Methane Overgrowth

[JT1992]

I have IBS M and have done for a while (used to be D but now changed to M). I came back from Brazil and had horrendous diarrhea for almost 3 weeks. All tests with the GP came back clear.

I started the fodmap elimination as well as going on sertraline and taking 1 tbsp of a linseed mix wiith my breakfast.. the stools have got much better, but still have the major gas and bloating every evening. I have done 6 weeks at elimination now and haven't started reintroduction as I am still not symptom free.

I paid for a SIBO test through healthpath which I have put off for over a year (£165...) but it has come back with high methane levels. I was always looking at hydrogen sibo because of the D.. so now I am thrown.

If anyone has any experience with this please can they pass on their advice.

I am yet to speak to the GP regarding the results but I have a strong feeling he won't be prescribing me the antibiotics.. everytime I have mentioned SIBO to him he has dismissed it. Quote: 'it's just IBS'

[Jackie1612]

sorry to hear this JT1992. Years ago, I paid for a test and my GP, although not really, recognising the test, took me more seriously as I had paid so much for it.

Are you able to see a different GP? Perhaps you could emphasise your problems since your trip to Brazil? The GP might order some more tests.

I hope this works out for you.

[JT1992 in reply to Jackie1612]

Thanks for the reply. Did your GP prescribe you the antibiotics, and did you manage to get rid of the overgrowth? My GP has actually been a lot better since I said about how bad it was after Brazil, and he did more stool and blood tests (all clear). He said the next step will be that he will contact the gastro team for advice so I am hoping he will ask them about treatment for the methane overgrowth

[Jackie1612 in reply to JT1992]

thanks for your message.

No, I didn’t get any antibiotics! He prescribed Imodium liquid, as I found the tablets would cause constipation. I could take the liquid in much smaller amounts and this really helped.

I hope you get the right advice from the Gastro team

[xjrs]

Unfortunately SIBO tests are not accurate. I was tested for hydrogen and methane and had a high reading for both. Nutritional therapists diagnosed me with SIBO based on these tests and were treating me for it. They nearly killed me with highly restrictive diets, recommending I take antibiotics and throwing anti-microbials on top of that. I lost loads of weight, became really ill and a shadow of myself.

Luckily I ended up with a good NHS gastro who diagnosed me with IBS-C and visceral hypersensitivity.

In all likelihood you may have picked up a bug from Brazil. My IBS started around 25 years ago after food poisoning from a trip to Mexico. In your shoes, the first thing I would try would be Alflorex probiotic, which has been scientifically studied for IBS on a 3 month trial, to help bring the microbiome back in balance. If during the 3 months, your symptoms get worse and worse and worse from taking the probiotics, rather than gradually improving over a long period of time, there is an outside chance it is SIBO since you might be adding more bugs on top of ones in your small intestine. However, please note, true SIBO cases are rare and not as common as the scavenging 'health industry' makes out. To have SIBO you would have to also have one of its predisposing factors - I have a list of these if you want it. Unless the cause of SIBO is treated, it will keep coming back, so there is no point in treating SIBO without treating its cause first.

In summary, try a very good probiotic such as Alflorex, if this makes your condition far worse at the end of the 3 month trial, speak to your GP regarding the possibility of SIBO whilst presenting the list of causes, so you can work through whether there is any possibility of having one of those.

[JT1992 in reply to xjrs]

I tried Alflorex at the start of the year after having surgery and it made me so much worse. I would love to try it again, but I'm scared to as I have only just got the D under control.

The bloating, gas, and Ibs M has been going on years.. but the D was very bad after Brazil for a few weeks.

I have Endometriosis and was on PPI's for over a year so I think that's why I was told by a dietitian to get a SIBO test.

I think my GP will referring me back to the gastro, but I haven't got high hopes as the last time I went there I was just told 'cut out gluten and dairy', although that was 4 years ago now..

[xjrs in reply to JT1992]

Sorry to hear that. Probiotics can make some people worse initially and then they settle. As mentioned if probiotics for a while make you worse, then SIBO might be indicated. I can understand your reservations if the D is more controlled now. Regarding the PPI's and SIBO, as I understand it, this refers to long term use. I'm not sure a year or so of PPI's would be considered long term. I'd been on PPIs myself, possibly for a similar time frame and was told that it wasn't long enough to cause SIBO (although I never had it in the first place). Hope you are referred to the gastro and get help with getting to the bottom of it (no pun intended!)

[b1b1b1 in reply to xjrs]

I agree with xjrs that you may have picked up a bug in Brazil. If things don't clear up or at least improve a lot, you may want to talk to a gastroenterologist or even a specialist in tropical medicine. Hopefully things will improve before you have to resort to that, however. I also agree with xjrs re SIBO. To me, it is a bit of a stretch to come back from Brazil with a problem, and at a similar time to develop SIBO. I did have SIBO and the overwhelming symptom was BMs that were sticky almost like glue. Sorry for TMI.

[JT1992 in reply to b1b1b1]

Sorry I don't think I was very clear.. after Brazil I had D for a few weeks but that seems to have settled.. the bloating , gas and IBS M I have been going through a bad flare up for over a year now :/

[DonnyInPain in reply to xjrs]

What are the SIBO predisposing factors please?

[xjrs in reply to DonnyInPain]

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 reflu. 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

If you do have SIBO and the root cause isn't tackled, it will only keep coming back.

[JT1992 in reply to xjrs]

Thank you for all of this info. I am surprised Endo is not on there as someone told me that is one of the main causes of Sibo. I thought having regular constipation could also be a cause as the stool is not being evacuated fully each day. Did they mention this to you?

[xjrs in reply to JT1992]

Neither of these were mentioned to me. Probably best to push for a gastro appointment and discuss it all with them.

[DonnyInPain in reply to xjrs]

I have fatty liver changes (not yet full blown NASH) and my BM when D is a bright yellow (sorry for TMI) which I've found out could be because of problems with the liver. So my gut could be suffering because my liver is fatty? Germs from my liver getting to my gut?

[xjrs in reply to DonnyInPain]

I'm not sure of the mechanics. Probably best to discuss this with a GP/gastro.

Though, I've just googled the link between these and found this:

ncbi.nlm.nih.gov/pmc/articl...

The internet is great.

[DonnyInPain in reply to xjrs]

Thank you so much for this! It's very helpful.