HomeAnswersMedical GastroenterologysiboI have SIBO and pain triggered by gluten, dairy products, along with other factors. Please help.

What could cause SIBO and pain after taking gluten or other dairy products?

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Published At January 18, 2023
Reviewed AtJanuary 18, 2023

Patient's Query

Hi doctor,

I have pain triggered by gluten, dairy, and other unknown triggers.

I have positive SIBO (methane and hydrogen).

Please ask questions for details.

Thank you.

Hi,

Welcome to icliniq.com.

It seems you have celiac disease.

  1. Have you ever tested for that?
  2. Has anyone checked your Anti-TTG antibody (Anti-transglutaminase antibodies) levels?
  3. What type of diet are you taking?
  4. Is it gluten and dairy free?
  5. Have you got treatment for SIBO (Small intestinal bacterial overgrowth)?

Thank you.

Patient's Query

Hi doctor,

Thank you for your answer.

I also think I have celiac disease. I have a gluten-free and dairy-free diet. Eating gluten makes me extremely sick. I never got tested because I would be required to eat gluten for three months.

Despite a gluten-free and dairy-free diet, I get these extremely painful symptoms, sometimes it is triggered by the food I eat by accident (dairy, dill, and arugula), and I do not know what triggers the symptoms. Often the symptoms show when I wake up, but I do not know why.

I have been dealing with this for four years and want to find a solution.

I have not started any treatment for SIBO. I hear a lot of comments about the different options, some being more harmful than helpful, so I do not know what to do.

Let me know if you have any questions that might help you find a solution for me.

Thank you.

Hi,

Welcome back to icliniq.com.

I recommend you get tested for celiac disease.

There is no such thing that you need to take gluten for three months and then get tested.

Take gluten for one week and then get the following tests.

Anti-tTG - IgA and IgG anti-tissue transglutaminase antibody test for SIBO (small intestinal bacterial overgrowth).

Take Tablet Flagyl (antibiotic) 400 milligrams three times a day after a meal for seven days.

Once you have done this, let me know so I can help you further.

Thank you.

Patient's Query

Hi doctor,

Thank you for your answer.

Yes, it is a protocol. It usually lasts longer than three months.

I likely have another issue as I am following a very strict gluten-free diet but yet, I get these excruciating painful symptoms four times a day.

That is the part I still need to solve.

Would you be able to provide advice on that?

Is Flagyl for Methane SIBO or Hydrogen SIBO?

What is the effectiveness of Flagyl for these two types of SIBO?

Thank you.

Hi,

Welcome back to icliniq.com.

You should get checked for a food allergy panel for further evaluation.

Flagyl is effective in 40 to 50 % of both types of SIBO (Small intestinal bacterial overgrowth).

Thank you.

Patient's Query

Hi doctor,

Thank you for your answer.

I did check for allergies, and nothing came out.

  1. Are there any treatments that are more effective for the combination of SIBO?
  2. Would there be something I can take to handle the symptoms better?
  3. I am in excruciating pain about four days per week, which is difficult to handle.
  4. What do you think causes the pain?
  5. Would it be SIBO?
  6. What would cause pain specifically when I wake up?
  7. How are the three issues connected?

Thank you.

Hi,

Welcome back to icliniq.com.

I would recommend getting treatment for SIBO (small intestinal bacterial overgrowth). It will ease your symptoms.

Besides, there are also chances that you have a concomitant Irritable bowel syndrome.

For that Tablet Mebeverine (Mebeverine Hydrochloride 135 miligrams) works very well.

IBS (irritable bowel syndrome) usually causes such a type of pain.

These three issues can be connected, celiac disease causes malabsorption, but if the diet is gluten-free, it does not cause trouble. In patients with celiac disease, chances of IBS (irritable bowel syndrome) and SIBO (small intestinal bacterial overgrowth) increase.

Thank you.

Patient's Query

Hi doctor,

Thank you for your answer.

Can you tell me the different options for the treatment of SIBO (methane and hydrogen), along with their efficiency, advantages, and disadvantages?

Thank you.

Hi,

Welcome back to icliniq.com.

We normally have bacteria in our intestines, but a rise or fall in the variety of bacteria is possible due to certain changes. If those who have overgrown produce methane called methane SIBO and those who develop hydrogen develop hydrogen SIBO.

We usually notice more bloating and constipation in methane SIBO and diarrhea in hydrogen SIBO.

Both are not advantageous over one another and must be treated.

Thank you.

Patient's Query

Hi doctor,

Thank you for your answer.

What are the possible treatments and their efficacy, side effects?

I would like to know what my options are. I believe methane SIBO is now called SiMO as bacteria do not exactly cause it.

I have a positive results to SIBO and SIMO (methane SIBO).

Thank you.

Hi,

Welcome back to icliniq.com.

If we take a holistic approach, treatment in bacterial overgrowth syndrome (BOS) should include correction of the primary underlying disease, if any, including antibiotic therapy and nutritional support.

In your case, IBS (irritable bowel syndrome) and malabsorption syndrome secondary to celiac disease could be the reason for this.

Studies show that Rifaximin eradicates bowel overgrowth syndrome in as many as 80 % of patients.

Higher doses (1200 or 1600 milligrams per day) are more effective than standard doses (600 or 800 milligrams per day).

Long-term favorable clinical results have been achieved with Rifaximin (antibiotic) in patients with irritable bowel and bacterial overgrowth syndrome.

Flagyl (Metronidazole) is often tried, with results around 60 %. As it is readily available, so it is still worth trying.

Other antibiotics have also been used, like Tetracycline, Ciprofloxacin, and Co-amoxiclav.

Nutritional support with dietary modifications such as a lactose-free diet, vitamin replacement, and correction of deficiencies in nutrients like calcium and magnesium should be an important part of bacterial overgrowth syndrome treatment if present.

Methane formation occurs as bacterias ferment the products, so bacteria cause fermentation. Words are quite interchangeable.

Thank you.

Patient's Query

Hi doctor,

IMO is caused by archaea, which are not quite considered bacteria. The research has progressed, and we now know this additional information.

Rifaximin is effective at 80 % but only for hydrogen SIBO. It drops to about 30 % for IMO.

It is important to stay up to date with science. Otherwise, the patient's health will not improve.

I have a medical background and am quite knowledgeable on the subject.

Would you be able to provide recommendations based on up-to-date medical research? I understand it is time-consuming, but patients cannot get better if they are not recommended the right treatment.

Thank you.

Hi,

Welcome back to icliniq.com.

Thank you for the comments and information.

I must appreciate it, and you have worked very well on SIBO and advancements, including terminology.

It has been an evolving and hot topic for research as it can solve many problems related to functional GI (gastrointestinal) disorders.

You are right archaea and bacteria have some differences, and IMO (intestinal methanogen overgrowth) is caused by archaea.

Treatment for IMO (intestinal methanogen overgrowth) is very complex. You must know about many things like diet, previous or current diseases, drugs, surgery records.

You also need to choose antibiotics cautiously as Rifixamin combined with Neomycin can take a response to 87 %, but Neomycin has its own side effects.

Prebiotics and certain probiotics are quite useful as well.

If we go for precise medicines, we will need stool analysis and microbiome assessment.

Thank you

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

Dr. Rajesh Kumar Bansari
Dr. Rajesh Kumar Bansari

Medical Gastroenterology

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