Q. How can I manage my chronic and recurrent gastrointestinal issues like GERD, SIBO, and IBD?

Answered by
Dr. Ajeet Kumar
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Aug 07, 2022

Hello doctor,

I have a bit of a long story here. I have been having gastrointestinal issues for about 13 years now. When it started, I suffered from an ulcer (H.pylori) which I cured, but now I have chronic gastritis and IBS - D (irritable bowel syndrome with diarrhea). I feel an urgency to go to the bathroom a few times, mainly in the morning, with bloating. Sometimes I have pain, brain fogginess, and fatigue. I found out I had hydrogen SIBO (small intestinal bacterial overgrowth) last year, and I had herbal antibiotics. I felt better for a while, but then it relapsed again. In the last couple of years, I started having some GERD (laryngopharyngeal reflux (LPR), swallowing issues, sore throat, and sometimes esophagus burn). I do not know what to do. I am not sure if this is a motility issue. Is this all caused by Sibo? Any suggestion is appreciated. I have tried proton pump inhibitors for LPR, but they make me nervous about taking them for a long time. Also, they make my digestion much worse. The only one I seemed to tolerate better was Lansoprazole. However, I am not taking that anymore.

I uploaded blood and stool test, abdomen radiology finding, endoscopy, colonoscopy, and thyroid panel. I take Pepcid (Famotidine), glutamine, vitamin D, slippery elm, and zinc carnosine. I take FDgard occasionally, but I do not see a difference. For throat inflammation, I am using a mix of distilled water with baking soda nose spray, which has helped a lot in reducing sore throat, globulus, and swallowing issues.

How can I cure myself? Is SIBO the root cause of everything I suffer from, or is SIBO a result of other issues?



Welcome to

I have seen all your reports (attachments removed to protect the patient's identity). They all are normal. Considering your symptoms, you likely predominantly have IBS-D (irritable bowel syndrome diarrhea). IBS is a functional problem of the large bowel, making it more sensitive to pain stimuli, causing loose stools and excessive gas and flatus. It is not uncommon to have other functional abdominal problems when one has IBS. In your case, you probably have available gas and bloating.

SIBO (small-intestinal bacterial overgrowth) is otherwise common, and the primary reason behind it is the proximal migration of colonic type bacteria in the small bowel. This, in turn, occurs because of abnormal motility of the large bowel and is a common feature of IBS. Also, SIBO is often recurring since you have some large bowel, which is the problem. Therefore, SIBO needs antibiotic treatment.

IBS must be treated with lifestyle modification, including daily exercise (swimming) and avoiding junk foods (high fodmap diet). And then there comes the role of anti-spasmodic type medications such as Mebeverine-135 mg thrice daily. Finally, you can have acid proton-pump inhibitors, whatever suits you, because they all essentially work to reduce acid.

Hello doctor,

Thank you for the reply.

I do have a few follow-up questions.

  1. Is IBS causing gastritis and GERD as well?
  2. Do you suggest Rifaximin for SIBO? How should I take it? For how long and should I be repeating?
  3. How long should I be taking Mebeverine? Is this supposed to fix or help the motility of the large bowel and, as a result, eventually help with the small intestine bacterial overgrowth?
  4. How long should I be taking PPI? I would hate to take it for too long since there are many side effects in the long run.
  5. Is this all I need to take?
  6. Doctors always mention the lack of stomach acid could cause all of this. So is there any merit to it, and maybe I should consider adding something to my diet like Betaine HCL or apple cider vinegar (of course, after hopefully fixing gastritis)?


Welcome back to

You have very valid questions.

IBS does not cause GERD or gastritis. Gastritis you have is non-erosive or non-ulcerative type. In other words, it is called non-ulcer dyspepsia or functional dyspepsia. The functional dyspepsia is again a functional problem, but with the stomach. You remember I said it is not uncommon to have two to three functional disorders of the gut at one time. IBS with functional dyspepsia, and functional gas with bloating, are the three different presentations of the same metabolic pathway of gut motility impaired in patients. These metabolic pathways of the gut are autonomous and not in the control of humans. It is influenced by lifestyle, diet, medications, infection, and genetics. These all factors come into play to cause functional bowel problems at once. Once we correct the lifestyle and diet and avoid medications that impair gut motility, the condition will revert to a normal bowel.

The following are my suggestions.

  • Rifaximin is good and should be taken 200 mg thrice daily for three weeks. The dose can be repeated more than once depending upon recurring symptoms of SIBO.
  • Mebeverine is a short-lived medication with a half-life of 4 to 6 hours. It is an antispasmodic and anti-secretory agent. It reduces the pain and decreases the volume of stools, thus helpful in IBS-D, your predominant condition. You must take an intermittent course lasting for a few days to one week and again retake it if symptoms recur.
  • The same with the PPI, but I do not think taking PPI for an intermittent duration, like days to one week, and then stopping for a week or so, would cause long-term complications. Or you can take it once a day, on the day where your symptoms are the worst. Meanwhile, you can take a simple antacid like alginate and milk of magnesia to control intermittent symptoms.
  • Your symptoms are not due to hypochlorhydria meaning low stomach acid production. It is more like a myth than reality. Most individuals have sustained the production of stomach acid for a relatively long time. It is possible in very old age individuals or individuals with stomach surgery or some autoimmune disorder such as pernicious anemia or atrophic gastritis.

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