Xifaxan for IBS-D

[MikeOr]

I would be interested to hear from you if you have tried Xifaxan, and if it has helped.

[xjrs]

Xifaxan (Rifaximin) is for SIBO (small intestine bacterial overgrowth). There has been far too much hype about this and many people are making vast sums of money diagnosing IBS sufferers with this - particularly very easy to do since the tests for it are not accurate. Plus my gastro said it isn't as prevalent as people think.

I did try this and it did nothing for me, because I didn't have SIBO. You will only potentially have SIBO if you have one of the root causes of it. If you have a root cause, that would need treating first otherwise it will keep coming back after each round of antibiotics.

I've posted the cause list before. If you haven't seen that I can post it again if needed.

[MikeOr in reply to xjrs]

Thanks xjrs, that was my feeling, too. A friend of mine got a breath test that "found" SIBO, but a long (I think 2 weeks) course of Xifaxan made no difference to his IBS-D.

I would really appreciate if you post the SIBO cause list again.

[xjrs in reply to MikeOr]

Yes. I came back postive for both hydrogen and methane. You can get lots of false positives depending on individual transit times, which is why they are not accurate. Plus I had 2 individual therapists who interpreted my results completely differently, so there is no agreed bench mark and even if there was one, depending on transit time that bench mark wouldn't mean anything. Here is the cause list:

Note that the first four causes of SIBO in the list below should be identifiable through a small bowel MRI scan:

Stasis: dysmotility – problems with muscle contraction in the gastrointestinal tract

Surgery (loops, vagotomy, bariatric)

Short Bowel Syndrome

Stuck open ileocecal valve (which sits between the small and large intestine) allowing bacteria from the large intestine to flow back into the small intestine

Achlorhydria – no stomach acid – unlikely if you can experience acid reflux. Additionally a faecal elastase test would show if you aren’t breaking down proteins correctly (which require stomach acid for digestion)

Hypochlohydria – low stomach acid – see above – the only real test is a PH test directly into your stomach, but many practices do not carry this out and home testing is inaccurate

PPIs – proton pump inhibitors for GERD/acid reflux – this is particularly related to long term use

Malnutrition – excess bacteria in the small intestine can compete for nutrients that your body needs

Collagen vascular disease – immune system inflammation e.g. arthritis

Immune deficiency

Advancing Age

Chronic Pancreatitis – this causes constant abdominal pain/fatty stools

Chronic antibiotic use

IgA Deficiency – identified from GP blood tests

Coeliac Disease – identified from GP blood tests

Crohn’s Disease – identified through GP tests and colonoscopy if GP tests indicate referral is needed

NASH – non alcoholic fatty liver disease –identified from GP blood tests

Cirrhosis

Fibromyalgia – widespread pain

Rosacea

[MikeOr in reply to xjrs]

Thanks for this list. Some of the causes are a bit hard to treat, for example Advancing Age If the cause is non-fixable, are there any long term maintenance treatments that do not involve antibiotics ?

[xjrs in reply to MikeOr]

A question for a gastro. Unfortunately, this is a relatively new area with a lot of contraversey and difficulties. Though I believe that Rifaximin is localised to the small intestine from memory. Antibiotics and natural antimicrobials presumably work on the whole gut so could compromise the large intestine long term.

[MikeOr in reply to xjrs]

Rifaximin and Xifaxan (mentioned in the subject) are the same thing. So do you think that Xifaxan could be useful, and taken long term ?

[xjrs in reply to MikeOr]

Sorry, I'm not a medical professional. You might want to google search that question.

[Hidden in reply to MikeOr]

Sorry to hear about your problems. You don’t say whether you have been diagnosed with SIBO, which isn’t particularly common outside the conditions which have been listed above. Individuals over the age of 65 years,though, are particularly deficient in the so called “friendly” bacteria, and, under normal conditions, excepting certain conditions, should consider taking a probiotic regularly.

One of the factors mooted as a cause for the high morbidity and fatality associated with COVID in the over 65 years, was this deficiency of these protective, friendly gut commensals. The suggested causal effect also for those who were obese, on poor unhealthy diets, and those taking medications known to damage the gut microbiome.

Antibiotics, especially ones which affect the gut microbiome, such as the quinolones, cephalosporins, and metronidazole, are definitely to be avoided unless medical necessity arises, so longterm use of antibiotics, unless clinically indicated are to be eschewed , but should be accompanied by taking a reputable probiotic to reduce the damage. The effect of antibiotics is on the large bowel microbiome, directly through the presence in the lumen and by the absorption of the antibiotic in the small bowel which can also be excreted into the large bowel through the liver,depending on the pharmacology of the antibiotic concerned.

I am taking two excellent probiotics, Alflorex and Ferrocalm, for previously intractable symptoms of IBS-C, which are making a significant improvement to my problems.

In your position, assuming you are not suffering from SIBO, I would start off by taking Ferrocalm, especially if you are troubled by long periods of relapse of your IBS, adding Alflorex, waiting 2-3+months, then trying Symprove. In addition, ensuring a good balanced diet with plenty of so-called prebiotics is essential, although, one should bear in mind that these inulin contains foods are high FODMAP’s, and might produce adverse side effects. Therefore, a low FODMAPs diet should be considered in the treatment of IBS in general.

Enterosgel can be useful in those suffering from IBS-D, which is a toxin absorbent, and won’t adversely affect the gut microbiome.

Good luck !

[MikeOr in reply to Hidden]

Thanks Rob223344. My symptoms of IBS-D do not seem to be affected by the diet except that eliminating fat clearly helps. But I cannot stay forever on a fat free diet unfortunately. WRT probiotics, there are a lot of them around. Long before the onset of my current IBS-D I used to take Florastor (yeast, not bacteria) when travelling to prevent traveller's diarrhea. It ended up in a pretty bad diarrhea. Of course I don't know if it has been caused by this specific yeast, but one of the stool tests I had at the time mentioned "a lot of yeast" as one of the lab findings.

[Hidden in reply to MikeOr]

Very interesting. I presume that malabsorption has been excluded, and that you don’t have an anatomical or physiological predisposition to slow transit. There are treatments for candida overgrowth, but one would have to be certain about the infection before receiving treatment.I’m not certain to which probiotics you refer, but the ones I listed are worth a try. You might also try unpasteurised Sauerkraut, which does contain yeasts, if you haven’t done so already. Enterosgel is also potentially helpful. I suggested this, as well as Ferrocalm to friend recently, who suggested that they have changed her life. Naturally, individuals respond idiosyncratically, so one must not expect 100% success every time! Good luck!