Irritable Bowel Syndrome Clearly Linked to Gut Bacteria

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.

Thanks Waverunner - good to see the clear link established.

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.

Ibs is equivalent to cfs in that there are multiple causes. The authors apparently don't
realize that. Tc .. X

Love these gut bug studies!

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.

Hi Nanonug,

I think the Science Daily article is talking about this study:

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

Hmm, I think you are right! The sciencedaily article points to a different paper though (at the end of the page)...

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

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.

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.

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

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

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

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.

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

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.

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]

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.

Hi Mellster,
How much Pantesa are you taking?