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HomeAnswersMedical Gastroenterologyirritable bowel syndromeI have IBS and seems to be related to SIBO. Please advise management.

How can IBS related to SIBO be managed?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At March 5, 2019
Reviewed AtJanuary 20, 2024

Patient's Query

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.

1. Leaky gut or intestinal permeability with multiple food intolerances.

2. 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.

3. 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 that 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 recurring.

Please guide.

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 (Tetracycline Hydrochloride) thrice a day two weeks.

2. Tablet Metronidazole 400 mg (anti-anerobic) 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.

Patient's Query

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,

Welcome back to icliniq.com.

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

Patient's Query

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,

Welcome back to icliniq.com.

Yes, you can use these drugs along with SSRI.

Patient's Query

Hi doctor,

Thanks so much doctor.

Very good response and advice.

Hi,

Welcome back to icliniq.com.

Yes, you can use that if it is giving relief. I also suggest using tablet Fluconazole 100 mg for two weeks.

Patient's Query

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,

Welcome back to icliniq.com.

SSRIs are a good choice for patients with IBS (irritable bowel syndrome) constipation. You need to take some antispasmodics along with them plus acid suppression drugs as well. First of all, drink plenty of water at least 10 to 12 glasses per day. Take a fiber diet as much as possible. Regarding bacterial overgrowth, you can use tetracyclines and Metronidazole, but Metronidazole will increase your constipation. But one thing to remember is that in bacterial overgrowth there is usually diarrhea not constipation, so forget about SIBO (small intestinal bacterial overgrowth).

Take the following medications which will help with IBS constipation.

1. Tablet Mebeverine 135 mg thrice a day before meals for 4 to 8 weeks

2. Tablet Rifaximin 550 mg twice a day before meals for two weeks.

3. Tablet Clearlax (Bisacodyl) 15 mg once daily at night for one month.

I hope you will feel better.

Patient's Query

Hi doctor,

Thank you for the reply.

Is it possible to have a phone consultation, please?

Hi,

Welcome back to icliniq.com.

Yes.

Patient's Query

Hello doctor,

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

Hi,

Welcome back to icliniq.com.

Yes, I will be available at that time for the consultation.

Patient's Query

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-DNase 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?

Please help.

Hi,

Welcome back to icliniq.com.

SIBO (small intestinal bacterial overgrowth) is not caused by Streptococcus but it can cause a sore throat and sometimes heart infection and joint pains. Get yourself tested with echocardiography for the heart as well. I suggest taking Azithromycin for at least two weeks.

Take care.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Sultan Zeb Khan
Dr. Sultan Zeb Khan

Medical Gastroenterology

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