exist and perhaps inseparable or the same at least for some IBS individuals. One of the objectives of the study was to look at the relationship between IBS and SIBO which was stated as "The study also aimed to further investigate the relationship between SIBO and IBS in the context of co-morbid conditions and drug intake (specifically proton pump inhibitor use)."
Unlike celiac's, SIBO, Crohns, etc there isn't a biomarker for IBS giving researchers a reliable way to separate IBS from SIBO if they are separable. At the moment the only way to determine if IBS and SIBO coexist or are independent from each other is by screening using the ROME II criteria and then apply proven statistical methods to the findings like those used in the study. Also, it is difficult and it is expensive to screen for SIBO as they did in the study. And a gold standard test for SIBO has yet to be developed.
It will be interesting to see how the GI community reacts to the study. And it will interesting to see if it has any impact on the FDA approval of Rifaximin.
I cannot wait to see how the relationship between IBS and SIBO is eventually resolved. 
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Is it possible that the overgrowth is not detected in the third part of the duodenum but would be detected further into the small intestine (closer to the colon) for many participants? Since an endoscopic scope does not enter the small intestine, a collection apparatus carried by a capsule endoscopy would need to be invented and used for this purpose.
Cheers.
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ibs-d (pseudo)with pain and bloating
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Very good question. I was wonder about that myself.
A previous study that cultured bacteria did aspiration from the jejunum using a catheter. They found only 4% of individuals with IBS had SIBO using concentration levels of more than 10^5 CFU/ml. In the paper you posted information about the authors state that when the concentration level was reduce to 10^3 CFU/ml then the jejunum aspirations showed a level of 43% not 4%. In the new study they used a level of 10^4 CFU/ml. Apparently there is still some debate about what level of bacteria should be used in the determination of SIBO. Also, in the previous study there were some methodological issues one of which was possible dilution of the fluid samples.
They are working on a GI capsule that can collect tissue samples. Perhaps the collection of small intestine fluid using a capsule might be possible too
Say Heather posted a link to the same study in a news release from Cedar Sina in the research library. It seems more balanced than the medical news today report.
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I guess we can all certainly agree that it's a very difficult thing to sort out all these different GI issues- there does seem to be at least the potential for two or even more of these issues to be present. Those of us with Celiac are often "screened out" of IBS studies, but if a person is strict in adhering to the Celiac diet, their Celiac should be in remission; it would not really be a cause for being screened out of studies for other GI issues. I have followed a very strict gluten free diet for nearly 10 years, but have had terrible IBS symptoms the past 3 years. I do also have SIBO (methane), but truly believe my problems are wrapped up somehow with all these different issues. I responded very well and very quickly to the IBS diet and still must adhere to it if I'm to be stable. BUT, I also still bloat and get pain even after being treated for SIBO.
I guess there is still just much to be learned in the world of IBS and other disorders. At least we can be thankful that we know so much about how to help ourselves feel better and deal with the pain, etc thru the various diets (IBS, Gluten-free, FODMAP...). I'm so grateful for this message board - it's very helpful to be able to get on here and read other people's questions and comments as we all try to work our way through our GI "stuff!"
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Definitive does appear in the first sentence of Heather's post, just not in the title.
In the Sedars Sinai protocol, if Rifaxamin fails the second step is 2 weeks (or more) of a liquid diet of a medical food called Vivonex. Vivonex is supposed to be digested very early in the first few feet of the small intestine thereby starving the bacterial overgrowth in the lower end of the ileum near the colon. This suggests that the bacterial collection should be taken from the lower end of the ileum near the colon.
Cheers.
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ibs-d (pseudo)with pain and bloating
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In the paper they acknowledge that ideally the sample should be taken from the proximal small intestine but there are difficulties with this approach. The reasons they give are "(a) the risk of contamination by bacterial flora of the oral cavity and of the upper respiratory tract, (b) anaerobe culture of specimens exposed to an aerobic environment prior processing, (c) interpretation of data [21], (d) access to only the most proximal small intestine, and (e) this method is only of research interest for the study of pathophysiology of patients but is too difficult for everyday clinical practice."
The Vivonex sounds like a rather unpleasant experience. Were you diagnosed with SIBO? If yes, have you tried the Vivonex routine?
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STABLE: ♂, IBS-D 50+ years - Science of IBS
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I believe all these problems go away if the sample could be captured using a swallowed capsule rather than an endoscopic probe.
Yes I was diagnosed with SIBO and did the Vivonex which did not help.
Cheers.
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ibs-d (pseudo)with pain and bloating
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Perhaps the transit time of the capsule could make a difference. In the papers on small intestine sampling they indicate the samples need to be cultured within 1-2 hours. It could take several hours or even a day for the capsule to exit the body after collecting the sample. It will interesting to see how this research evolves
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STABLE: ♂, IBS-D 50+ years - Science of IBS
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Thanks. I didn't think of that. Perhaps a way could be developed for the culturing process to take place within the capsule as it traverses the remainder of the small intestine and colon.
Cheers.
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ibs-d (pseudo)with pain and bloating
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I've been on the IBS diet for about a year and a half. All was going really well and then I started developing more unusual symptoms, such as arm pain and numbness in my fingers - among other things. My brother talked me into trying gluten free and these symptoms all but disappeared. Now I'm trying to stick to both programs, which takes a little getting used to with all the different foods that gluten is actually in. Things I could eat before are now off limits.
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Celiac disease
#367691 - 06/27/12 04:36 AM
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Syl
Reged: 03/13/05
Posts: 5499
Loc: SK, CANADA
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Have you seen a GI doctor about being tested Celiac disease ? It is a serious disease that shouldn't be self diagnosed.
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Syl, I am a bit confused.
In the article it is said:
Quote:
Following a well-balanced, gluten-free diet is generally the only treatment you need to stay well.
Then why shouldn't it be self-diagnosed? If ultimately that is what they are going to recommend.
The reason I am asking this is because it is only through self observation can we find out that we have symptoms that are repeatedly occurring like mouth ulcers, skin problems, joint pains etc. Also in the initial stages it appears to be under the umbrella of IBS.
It is also difficult to go back to taking gluten when you know GF diets are working alright.
_____________
IBS-D
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Celiac disease is a serious disorder whose management and diagnosis should always be done under the direction of trained health care professionals. A confirmed diagnosis of Celiac disease instead of suspected self-diagnosis of Celiac disease will ensure that you receive proper treatment for all subsequent health problems that takes into account a confirmed Celiac diagnosis. It is not worth while play around with a serious disease like Celiac disease.
In the article ''You don't need a prescription to go gluten-free'': The scientific self-diagnosis of celiac disease some of the people interviewed said that a firm diagnosis from a health care professional stopped others including family and friends from calling them hypochondriacs. A medical diagnosis becomes part of a patient's formal medical record and medical personnel recognize it as legitimate.
There is also an interesting statement in Celiac Disease for Dummies written by two MDs. "If you have not been diagnosed with celiac disease, yet you find yourself feeling better after starting yourself on a gluten-free diet, don't take this as evidence that you have this ailment. In fact, a recent study showed that only one-third of people in this situation actually had celiac disease. The other two-thirds of the group were using a rather restrictive diet to treat conditions that should have been treated in other ways. The only way to be definitively diagnosed with celiac disease is to first have a small intestine biopsy."
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Thanks Syl for the info about Celiac disease.
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Yes, I have been tested. I'm not intolerant, but for sure sensitive as are a number of people in my family
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Dear Heather,
Your site and info has been a help to me these now 12 years I've been dx with a "sensitive gut" with bouts of IBS-D symptoms (but did not fit full criteria). Mainly it was morning gas and discomfort, crazy gurgling stomach at night, and sometimes nausea- it's morphed all around, symptoms waxing and waning, chronic and usually mild, w/ flare ups when exhausted etc. This all followed a long trip to Central America and gastrotitis attack. New fab GI said I'm not satisfied w/ "IBS" dx with you (endoscopy and colonoscopy were negative) so I want you to go have this hydrogen breath test. So many dead endds I put it off a year. New BF who traveled in a lot of 3rd world places said you have to do this. Well GUESS WHAT?? Normal baseline 0-15, mine was 58. Average spiked count for someone w/ SIBO- 48 at END of two hour test. Mine was 120 after ONE hour!!! I am so happy that this med I read about rifaximin may cure me- or at least really reduce things- and I have to follow a diet too I think. Have not seen GI yet- only tester at hospital. But I want to pass this on bc there may be people like me who don't know about this test who had these symptoms that don't fit IBS perfectly, after a GI "attack" (food bourne in my case abroad) and must insist on this test! I will be interested to see what happens to me now! Wishing you all the best!!! Maggie
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and a helpful diagnosis. Why this test isn't given right off the bat to people who kinda sorta fit the IBS criteria remains a mystery. They're still not often tested for celiac, or fructose intolerance, or even inflammatory bowel diseases either. You have to insist and sometime also persist - like you!
Best,
H
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Sorry, what is this test and what exactly do I ask for I am so weary of this I would love to know what tests I need to ask for please. I am in Australia and my GP just wants me to stay forever on gastro stop (loperamide). Please tell me what the test is for and what to ask for and what is SIBO? Thank you.
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SIBO is small intestine bacteria overgrowth. It has not been confirmed that it is related to IBS. While some people with IBS are treated with an antibiotic for SIBO so far the evidence shows that only about 10-15% of individuals with IBS 'may' have SIBO. However, the antibiotics don't cure the problem they only reduce symptoms in some people for a while and then frequently they have to take another course of antibiotics. The FDA in the US won't approve the use of antibiotics for treating IBS last year. You might talk to your GP about SIBO. The test is a breath test but it is not conclusive.
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STABLE: ♂, IBS-D 50+ years - Science of IBS
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