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Irritable Bowel Syndrome Clearly Linked to Gut Bacteria

Waverunner

Senior Member
Messages
1,079
SIBO seems to be one of the root causes of IBS. Rifaximin seems to be the best treatment approach so far. If probiotics cause problems for you, I would highly discourage you from taking them.

http://www.sciencedaily.com/releases/2012/05/120525103354.htm

ScienceDaily (May 25, 2012) — An overgrowth of bacteria in the gut has been definitively linked to Irritable Bowel Syndrome in the results of a new Cedars-Sinai study which used cultures from the small intestine. This is the first study to use this "gold standard" method of connecting bacteria to the cause of the disease that affects an estimated 30 million people in the United States.

Previous studies have indicated that bacteria play a role in the disease, including breath tests detecting methane -- a byproduct of bacterial fermentation in the gut. This study was the first to make the link using bacterial cultures.
The study, in the current issue of Digestive Diseases and Sciences, examined samples of patients' small bowel cultures to confirm the presence of small intestinal bacterial overgrowth -- or SIBO -- in more than 320 subjects. In patients with IBS, more than a third also were diagnosed with small intestine bacterial overgrowth, compared to fewer than 10 percent of those without the disorder. Of those with diarrhea-predominant IBS, 60 percent also had bacterial overgrowth.
"While we found compelling evidence in the past that bacterial overgrowth is a contributing cause of IBS, making this link through bacterial cultures is the gold standard of diagnosis," said Mark Pimentel, MD, director of the Cedars-Sinai GI Motility Program and an author of the study. "This clear evidence of the role bacteria play in the disease underscores our clinical trial findings, which show that antibiotics are a successful treatment for IBS."
IBS is the most common gastrointestinal disorder in the U.S., affecting an estimated 30 million people. Patients with this condition suffer symptoms that can include painful bloating, constipation, diarrhea or an alternating pattern of both. Many patients try to avoid social interactions because they are embarrassed by their symptoms. Pimentel has led clinical trials that have shown rifaximin, a targeted antibiotic absorbed only in the gut, is an effective treatment for patients with IBS.
"In the past, treatments for IBS have always focused on trying to alleviate the symptoms," said Pimentel, who first bucked standard medical thought more than a decade ago when he suggested bacteria played a significant role in the disease. "Patients who take rifaximin experience relief of their symptoms even after they stop taking the medication. This new study confirms what our findings with the antibiotic and our previous studies always led us to believe: Bacteria are key contributors to the cause of IBS."
The study is a collaboration with researchers at Sismanogleion General Hospital in Athens, Greece, and at the University of Athens.
 

mellster

Marco
Messages
805
Location
San Francisco
Interesting - note that there is a few gut specialists that think Pimentel has it backwards: there is general inflammation first which then allows the gut to become out of balance and be colonized with too many of the wrong bacteria. Thus treating the inflammation (e.g. with Mesalamine/Pentasa) or its root cause should correct the SIBO by itself. This is of course a chicken and the egg problem and almost impossible to prove.
 

nanonug

Senior Member
Messages
1,709
Location
Virginia, USA
SIBO seems to be one of the root causes of IBS. Rifaximin seems to be the best treatment approach so far.

What is even more interesting is that in the case of IBS-C, the culprit are archaea and not bacteria. In this case, a combo of rifaximin together with neomycin or metronizadole appears to do the trick.

The paper that sciencedaily is talking about is, I believe, this one:
Methanobrevibacter smithii Is the Predominant Methanogen in Patients with Constipation-Predominant IBS and Methane on Breath

Here is "daddy" himself talking about this stuff: DDW 2012. I owe this guy my first successful treatment for IBS-D. As such, I have a strong man-crush on him.

By the way, I was "cured" of my CFS and IBS-D a few years ago after getting rid of Helicobacter pylori infection and taking rifaximin.
 

xchocoholic

Senior Member
Messages
2,947
Location
Florida
Would clarithromycin, keflex and metronidazole kill the same bacteria that causes sibo ?

There really are a lot more reasons for ibs that sibo.

I hate it when researchers make blanket statements like this. How many times have these people made the same kind
of claims about cfs ?

It makes for an exciting read for other half wits but that's all .. Lol .. Tc .. X
 

Glynis Steele

Senior Member
Messages
404
Location
Newcastle upon Tyne UK
Would clarithromycin, keflex and metronidazole kill the same bacteria that causes sibo ?

Hi,

I would imagine that other minimally absorbed abx would work against these bacteria, but would also point out that each person's gut bacteria are unique, with some responding to abx that would not be effective in another person, depending on their abx resistance, if that makes sense, lol. o_O
 

nanonug

Senior Member
Messages
1,709
Location
Virginia, USA
Would clarithromycin, keflex and metronidazole kill the same bacteria that causes sibo?

When I first took amoxicillin and clarithromycin for Helicobacter pylori infection, I noticed an immediate and strong improvement in my IBS-D symptoms (meaning, all the IBS-D symptoms disappeared.) However, after a couple weeks, those symptoms came back again. After taking rifaximin, my IBS-D was gone for months. Given that that rifaximin is a non-systemic antibiotic, you can take tons of it. In addition, it is incredibly board spectrum against both gram-positive and gram-negative bacteria (not good against archaea, though).

There really are a lot more reasons for ibs that sibo

Maybe that's true considering that IBS is not a disease but a set of symptoms (same as with ME/CFS). However, Pimentel is the only one with both the science and a strong clinical trial in his bag. Other researchers continue to talk about functional bullcrap.

It makes for an exciting read for other half wits but that's all

Well, in my case, the impact was very real for my quality of life.
 

xchocoholic

Senior Member
Messages
2,947
Location
Florida
Hi,

I would imagine that other minimally absorbed abx would work against these bacteria, but would also point out that each person's gut bacteria are unique, with some responding to abx that would not be effective in another person, depending on their abx resistance, if that makes sense, lol. o_O

I read that these are broad spectrum but with new info coming out on which
bacteria does what all the time I wasn't sure where the research is on this.

I just finished treating with all three of these so I was wondering if I needed to be tested for sibo.

Btw. S boulardi fixed the d caused by either h pylori or the antibiotics within a few days.

Tc .. X
 

nanonug

Senior Member
Messages
1,709
Location
Virginia, USA
Btw. S boulardi fixed the d caused by either h pylori or the antibiotics within a few days.

Yes, saccharomyces boulardii is something I always take when taking antibiotics, systemic or non-systemic. It is great protection against clostridium difficile overgrowth/infection.
 

xchocoholic

Senior Member
Messages
2,947
Location
Florida
When I first took amoxicillin and clarithromycin for Helicobacter pylori infection, I noticed an immediate and strong improvement in my IBS-D symptoms (meaning, all the IBS-D symptoms disappeared.) However, after a couple weeks, those symptoms came back again. After taking rifaximin, my IBS-D was gone for months. Given that that rifaximin is a non-systemic antibiotic, you can take tons of it. In addition, it is incredibly board spectrum against both gram-positive and gram-negative bacteria (not good against archaea, though).



Maybe that's true considering that IBS is not a disease but a set of symptoms (same as with ME/CFS). However, Pimentel is the only one with both the science and a strong clinical trial in his bag. Other researchers continue to talk about functional bullcrap.



Well, in my case, the impact was very real for my quality of life.

Hi nanonug,

I'm happy to hear this helped you but hope you realize that this isn't the only reason for cfs or ibs.
And researchers who want to promote a one cause / one solution to either are wasting time. How hard is it
to look for multiple causes ?

I lost 10 lbs in one month due to non stop d back in june 2005. I think that's when I first got celiac disease. I changed my diet
from sad to wfsfefcf (gf later) etc. etc
and it stopped. I'd had explosive D and then would have C for many years prior but heard I had ibs-d / c. What a crock ...

That's just one example .. I got accute food poisoning 3 times last year but I'm sure lesser infections would cause
D in some.

I have a freind with severe diverticuli that get inflamed all the time ..

Tc .. D
 

oceanblue

Guest
Messages
1,383
Location
UK
Er, this looked really interesting until I looked at the abstract referenced by the Science daily paper: n=9!! So unless the story is about another paper this amounts to nowt so far:
from Sciencedaily report:
Journal Reference:
  1. Gene Kim, Fnu Deepinder, Walter Morales, Laura Hwang, Stacy Weitsman, Christopher Chang, Robert Gunsalus, Mark Pimentel. Methanobrevibacter smithii Is the Predominant Methanogen in Patients with Constipation-Predominant IBS and Methane on Breath. Digestive Diseases and Sciences, 2012; DOI: 10.1007/s10620-012-2197-1
Abstract
Purpose

Among irritable bowel syndrome (IBS) patients, breath methane producers overwhelmingly have constipation predominance (C-IBS). Although the most common methanogen in humans is Methanobrevibacter smithii, incidence and type of methanogenic bacteria in C-IBS patients are unknown.
Methods

By use of a questionnaire and lactulose breath testing, subjects with Rome II C-IBS and methane (>3 ppm) were selected (n = 9). The control group included subjects with IBS who had no breath methane (n = 10). Presence of bacterial DNA was assessed in a stool sample of each subject by quantitative-PCR using universal 16S rDNA primer. M. smithii was quantified by use of a specific rpoB gene primer.
Results

M. smithii was detected in both methane and non-methane subjects. However, counts and relative proportion of M. smithii were significantly higher for methane-positive than for methane-negative subjects (1.8 × 107 ± 3.0 × 107 vs 3.2 × 105 ± 7.6 × 105 copies/g wet stool, P < 0.001; and 7.1 ± 6.3 % vs 0.24 ± 0.47 %, P = 0.02 respectively). The minimum threshold of M. smithii resulting in positive lactulose breath testing for methane was 4.2 × 105 copies/g wet stool or 1.2 % of total stool bacteria. Finally, area-under-curve for breath methane correlated significantly with both absolute quantity and percentage of M. smithii in stool (R = 0.76; P < 0.001 and R = 0.77; P < 0.001 respectively).
Conclusions

M. smithii is the predominant methanogen in C-IBS patients with methane on breath testing. The number and proportion of M. smithii in stool correlate well with amount of breath methane.
If there has been a mix up with the paper than please let me know.
 

Glynis Steele

Senior Member
Messages
404
Location
Newcastle upon Tyne UK
Er, this looked really interesting until I looked at the abstract referenced by the Science daily paper: n=9!! So unless the story is about another paper this amounts to nowt so far:
from Sciencedaily report:
Journal Reference:
  1. Gene Kim, Fnu Deepinder, Walter Morales, Laura Hwang, Stacy Weitsman, Christopher Chang, Robert Gunsalus, Mark Pimentel. Methanobrevibacter smithii Is the Predominant Methanogen in Patients with Constipation-Predominant IBS and Methane on Breath. Digestive Diseases and Sciences, 2012; DOI: 10.1007/s10620-012-2197-1
If there has been a mix up with the paper than please let me know.

Hi Oceanblue,

I think we worked out that the study we were talking about was this one:

http://www.researchgate.net/publica...re_Relationship_with_Irritable_Bowel_Syndrome

Perhaps Science Daily linked the wrong study? I believe the author wrote both studies and they appear to be side by side in relation to time-wise and study subject.
 

CBS

Senior Member
Messages
1,522
<snip>
Here is "daddy" himself talking about this stuff: DDW 2012. I owe this guy my first successful treatment for IBS-D. As such, I have a strong man-crush on him.

By the way, I was "cured" of my CFS and IBS-D a few years ago after getting rid of Helicobacter pylori infection and taking rifaximin.

I have had great success with Rifaxamin and my SIBO (IBS-D; diagnosed first by culture in 2007 at the Mayo - the only thing the Mayo clinic did right- and later by hydrogen/methane breath testing). Culture sampling is not widely available and it is susceptible to contamination by bacteria in the mouth/esophagus/stomach yielding a false positive if it is not done carefully.

My experience is also consistent with Pimentel's statement that the underlying issue is a loss of motility due to neurologic dysfunction/damage. As I have posted elsewhere, I am seeing some surprisingly positive results from a trial of Equilibrant. I started taking Equilibrant at the end of my last cycle of Xifaxamin in October. Pimentel states (in the video link above) that Xifaxamin provides relief for about 3 months. That was about what I was getting from a course of Xifaxamin. I'm now nearly eight months out from my last course of Xifaxamin and I am SIBO symptom free (still dealing with ME). Dr. Chia's hypothesis is that in boosting your immune system your body can more successfully suppress the enteroviruses which are known to interfere with the neural action in the digestive tract.

In 2009, before starting on Xifaxamin I contracted a GI campylobacter infection that lead to septic shock. Four days on the heart/lung unit at the regional medical center convinced me that the combination of GI and immune issues should not be taken lightly.

FWIW,

Shane

 

Waverunner

Senior Member
Messages
1,079
My experience is also consistent with Pimentel's statement that the underlying issue is a loss of motility due to neurologic dysfunction/damage.

This is exactly what I think. Low numbers of certain neurotransmitters could cause or aggravate SIBO. A messed up gut in the next turn could lead to even more messed up brain chemistry etc.. When talking to a gastroenterologist, he told me that 90% of his patients with SIBO also have diabetes, which messes up their gut motility.

This is why I think that certain drugs like Linaclotide could help with this problem. They normalize motility, increase the number of goblet cells and decrease intestinal permeability.
 

oceanblue

Guest
Messages
1,383
Location
UK
Hi Oceanblue,
I think we worked out that the study we were talking about was this one:
http://www.researchgate.net/publication

Perhaps Science Daily linked the wrong study?.
Thanks, hadn't refreshed the page from an earlier visit so missed the intervening updates before I posted. The new study looks much better, though not as compelling as the authors imply

Here's the abstract [I've calculated the relevant numbers in square brackets to match the given percentages]
Objectives

Many studies have linked irritable bowel syndrome (IBS) with small intestinal bacterial overgrowth (SIBO), although they have done so on a qualitative basis using breath tests even though quantitative cultures are the hallmark of diagnosis. The purpose of this study was to underscore the frequency of SIBO in a large number of Greeks necessitating upper gastrointestinal (GI) tract endoscopy by using quantitative microbiological assessment of the duodenal aspirate.

Methods
Consecutive subjects presenting for upper GI endoscopy were eligible to participate. Quantitative culture of aspirates sampled from the third part of the duodenum during upper GI tract endoscopy was conducted under aerobic conditions. IBS was defined by Rome II criteria.

Results
Among 320 subjects enrolled, SIBO was diagnosed in 62 (19.4%); 42 of 62 had IBS (67.7%). SIBO was found in 37.5% of IBS sufferers [42 ex 112]. SIBO was found in 60% of IBS patients with predominant diarrhea [21 ex 35] compared with 27.3% without diarrhea [21 ex 77] (P = 0.004). Escherichia coli, Enterococcus spp and Klebsiella pneumoniae were the most common isolates within patients with SIBO. A step-wise logistic regression analysis revealed that IBS, history of type 2 diabetes mellitus and intake of proton pump inhibitors were independently and positively linked with SIBO; gastritis was protective against SIBO.

Conclusions
Using culture of the small bowel, SIBO by aerobe bacteria is independently linked with IBS. These results reinforce results of clinical trials evidencing a therapeutic role of non-absorbable antibiotics for the management of IBS symptoms.

A few comments:
  • Although the sample of 112 IBS patients is quite large, they were IBS patients who had been given an upper GI endoscopy so may well not be representative of IBS patients in general.
  • Most IBS patients (62%) did not have SIBO
  • As others have pointed out, correlation is not causation
Given that IBS is often cited as another 'Functional Somatic Syndrome' it would be nice to nail it to a gut bacteria problem but this research isn't strong enough to do that.

However, using the data above, compared with the other endoscopy patients IBS patients had an Odds Ratio of 5.6 of having SIBO (95% CI 3.1-10.3, my calcs, PM me if you want the spreadsheet). Such a high Odds Ratio is rare and does suggest something important is going on.