Irritable Bowel Syndrome Message Boards

Here is a long write-up one SIBO that I wrote for another group. Something to note - the antibiotic used in the US to treat SIBO -Rifimaxin - is not approved for use in the UK or the US for treating IBS. The US FDA refused approval last year due to lack of evidence and very high rate of re-occurrence of symptoms require many repeats. It is being used off label in the US as it is available to treat traveller's diarrhoea.

It was hypothesised by Dr. Pimental 2006 in a book he wrote titled "A New IBS solution" that most (70%+) individuals with IBS also had SIBO - small intestine bacterial overgrowth - which could be cured or controlled using antibiotics. This sparked a big debate in the IBS research community. Eventually it was found that the test (lactulose breath test) that was used for diagnosing SIBO was problematic leading to many false positives. When an expensive and accepted test was used the findings showed about 4% of IBS individuals had SIBO.

A couple years ago the company that makes the non-absorbable (i.e. from the gut into the body) antibiotic Xifaxan (rifaximin) applied to the FDA for approval for its use to treat IBS-D. It was rejected for a variety of reason. For example, the efficacy was low and the symptoms returned at a high frequency after treatment. Dr. Bolen who writes a regular column about IBS on About.com wrote an article about Xifaxan in which she did a critical analysis behind the headline news and points out these problems. You can read it here

http://ibs.about.com/b/2011/01/09/the-two-week-xifaxan-for-ibs-study.htm

Over the past 20 years it has become apparent from some improvement by some people with probiotics and antibiotics as well as the onset of IBS after a diverticular diseases or GI infections (PI-IBS and PD-IBS) that colonic bacteria - collectively known as the microbiota - seemed to be evolved in the etiology of IBS. Dr. Quigley, past president of the American College of Gastroenterology and the World Gastroenterology Organization is a researcher in this area as well as a practising GI doc wrote the above comments in one of his recent articles on how the gut bacteria effect GI motility. He is not a strong believer in the SIBO theory.

If one can manage IBS/SIBO reasonably well using dietary approaches like the FODMAP approach this might be the best option as the likelihood that antibiotics will give complete and continuous relief is very low - if at all. And repeated antibiotic treatment without knowing exactly which organisms are being treated doesn't make sense given the possibility for antibiotic resistant to occur and other side effects. If you have tried **ALL** other options and you have serious IBS-D then it might be worth considering.

Here is a fairly recent article by Dr. Quigley Small intestinal bacterial overgrowth: what it is and what it is not

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STABLE: ♂, IBS-D 50+ years - Science of IBS

The FODMAP Approach to Managing IBS Symptoms
Evidence-based Dietary Management of Functional GI Symptoms: The FODMAP Approach
FODMAP Chart & Cheatsheet
The Role of Food & Dietary Intervention in IBS

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