Sibo and Silent reflux

[Dragonfly66xx]

I was diagnosed with Sibo, silent reflux , low stomach acid and coeliac. Does anyone have experience how to get rid of Sibo without antibiotics. The stomach is also swollen like balloon .I also need to increase stomach acidity. Because of the Sibo I can’t consume kefir and sauerkraut. I have tried diluted apple cider vinegar but this experiment still ended with a sore throat.

[xjrs]

Who diagnosed you with SIBO, silent reflux , low stomach acid and coeliac? What tests did they carry out to come to this diagnosis?

Do you have any of the underlying causes of SIBO? It is only possible to have SIBO if you have one of its root causes. Focus should initially be on treating the cause of SIBO, then tackling the overgrowth of bacteria, otherwise it will keep coming back. 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

[Dragonfly66xx in reply to xjrs]

I had blood test done for Coeliac. SIBO breath test- positive for methane. Alkaline stool PH.Elevated levels of fat and carbohydrates in the stool- maldigestion. I was taking PPI for quite long time.

[xjrs in reply to Dragonfly66xx]

Was this all through the NHS?

Just be aware that breath tests are not accurate and can have false positives. This is what happened to me. I followed a SIBO protocol and it made me far worse in the end, since I didn't have SIBO. I also was on PPIs for a couple of year stretches, but was told this wasn't long enough to cause SIBO.

One thing of interest is whether you've tried probiotics and if these make your symptoms far worse over time or have symptoms improved? If it makes symptoms worse over a 3 month trial that might be an indicator, you have SIBO (though not guaranteed).

I understand that Rifaxamin acts locally in the gut - but that is mainly for hydrogen, I believe.

Just be careful going down the SIBO route. If you don't get any relief from the protocols for a short period of time, you may not have SIBO.

You may find this of interest:

zoe.com/learn/why-understan...

[Tuscansun in reply to xjrs]

Could you clarify how Rosacea can be a cause of SIBO please?

IMO Rosacea is a symptom that something is wrong with your gut - not the other way around.

[xjrs in reply to Tuscansun]

In that particular case, I think it is more of an associative link. Since SIBO is hard to test for, having rosacea may be an indicator that it is present:

omedhealth.com/insights-hub....

[Tuscansun in reply to xjrs]

Yep, agree with that! For me majors SIBO (SIFO) indicators are fatty “floating” stool and bloating.

[xjrs in reply to Tuscansun]

Though both those symptoms could be related to gas, so it is quite a mine field 🙂.

[Tuscansun in reply to xjrs]

But it’s bacteria that produces gas. Too much gas is an indicator of too much bacteria in the gut.

[xjrs in reply to Tuscansun]

All of this is not absolute and definitive.

Bloating can be caused by trapped gas in a particular part of the small intestine, caused by poor gas clearance which can be due to poor abdominal muscle tone.

Floating stools can be due to fibre consumption:

medicalnewstoday.com/articl...

You can't definitively identify SIBO from symptoms, since there are so many overlaps with other things, unfortunately.

[Tuscansun in reply to xjrs]

I agree that many symptoms overlap and you cannot rely on them for accurate diagnosis.

However, regarding trapped gas. Where do you think that gas is coming from? All gas in our gut is produced by our microbiome. It’s not external gas coming from outside environment.

[xjrs in reply to Tuscansun]

Here is my research into bloating and gas:

In studies, when healthy individuals are continuously fed gas into the intestines, they normally evacuate all gas without discomfort, passing more easily when a person is standing than laying down. They can tolerate 1.8 litres per hour and distension is related to the amount of gas within the gut. There is a better tolerance to gas when the gut is relaxed and if it is in the large bowel rather than the small bowel. (3)

Daily evacuation of gas in healthy people is around twenty times, depending on diet. Some foods are fermented in the large intestine producing gases, since they are not completely absorbed in the small intestine. This includes some dietary fibres, starches, complex carbohydrates such as beans and sorbitol and fructose sugars. Beans contain a compound that blocks the intestinal enzyme that helps to digest starches in the small intestine meaning more enters the large intestine thus increasing gas production through fermentation. (3)

Many IBS sufferers complain of excessive gas production, but studies have shown that the volume of gas produced by IBS sufferers is normal (1) (3) (7).

However, gas related pain and bloating in IBS sufferers may be connected to impaired transit of gas (3), resulting in gas retention and distension. However, a study using sophisticated measuring techniques didn’t find excessive retention of gas in IBS subjects (3). In contrast, the transit of solids and liquids didn’t experience significant abnormalities (3). IBS patients demonstrate symptoms such as intestinal gas retention, abdominal distension, and/or abdominal symptoms from an intolerance to intestinal gas loads that would normally be well tolerated by healthy subjects (1) (2) (3) (5). Studies that involved the infusion of gas into the intestines of IBS patients showed impaired gas clearance due to abnormal gut reflexes which lead to delayed gas transit and retention (3).

It is often thought that gas is retained in the large intestine. However, a study of those complaining of bloating had the movement of infused gas tracked through different areas of the intestines using radioactive isotope. It was found that the small intestine was responsible for the impaired gas transit. Other studies found that gas infused into the first part of the small intestine, stayed there, since it was not propelled into further parts of the intestine. However when infused into more distant parts of the intestine, it cleared normally. This means that in IBS patients, the total volume of gas is not increased, but it tends to pool in specific areas resulting in a perception of distension and bloating due to IBS patients being hypersensitive (responsive to stimulation) to the presence of excess gas in these areas. Bloating relates to a feeling that can result from fullness after eating, constipation, functional dyspepsia or IBS (8). Whereas, distension relates to the increase in abdominal girth. Often this perception of distension evolves during the day and resolves overnight. Measuring techniques have found that this distension, that is a wider girth, is real and not just perceived. (3)

In healthy subjects, electromyography, which highlights electrical impulses in the muscles, has shown that there is abdominal muscle contraction in reaction to the volume of infused gas in specific areas, that is, the body adapts to the handling of the excess gas. However, in those complaining of bloating, this reflex contraction does not happen which leads to abdominal protrusion, even though there isn’t a true increase in the overall volume of gas. Subsequently, it is the abnormal control of abdominal muscles that causes the bloating and not necessarily gas in itself. (3)

The Rome Foundation explains the mechanics of bloating and distension (8):

Meals stretch the stomach or intestines causing the bloating sensation

A brain reflex response to the sensation is to move the diaphragm down into the abdomen and relax the abdominal wall muscles

Due to the increase in pressure, the abdominal cavity pushes out through the abdominal wall leading to distension (abdomino-phrenic dyssynergia)

Bloating and distension are independent. Some experience bloating and no distension and others have distension without a bloating sensation. The Rome Foundation may treat this with rebreathing techniques, central neuromodulators (drugs to reduce hypersensitivity improving brain regulation of the sensation to raise thresholds for bloating and pain), and less commonly biofeedback with esophageal probes. By treating the brain/gut communication bloating sensation may be reduced thus decreasing the possibility of distension occurring as a reflex to the bloating. (8)

10%-30% of healthy individuals experience bloating often, frequently or greater than 25% of the time meaning that bloating is not just limited to IBS sufferers. Some people who have gained weight might complain of bloating perhaps due to a reduction in volume into which abdominal contents can expand due to abdominal fat stores. As mentioned, weakness in abdominal muscles may also play a part. A third of patients complaining of bloating are unable to do one sit up. In addition to abdominal exercises, physical activity generally may help bloaters. (16) Theoretically, if part of the issue is connected with abnormalities in the gut/brain connection, gut directed hypnotherapy apps such as Nerva may help.

Latterly it has been suggested by scientists that gut microbiota hydrogen and carbohydrate metabolism may be altered in patients with IBS, which contributes to gas formation and abdominal pain (19).

[xjrs in reply to Tuscansun]

Further, normally (and when SIBO isn't present), most bacteria is concentrated in the colon (large intestine). This is where fermentation of fibre and undigested foods occurs and gas is produced as a by-product. You don't need to have SIBO to have what feels like excessive gas.

[Tuscansun in reply to xjrs]

Yes but with SIBO you have double that. And it’s not just SIBO - it can be SIFO or both at the same time. Which is probably the worst.

[xjrs in reply to Tuscansun]

Undoubtedly more research and better diagnostic tools are needed.

[Tuscansun in reply to xjrs]

Totally agree

[Nobby21]

No personal experience, but Dr William Davies (Supergut book & you tube) uses fasting and L reuteri yoghurt to treat SIBO. Dr Eric Berg (you tube) also has things to say about healing digestive system, and increasing stomach acidity to reduce acid reflux.

[Dragonfly66xx in reply to Nobby21]

Amazing video from dr. Eric Berg. Very good explanation. Thank you!

[Starfush in reply to Nobby21]

Just came here to say. Fasting whether intermittent 18 hours or full 24+ .

[Mutleyforever]

Well done for getting those tests done!, another good you tube video is by Elliot Overton, who talks about 5 steps to address sibo without antibiotics, he also mentions L. Reuteri for use in the recovery phases. I am taking Cider apple vinegar twice a day, but maybe you could try the gummies with the mother or Betaine hydrochloride . Hope it is of help!

[Dragonfly66xx in reply to Mutleyforever]

Thank you!