Q. How can IBS related to SIBO be managed?

Answered by Dr. Sultan Zeb Khan and medically reviewed by iCliniq medical review team.

 

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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.


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Dr. Sultan Zeb Khan
MBBS., FCPS
Medical Gastroenterology

Hi,

Welcome to icliniq.com.

The best is to avoid eating foods that cause trouble. Secondly, for SIBO (small intestinal bacterial overgrowth), it is better to use a combination of Tetracyclines plus Metronidazole for two weeks. Effective probiotic will also help.

Take the following medications:

1. Tablet Tetracycline 500 mg thrice a day two weeks.

2. Tablet Metronidazole 400 mg thrice a day for two weeks.

3. Take a good probiotic for two weeks at the end of the previous two drugs.

4. Take fresh homemade yogurt twice daily in a small bowel.

 

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.

 

Dr. Sultan Zeb Khan
MBBS., FCPS
Medical Gastroenterology

Hi,

Welcome back to icliniq.com.

Yes, you can use tablet Itopride 50 mg or Levosulpride 25 mg thrice a day before meals for 2 to 4 weeks.

 

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.

 

Dr. Sultan Zeb Khan
MBBS., FCPS
Medical Gastroenterology

Hi,

Welcome back to icliniq.com.

Yes, you can use these drugs along with SSRI.

 
Thanks so much doctor. Very good response and good advice
 

Dr. Sultan Zeb Khan
MBBS., FCPS
Medical Gastroenterology

Yes you can use that if it's giving relief. Use fluconazole 100 mg for 2 weeks
 
 
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