SIBO tests

[BBEliza25]

I had a test for SIBO in Dec 2017 which was negative. My symptoms (bloating and gas) are worse now and I have been told SIBO tests are now more accurate & sophisticated than they were 3 yrs ago. Anyone know if it is worth having another test - anyone done this?

[Tara_Jane]

Yes. Go for it. Make sure it’s a breath test that asks for multiple samples.

[Nancydk]

I did it years ago and again recently. Its similar but I did it at home. No idea how accuracy compares as I was positive both times.....much moreso the first time though.

[userotc]

Just some caution. I believe I had a false positive in my test a year ago. You may be able to find a reference to that by viewing my posts in past few months eg Aug 19, otherwise pm me and I'll send details if you want.

[xjrs]

Unfortunately there are no accurate SIBO tests - the breath tests are inaccurate. The only sure way is an operation to aspire liquid from the small intestine and test that. Obviously due to the invasive nature I've only seen this conducted in research studies and probably to find out how inaccurate the other SIBO tests are!

If you truly suspect SIBO, I was presented with this handout which shows the root causes of SIBO:

clinicaleducation.org/docum...

On the right hand side you will see the box containing the heading "Aetiology" which actually means 'a set of causes'. I went through this list with my gastroenterologist and I have added comments from my own health perspective.

He said that these areas would be covered by the Small Bowel MRI scan that I had:

• Stasis: dysmotility – not apparent

• Surgery (loops, vagotomy, bariatric) – not apparent

• Short Bowel Syndrome - not apparent

• I also added ileocecal valve (which sits between the small and large intestine) to this list, which my therapist kept going on about. She said that my ileocecal valve was stuck open allowing bacteria from my large intestine to wash back into my small bowel and I'd need to visit an osteopath who practices visceral (organ) manipulation to get them to close it for me (or you can do it yourself via a youtube video). I had to go to another city 1.5 hours away to visit such an osteopath who eventually said he didn't manipulate the ileocecal valve (although a phone call indicated he might), but I had a couple of sessions of him manipulating my intestines because they were stiff. My small bowel MRI showed there was nothing at all wrong with my ileocecal valve - it was closed and showed no inflammation or any abnormality that would cause SIBO.

And now for the rest:

• Achlorhydria – no stomach acid – he said this was highly unlikely and also considering I can experience acid reflux

. I also would have thought a fecal elastase test would show if you aren't breaking down proteins correctly (which require stomach acid for digestion) and mine came back OK.

• Hypochlohydria – low stomach acid – same answer as above – the only real test is a PH test directly into your stomach, but he said they didn't do this any more and home testing is inaccurate

• PPIs – my therapist said that I hadn't been on PPIs long enough to make a difference

• Malnutrition – no

• Collagen vascular disease – immune system inflammation e.g. arthritis – not in my case

• Immune deficiency - unlikely

• Advancing Age – no

• Chronic Pancreatitis – this causes constant abdominal pain/fatty stools - no

. It is interesting that another IBS Network member had responded to Rifaxamin but was also diagnosed with a compromised pancreas.

• Chronic ABX use – no

• IgA Deficiency – my tests show this is normal range

• Coeliac Disease – I had blood tests with the GP and these came back fine

• Crohn’s Disease – I had blood tests with the GP and these came back fine

and colonoscopy was OK

• NASH – non alcoholic fatty liver disease –looked at my records for this and this is normal

• Cirrhosis - no

• Fibromyalgia – widespread pain - no

• Rosacea – no

I don't know whether this list helps at all, but might be worth working through with a GP or gastroenterologist from your perspective. If you don't have any of these it's highly unlikely you have SIBO. If you do have SIBO and the root cause isn't tackled, it will only keep coming back.

You might also want to read this about SIBO:

drchristianson.com/is-sibo-...

[Summersun1 in reply to xjrs]

Can I ask do you know how long you’d have to be on ppis to cause a SIBO issue? I took a month course and I’m struggling with lower gut pain bloating trapped gas (stopped 2 weeks ago) and I’m wondering if SIBO is a possibility although I wasn’t on them for long...I do have ibs but I’ve been symptom free as have worked with a dietician on the low FODMAP diet and lifestyle management. This feels different to my usual ibs symptoms as it’s been a constant for the last few days GP says it’s just my sensitive gut readjusting after the ppis, I had nausea all last week but that’s passed (GP said likely rebound acid issue)

Thanks

[xjrs in reply to Summersun1]

I had been on ppis for 6 months and I was told that 6 months wasn't long enough to cause SIBO issues - this is more for people who had been on them for years I believe. It is possible you are adjusting to coming off ppis. As mentioned below Alforex probiotic has settled my system so much that I am now able to tolerate many FODMAPs - I previously needed to be on a very low FODMAP diet.

[Summersun1 in reply to xjrs]

Thank you that’s reassuring to know. I doubt it’s SIBO far more likely my v sensitive gut adjusting. I’m seeing a new dietician in a couple of weeks as I still have some FODMAP to challenge but there’s quite a few I’m fine with. Hope this passes soon making me miserable! I used Alflorex a while ago but it gave me a lot of pain sadly so frustrating as I’ve been symptom free until I took PPIs

[xjrs in reply to Summersun1]

Sorry to hear the Alflorex didn't work for you. How long did you try it for since they say that you can get symptoms initially and then they can die down. Usually 2 months or slightly more is a good test. I'm glad there are lots of FODMAPs you can tolerate since FODMAPs are very good for your health. When I did the FODMAP elimination and reintroduction there were hardly any I could tolerate.

[Summersun1 in reply to xjrs]

Mmmm only a few days as I was miserable and uncomfy a bit like now 😂I’m just praying this calms down over the next week or so but I’ll see what new dietician thinks as maybe time to try probiotics again!

[xjrs in reply to Summersun1]

Yes might be worth giving them a go for longer. Precision Biotics who manufacture Alflorex have a help line where they can support you through the initial phases and let you know whether what you are experiencing can be considered 'normal' for the stage you are at.

[xjrs]

I'm also just wondering what else you have tried to help your symptoms? Here is some information about IBS that I have shared with others in this group which you might find useful if you are not aware of some of these aspects already:

IBS can be due to a number or combination of factors - these can be stress (including stress from early life experiences) which impacts the communication between the brain and the digestive system. There are lots of free webinars online at the moment regarding mindfulness meditation which might help. Plus you can ask to be referred for CBT or something similar to reduce your anxiety - I would have thought online appointments are available. Exercise can play a major role in IBS in terms of reducing stress, helping your gut microbiome and regulating bowel movements.

There is also not absorbing certain types of carbohydrates called FODMAPs very well, the residue ending up in the colon and bacteria feeding off them causing symptoms. Ordinarily feeding gut bacteria is a really good thing - when you feed good gut bacteria these produce by-products that have great health effects in the gut and throughout the body. However, in some people with IBS bad bugs might have the upper hand over good - these bad bugs may cause symptoms such as pain, gas, bloating or disordered bowel movements. There is an interesting infographic on this here:

gutmicrobiotaforhealth.com/....

This is why it’s worth trying probiotics such as Alflorex (which has been scientifically studied for IBS) or Symprove to crowd out the bad bugs and make their numbers die down. If that doesn't work you can try the FODMAP elimination and reintroduction diet. This is normally under the guidance of a nutritionist via GP referral - this may not be possible at the moment so you can read about it online. If you download the Monash University FODMAP app it will tell you which foods contain FODMAPs and in what quantities. You can eliminate all FODMAPs for 2 weeks and then introduce each type of FODMAP one at a time starting in small quantities, increasing over a 3 day period and wait up to 4 days for symptoms. I go much slower than this - only introducing a small amount (1/4 to 1/3 of a normal portion size) of the same food for 3 days and then increase if tolerable or no symptoms and cut back to the previous amount if symptoms for longer and then try to increment again . I've read your microbiome can adapt to handling a new food if introduced very slowly and your bad bugs are under control with a good probiotic. Ideally you want to eat as many FODMAPs as you can since they are good for your health. Many people with IBS don't have diverse gut bacteria - it has been found that people who lack a diverse microbiome are more prone to diseases in general. In the long run, if you can get your symptoms under control, the ideal situation is to have a very varied diet - lots of different coloured fruits and vegetables, a variety of protein and carbohydrate sources including cereal fibres. This may seem a long way off, but with the right treatment all of this is possible. Last year all I could consume to control my IBS was white rice, protein and limited low fodmap veg. Using the approach above (particularly introducing Alflorex) I am now able to consume far more foods - more than I've ever dreamed of including wholewheat bread which is unheard of for me.

If you are also suffering from pain, you may be suffering from visceral hypersensitivity (functional abdominal pain) - there is info about it here:

iffgd.org/lower-gi-disorder...

It is where the brain interprets the normal activity of the bowel as pain - this is due to a wearing down of neurons in pain control centres of the brain which can be caused by PTSD, neglect or abuse in childhood, extreme stressful events etc. The first line treatment is nerve pain agents such as low dose amitriptyline. There is a theory that being on something like amitriptyline for 6-12 months can help the pain control centre neurons to regenerate. Note that amitriptyline can cause constipation, but this can be helpful in people who are diarrhea dominant. Unfortunately I couldn't tolerate these. Linaclotide (for IBS-C only) & Alflorex have helped me with this intestinal pain.

By the way as per my post above I was told by nutritional therapists that I had SIBO when in fact I didn't. They spent ages killing off my microbiome with antimicrobials and antibiotics which made me very ill, much worse than where I started. The best way to shift any large intestine gut imbalances is with probiotics.

You may also find assistance with anti-spasmodic medication such as mebeverine (Colofac) or enteric coated peppermint.

You can find some info on self management here:

theibsnetwork.org/the-self-...

[Tara_Jane in reply to xjrs]

Interesting. I was tested for SIBO and it came back positive. SIBO treatment has changed my life! I’m all but back to normal. So it pays to try.

[xjrs in reply to Tara_Jane]

Unfortunately it's a bit of pot luck. Glad it worked for you. If anyone is considering it it would be best to do it under the guidance of a gastroenterlogist, so they can consider all the other aspects i.e. whether you have any of the root causes and tackle those first prior to coming to a conclusion.

[Tara_Jane in reply to xjrs]

Definitely. For me it was easy to determine the root cause. I was perfectly healthy before being under-medicated for my thyroid. Then it was a knock on effect that went something like this..

Hypothyroidism > low stomach acid > poor motility > gastroparesis > major deficiencies (including vit D and iron) > anemia > cadida > sibo

All because my doctor thought my T4 was too high and didn’t take into account that my T3 and TSH were fine. 🙄 Thanks Doc.

[xjrs in reply to Tara_Jane]

Great that you were aware of the root cause - so important to avoid it returning if you have it. Sorry to hear your thyroid has been mismanaged.

[Tara_Jane in reply to xjrs]

Thanks. 🙂 Honestly, if we had a dollar for every time we hear about the medical profession mismanaging thyroid issues...

💰💰💰💰💰💰💰💰💰💰

[Ollie2]

I tested positive for SIBO last year and was prescribed Rifaximin 2 a day for 1 month, didn’t work for me. It was suggested I cut out wheat from my diet. I’m now 90% wheat free it’s made a huge difference regards bloating and gas. If you haven’t tried that yet, it might be worth a try

Hope you get relief soon

[BBEliza25 in reply to Ollie2]

Are you just avoiding wheat or all gluten?

[Ollie2 in reply to BBEliza25]

I saw a Kinesiologist who suggested I give up lots of different foods most of which I already knew, and some I’ve already gone back on. The big surprise for me was wheat, and dairy. That really has made a big difference . if I can’t get wheat free products I go gluten free - I would get bloated and gassy but not as bad

There are lots of own brand wheat free products in Tesco and Marks Most supermarket and bakery’s have spelt and honey bread some are lovely, some like cardboard. I often make my own with spelt flour. I made my own pizza from scratch only with stuff I can eat- heaven! I eat small amount wheat at times also as there is a lot of things disagree with me and it’s the best of a bad lot.

Hope this helps

[301246]

I would say what is the point of having the test at all. From my experience , my test was positive for hydrogen and yet the gastroenterologist took absolutely no action. I wonder what the remedy is. In the USA they use Rifaximin but that's mainly for IBS-D. It's not the first line of defense in the UK.