SIBO?

[Dr Nick Read]

It sounds as if you have suffered from post infectious IBS. In other words, your gut has remained sensitive after a bout of gastroenteritis. This explains why you are intolerant to foods that produce gas and distend the gut as well as those that irritate it and cause contraction. So fatty foods, coffee, hot spices and high fibre foods will cause problems as well as Fodmaps. In most people, symptoms clear up fairly quickly after a bout of gastroenteritis, but research indicates that symptoms will persist if the original bout of infection was associated with anxiety or depression and especially if the emotional tension has persisted. You are clearly very worried about your symptoms and need to break the vicious cycle by relieves the symptoms and/or the anxiety.

I doubt you have SIBO and in my opinion, the breath tests are not a reliable indicator for this. The bowel does not have to be inflamed to be sensitive and if you have inflammation, it is likley to be minor and probably of little long term consequence.

I would be inclined to address whatever else might be causing the anxiety and try to quell that. And for more information, why not consult the IBS Network's Self Care Plan (www.theibsnetwork.org/the-self-care-plan).

Dr Nick Read

[Dr Nick Read]

1. Your advice was correct. We don't know much about blastocystis. Will be good to see the results of his research.
2. Perhaps not, but it wouldn't have interfered with the metranidazole.
3. No, stress is never really the sole cause, but it's such an important one, as it can sensitise the bowel, causing bloating, spasm and giving rise to food intolerance. And it's something that you can do something about.
4. fodmaps foods would not cause belching. That is something else perhaps reflux of bile into the stomach producing CO2 or swallowing air or transient relaxations of the lower oesophageal sphincter, all of which can be exacerbated by emotional tension. But why should stress affect the gas produced by fodmaps? it wouldn't necessarily but it will make you more aware of gaseous distension by increasing sensitivity.
5. The effect of stress on dyspeptic symptoms didn't go away when they discovered helicobacter (just like the fact that depression exacerbated TB was not dysproven by effective antibiotics for TB). Diseases are often multifactorial. Somebody may sometime discover a major specific cause and treatment of IBS, but until they do, treating stress is one of the most effective remedies we have.
6. Yes it may be worth trying relaxation methods again.
7. the diagnosis of SIBO is made by interpretation of breath tests, an early rise in hydrogen after a load of sugar, but I suspect this is a misinterpretation caused by rapid transit of the sugar to the colon. Having pioneered breath tests (to assess transit time) in the nineteen eighties, I think as a test for SIBO, it is flawed. When researchers have tried to collect and culture samles from the small intesine, it hasn't confirmed the results of the breath tests. SIBO is not necessarily a cause of fatigue, but IBS is often associated with chronic fatigue and emotional tension features prominently.
8. Rifamixin is a non absorbed broad spectrum antibiotic that probably acts by reducing benefical populations of bacteria in the colon, this reducing fermentation, but we know that these bacteria are protective and we destroy them at our peril because of the risk of antibiotic associated colitis, a much more serious illness.

It seems that the only things that has worked for your sensitised bowel, James, are the combination of FODMAPs, hypotherapy and yoga - FOOD and MOOD. http://www.theibsnetwork.org/the-self-c ... oodandmood

Hope this helps, Nick