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Sibo Recurrence
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In addition to presumed non-celiac glucose intolerance I've been battling recurring SIBO for the last 5 or 6 years. Was finally diagnosed in 2009 and I'm now on my 4th course of rifaximin (antibiotic) over the last two years due to relapse/recurrence.

I know there are a number of other people here with current or past) SIBO and I know it's common for it to recur...

Has anyone had any success with stopping SIBO for good?

I'm slowly modifying my diet to try to drastically cut down on sugar/carbs (I fear I'll never be able to elminate it completely though)and going gluten-free definitely helped, but I'm back on antibiotics right now, so I know that's not enough by itself.

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Yes, I had 8 bacterial, parasitic and yeast overgrowth 'infections' over a 4 year period. However, I was diagnosed with each of those by stool tests which identified the exact 'bug' and tested which drugs and/or botanicals could kill my specific bug. Then I was given a treatment which was specific (according to lab tests) to that gut bug. I eliminated every gut bug and then found a doctor who discovered the source of my low immunity: (1) low stomach acid (dx'd by Heidelberg capsule test), (2) low thyroid function (blood tests for TSH, free t3, free t4, TPOab), (3) low vitamin D3 levels (blood test) and (4) low good bacteria (stool test). After treating all those 'causes' (and killing the last overgrowth parasite), I haven't had another gut bug 'overgrowth' for almost 2 years after that 4 year period of infections. (Subsequent stool tests were clear of 'bad' levels of gut bugs.) So I want to ask you:

How were you diagnosed with 'SIBO'?

Did your diagnostic test identify the exact gut bug (bacteria, parasite or yeast)?

Did your doc prescribe rifaxim because tests showed it would kill your specific gut bug? Or did your doc prescribe rifaxim, becuase he considers it an all purpose antibiotic (none exists)???

Have you had a stool test(s) which identifies your good and bad gut bacteria?

Are you taking probiotics after each treatment with rifaxim? How potent (number of live cells per capsule) are your probiotics?

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Yes, I had 8 bacterial, parasitic and yeast overgrowth 'infections' over a 4 year period. However, I was diagnosed with each of those by stool tests which identified the exact 'bug' and tested which drugs and/or botanicals could kill my specific bug. Then I was given a treatment which was specific (according to lab tests) to that gut bug. I eliminated every gut bug and then found a doctor who discovered the source of my low immunity: (1) low stomach acid (dx'd by Heidelberg capsule test), (2) low thyroid function (blood tests for TSH, free t3, free t4, TPOab), (3) low vitamin D3 levels (blood test) and (4) low good bacteria (stool test). After treating all those 'causes' (and killing the last overgrowth parasite), I haven't had another gut bug 'overgrowth' for almost 2 years after that 4 year period of infections. (Subsequent stool tests were clear of 'bad' levels of gut bugs.) So I want to ask you:

How were you diagnosed with 'SIBO'?

hydrogen breath test

Did your diagnostic test identify the exact gut bug (bacteria, parasite or yeast)?

No. The HBT doesn't do this...unfortunately.

Did your doc prescribe rifaxim because tests showed it would kill your specific gut bug? Or did your doc prescribe rifaxim, becuase he considers it an all purpose antibiotic (none exists)???

I presume the latter, however rifaximin has worked for me 3 out of the 4 times I've taken it (at least in terms of symptom-improvement).

Have you had a stool test(s) which identifies your good and bad gut bacteria?

no

Are you taking probiotics after each treatment with rifaxim? How potent (number of live cells per capsule) are your probiotics?

I have been, yes. I took Align twice and another rband I got at the health food store once. None of them seemed to make a bit of difference, although I assume they helped somewhat with good flora? I'm trying a different brand this time (after the abs are done): Custom Probiotics. I think I actually saw a post of yours somewhere saying you took these and they helped. Not other pro-Bs I've taken have helped; I may as well be taking a sugar pill.

Responses in bold. Do you think I should pester my GI doc about the stool test for specificity (even with symptom-improvement on the rifaximin)?

I also mentioned hypochloridia to my doctor well over a year ago and he didn't seem to think that was an issue due to my age... ??

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Well, as a quick follow up (if anyone cares) the rifaximin did the trick... but my doctor thinks I have small bowel dysmotility (not his words, but I'm putting two and two together). Seems he's right since I've had SIBO recur 4 times over the last 3 years.

Now on Reglan which I'm not happy about at all... it's already starting to make my insomnia slightly worse, although that could be attributed to other things.

Has anyone here used Iberogast before??

It's an herbal prokinetic and it's (according to 3 research articles I've read so far) supposed to be comparable to prokinetic drugs like Reglan, but without the horrific side effects.

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Well, as a quick follow up (if anyone cares) the rifaximin did the trick... but my doctor thinks I have small bowel dysmotility (not his words, but I'm putting two and two together). Seems he's right since I've had SIBO recur 4 times over the last 3 years.

Now on Reglan which I'm not happy about at all... it's already starting to make my insomnia slightly worse, although that could be attributed to other things.

Has anyone here used Iberogast before??

It's an herbal prokinetic and it's (according to 3 research articles I've read so far) supposed to be comparable to prokinetic drugs like Reglan, but without the horrific side effects.

I never used Iberogast. However, you need a probiotic with at least 12-50 billion live cells per capsule. I don't think Align has that much. Custom Probiotics would supply a more potent probiotic.

I don't think your doc said 'motility' unless he suspected you're hypothyroid, which causes metabolic motility issues and constipation. However he could have suggested you don't have enough good bacteria, which would allow those overgrowth bacteria to flourish. So taking high dose probiotics now (after killing the last one with Rifaxim, if you know for sure) would be a good idea.

How do you know for sure that Rifaxim 'did the trick'? Did you retest for SIBO? I don't understand how hydrogen breath tests work. Can you explain? Also I think Rifaxim is a gamble, because there are no all-purpose antibiotic drugs. Each kills specific bugs. Maybe you were lucky.

I hope you don't have more recurrences of SIBO. Like I said, I had 8 different gut bugs over a 4 year period, until I was diagnosed with low stomach acid production and resolved that along with taking really high dose probiotics. I also had to address several other issues which challenged my immmunity like low vitamin D3 levels, low thyroid, low White blood cells and low DHEA.

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I don't know for sure that the rifaximin worked because I did not have a follow-up breath test, but the four times I've taken it my symptoms (abdominal distention and incomplete evacuation/poor stool quality) have all disappeared by the end of the course. So I think I can reasonably assume that it worked?

On your recommendation and another I got from a different site I am using the Custom Probiotics along with the Reglan (my doctor did recommend that I use pro-bs).

Reglan is used for motility issues is it not? (it's a prokinetic) I guess that's why I assumed that I had a motility issue... well, that and I mentioned it in an email to my doctor and he didn't dispute the point and went on to prescribe the Reglan.

Are thyroid issues the only thing that can cause intestinal motility problems? (My thyroid checked out normal on blood test last time it was tested).

For the breath test see below (I've had the one with the lactulose performed 3-4 times now, before antibiotics, and it's been positive every time):

http://www.motilitysociety.org/patient/pdf/Breath%20Hydrogen%20Tests%20Patient%20Information%208%2015%202005.pdf

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