Over the past six months a couple of important developments in the treatment and understanding of Small Intestine Bacterial Overgrowth and Irritable Bowel Syndrome have occurred. Number one is that there now is a blood test that can positively diagnose IBS. This test measures the antibodies to Cytolethal Distending Toxin (CDT) found in C. jejuni, E. Coli, Salmonella and Shigella that cause food poisoning and antibodies to Vinculin that damage the nerves in the gut. The CDT toxin is similar to the protein in Vinculin. After an episode of food poisoning the immune system mistakenly builds antibodies to Vinculin resulting in a condition of autoimmunity that slows gut motility leading to an overgrowth of bacteria in the small intestine (SIBO) that cause the symptoms of ISB. Finally the medical community has a diagnostic tool that proves that IBS is a real disease and that it is not a psychological disorder diagnosed by exclusion of other conditions.The test called IBS Check was developed by Dr. Mark Pimentel and his colleagues at Cedars-Sinai Medical Center and is 90% accurate.
Number two is that the FDA approved Rifaximin as a treatment for IBS so insurance companies should begin to cover this treatment. The approval was based on rigorous studies that proved the effectiveness of Rifaximin in the treatment of SIBIO and IBS and established that the drug does not cause bacterial resistance even after multiple courses. Rifaximin goes directly to the gut and is not absorbed in the blood stream so it does not have any side effects and it does not affect the microbiome.
Check out this video of Dr. Mark Pimentel explaining IBS and the new test https://www.youtube.com/watch?v=iUMrr_TWyFw
This is good news for patients with Irritable Bowel Syndrome and fibromyalgia. In many cases including myself the treatment of SIBO with Rifaximin or herbs, prokinetic agents and diet can permanently reverse the symptoms of fibromyalgia. I did the IBS check last summer and tested positive to both CDTb and Vinculin antibodies. Although I am not cured of SIBO and need to maintain current treatment, I no longer have any gas or bloating, I have regular bowel movements, and my fibromaylgia symptoms are almost completely gone. My treatment includes following a diet low in specific sugars and fiber, taking the prokinetic drug Resolor, 5HTP and ginger root to stimulate gut motility, and taking occasional courses of Rifaximin to treat overgrowth of hydrogen and methane producing bacteria in the small intestine.
Many people are successful at treating SIBO by taking herbs that have antibacterial properties. These include Allimed, a concentrated form of allicen; Neem Plus, a combination of Ayruvedic herbs; and berberine containing herbs such as barberry, goldenseal, coptis, phellodendron and Oregon grape. I am not able to tolerate these herbs due to my sensitivities and their broad based nature however I had no problems with the antibiotic drugs. I initially took Rifaximin and Neomycin because I primarily had overgrowth of methane producing bacteria. Then my breathe tests showed an overgrowth of hydrogen producing bacteria so my follow up treatments have been with Rifaximin alone. I can actually tell the difference because when I had high levels of methane my stools floated and now they sink. I think this is because methane is a lighter gas than hydrogen. It is important to stress that any SIBO treatment plan include taking a prokinetic drug - low dose naltrexone, low dose erythromycin or Resolor. Additionally Ginger root and 5HTP can help with gut motility.
For more information on SIBO and its relationship with fibromyalgia read my first post on the subject: http://fibrofriends.typepad.com/fibro_friends/2014/07/small-intestine-bacterial-overgrowth-a-complication-of-chronic-fatigue-and-fibromyalgia-syndromes.html