Q. How can IBS related to SIBO be managed?

Hi doctor,

I realize I have IBS symptoms and they seem to be related to SIBO. I need your advice on how to treat it effectively. Here are some symptoms and test results.

Leaky gut or intestinal permeability with multiple food intolerances. Seems to have hydrogen sulfide based SIBO, severe farting with a foul smell of eating foods like cabbage, broccoli, cauliflower, high protein foods. I may have an overgrowth of sulfate-reducing bacteria. Rifaximin seems to help with SIBO but it is temporary. I have to eat rice as I cannot eat gluten or wheat. Some experts on SIBO say that MMC or vagal nerve dysfunction is the root cause of SIBO. I have heard a lot of patients get better when they increase gut motility. So I wanted to ask if taking prokinetic or cholinergic support will help SIBO from reccuring.

Thank you doctor,

I have tried Metronidazole but it caused me side effects. So I had to stop it. A lot of the serotonin gets created in the gut and I do have OCD. How about taking a prokinetic that is a 5HT4 receptor agonist that can stimulate gut movement.

Hi doctor,

Thank you so much. I am on SSRI. So, is it fine if I take the tablet you mentioned? Hopefully, there is no interaction or increase in serotonin levels.

Hi doctor,

Thanks so much doctor.

Very good response and advice.

Hi doctor,

I consulted you for IBS/SIBO issues.

I want to take your opinion again, here are my main issues:

1) IBS symptoms, severe gas, and farting.

2) IBS constipation.

3) Sometimes I suddenly feel cramps in my stomach and my palms sweat.

For the last few days I have had sounds in the stomach, and irritation in the stomach, accompanied by increased anxiety. I am on SSRI but that does not seem to help when I have an IBS flare-up and seem to have lactic acid when I eat carbohydrates or rice. I cannot tolerate fermented foods, probiotics, or sulfur foods as it increases my symptoms. I read some research articles where it says that SSRIs block the serotonin transporter in the gut and cause constipation. Please advise if I can take antibiotics for the bacteria overgrowth and anything that can regulate serotonin in the gut.

Hi doctor,

Thank you for the reply.

Is it possible to have a phone consultation, please?

Hello doctor,

I got a message for a phone consultation at 3.30 PM today. Just wanted to inform you. Thanks

Hello doctor,

I had a throat infection and I had to take the antibiotic Azithromycin 500 mg 1-0-0 for five days. I got myself tested for Streptococcus pyogenes antibodies and I have high titers (anti-BDNase and ASO).

During the course of the antibiotics, I reduced my nervous shoulder tics, my anxiety, and my carbohydrate cravings and I am able to reduce my sleep medication by almost half. Could I have an overgrowth of Streptococcus SIBO? And what medicines will work for this?