small bowel bacterial overgrowth another cause for ibs symptoms karenn hall, bsn, rn,cgrn

Small Bowel Bacterial Overgrowth

Another Cause for IBS Symptoms

Karenn Hall, BSN, RN,CGRN

IBS FactsWomen 3.2 times more likely than menWhites 5.3 times more often than blacks20% of Americans, 54 millionAccounts for between 2.4 million and

3.5 million visits to a provider per yearSecond only to the common cold for

missed work days

Irritable Bowel SyndromeSymptoms –

A, B, C, D, ECauses

Genetic, inflammation, neurological, infectious, SIBO, other

Treatment Symptom based

Rule out other causes of Sx’sCeliac SprueThyroid dysfunctionC. DiffCrohn’s or ulcerative colitisOther warning signs not IBS

Small Bowel Bacterial Overgrowth (SBBO or SIBO)

Bacteria and the gutDefinitionSymptomsCauses and conditions

Hydrogen Breath TestingQuinTron: www.quintron-usa.com

Measures both hydrogen and methane Mail-in kit option

MicroDirect: www.breathh2.com Measures hydrogen only Web site offers info on billing, coding,

reimbursementGI Pathology: offers mail-in kit

Testing Instructions No antibiotics for at least 7 days NPO for 12 hours before test NPO during test except for substrate in 6-8

ounces of water Avoid eating slowly digesting foods the day

before No smoking 30 min. before or during test No sleeping 30 min. before or during test

Testing Instructions

Baseline breath sampleSubstrate (lactulose 10 grams) mixed in

6-8 ounces of water.Additional breath samples taken at 20

minute intervals for at least 5 additional samples.

Interpreting ResultsLook for bi-phasic peaks in true

positivesEarly increase of at least 12 ppm Investigate interferences to accurate

results: Smoking, laxative use, last meal, antibiotic

use, previous surgeries, COPD

Treatment Options

The goal is to treat the underlying cause(s), eradicate the bacterial overgrowth, and nutritional support

Antibiotic therapyProkinetic agentsProbioticsNutritional support

Galen Medical Group Research Study Purpose Criteria Group I - Xifaxan® 200 mg po tid x 2 weeks Group II – Augmentin 875 mg po bid x 2

weeks Both groups - Align® one po daily x 3 weeks Group III – Align one po qd x 3 weeks

Conclusion and Questions