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