Last weekend I had the opportunity to head to Los Angeles to the Cedars-Sinai Medical Center for the Global Outreach Symposium on IBS and SIBO. Over 19 countries were in attendance either physically or virtually to hear the latest research updates by Dr. Pimentel and his team on Irritable Bowel Syndrome (IBS) and Small Intestine Bacterial Overgrowth (SIBO). Get the hottest updates on IBS and SIBO without sitting through 8-hours of lecture:
IBS May Be Getting A New Name!
- Okay, so don’t hold your breath over this one, but Dr. Pimentel seemed optimistic that the term “irritable bowel syndrome” will be changing to better reflect what this condition is really about. He informed us that this syndrome impacts 48 million Americans and almost 1 billion people worldwide. The current exclusion diagnosis criteria and poor understanding of root cause is under-serving this population.
- The “syndrome” classification already belittles the harsh reality those with IBS encounter on a daily basis.
- A disease is a pathophysiological response to internal or external factors
- A disorder is a disruption to regular bodily structure and function
- A syndrome is a collection of signs and symptoms linking a specific health-related cause
- The question remains, is IBS a syndrome or is there something else going on that may actually classify it as a disease or disorder? Continued research is vital.
SIBO Is The Most Common Cause of IBS & Can Be Assessed In The Breath
- The IBS and SIBO connection began with research by Cedars-Sinai in 1999. Over 60% of IBS is due to SIBO based on culture findings done in the small intestine.
- SIBO is >10^3CFU/mL of bacteria, specifically E. coli and Klebsiella species, in the jejunum of the small intestine. So, how does SIBO cause IBS? Well, these bacteria produce unique and undesirable effects on the body. They change the motility of the bowel, ferment food, and create gas byproducts, specifically methane (CH4) and hydrogen (H2) gases.
- Small intestine culture, the supposed gold-standard of diagnosing SIBO, is highly invasive, timely, expensive and impractical for most. Therefore, alternative testing options are available to accurately diagnose SIBO. By measuring CH4 and H2 gases in the breath, one may assess for the presence of SIBO as human cells alone are incapable of creating these gases.
There Is A Strong Correlation Between Food Poisoning And IBS
- Various types of food poisoning (i.e. Salmonella, E.coli, Listeria, Campylobacter, etc.) produce a toxin in the body called cytolethal distending toxin (CdtB). This toxin produces an antibody that appears similar to vinculin, a protein that plays a role in digestive motility.
- The molecular mimicry that occurs upon exposure of this toxin is a form of autoimmunity producing damage in the digestive system. Damage reduces the ability of the body to undergo its janitorial duties completed by the migrating motor complexes (MMC). When the small intestine is not properly cleaned, SIBO more likely develops. Mouse models successfully replicate this mechanism and human trials are underway.
- If you already have IBS, then you are 2.9x more likely to get food poisoning.
- IBScheck assess for the presence of CdtB antibodies
SIBO May Be Treated With Antibiotics & Statins
- Rifaxamin (Xifaxin) is the FDA-approved antibiotic for treating IBS-with diarrhea (IBS-D). In a 2011 double blind placebo controlled trial, Rifaxamin showed benefit over the use of placebo to help achieve IBS remission.
- However, this treatment alone does not seem to help those with IBS-constipation (IBS-C). These individuals are more likely to have methane gases (SIBO-methane) produced by methanobrevibacter smithii that slow motility, causing constipation. A 2010 study found that combining Rifaxamin with low dose Neomycin helped improve these patients over Rifaxamin treatment alone.
- New research that recently completed phase II trials explored the use of lovastatin (SYN-010) to help with IBS-C and SIBO-methane. Phase III trials begin in January, so stay tuned for results!
The symposium offered valuable information for both patients and practitioners dealing with IBS and SIBO. The information may feel overwhelming if you are just starting your journey to recovery. I highly recommend working with an educated practitioner to help you through the recovery process. Contact me today if you would like more information or one-on-one guidance on overcoming and improving IBS, SIBO, or any other digestive disorder.