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Hey Doctor, I Just Wanted To Get A Bit More
Posted on
Wed, 17 Jul 2019
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Wed, 17 Jul 2019
Answered on
Last reviewed on
Question : Hey doctor,
I just wanted to get a bit more info on a condition called SIBO (Small Intestine Bacterial Overgrowth) as I think I may have it. I was on PPI’s and antibiotics a couple years back for about a year which I’m now off. One of of the very first things I noticed when going on them which I never had prior to that in my life is this sense of being thirsty and having bad breath which I had never had before taking that medicine. I also have a lot of digestive complaints mainly consisting of upper sided stomach pain predominately in the centre of my epigastric region and right sided that feels like a bad ache, nausea, a lot of gas and sometimes diarrhoea. I’ve also had gastroscopy/colonoscopy in the past which showed nothing so there’s nothing physically wrong it’s more so to do with the gut. From what I read IBS and SIBO seem to be interlinked a lot of people with IBS actually have SIBO but have been diagnosed incorrectly, I feel that is the case with me also. Some interesting things I’ve found and why I believe I have it is that after trying numerous probiotics including yeast strains for some reason Yakult has the biggest positive effect it decreases my stomach pain, nausea, diarrhoea and even my acne which is bizarre. I also find sugar makes everything 10x worse especially stuff like sweets or even refined carbs like white bread, pasta etc some vegetables also cause symptoms to become worse like cauliflower, broccoli basically any foods that feel like they are sitting there’s in my stomach for long periods of time make me really sickly. The foods that kind of just roll through without sitting there seem to be the best ones. What are your thoughts and what’s the best way to diagnose and treat SIBO?
I just wanted to get a bit more info on a condition called SIBO (Small Intestine Bacterial Overgrowth) as I think I may have it. I was on PPI’s and antibiotics a couple years back for about a year which I’m now off. One of of the very first things I noticed when going on them which I never had prior to that in my life is this sense of being thirsty and having bad breath which I had never had before taking that medicine. I also have a lot of digestive complaints mainly consisting of upper sided stomach pain predominately in the centre of my epigastric region and right sided that feels like a bad ache, nausea, a lot of gas and sometimes diarrhoea. I’ve also had gastroscopy/colonoscopy in the past which showed nothing so there’s nothing physically wrong it’s more so to do with the gut. From what I read IBS and SIBO seem to be interlinked a lot of people with IBS actually have SIBO but have been diagnosed incorrectly, I feel that is the case with me also. Some interesting things I’ve found and why I believe I have it is that after trying numerous probiotics including yeast strains for some reason Yakult has the biggest positive effect it decreases my stomach pain, nausea, diarrhoea and even my acne which is bizarre. I also find sugar makes everything 10x worse especially stuff like sweets or even refined carbs like white bread, pasta etc some vegetables also cause symptoms to become worse like cauliflower, broccoli basically any foods that feel like they are sitting there’s in my stomach for long periods of time make me really sickly. The foods that kind of just roll through without sitting there seem to be the best ones. What are your thoughts and what’s the best way to diagnose and treat SIBO?
Brief Answer:
Stool test.
Detailed Answer:
Hello and thanks for choosing"Ask a Doctor" service for your query,
Have seen your details.
IBS is usually a diagnosis of exclusion which means that when a person have symptoms but all tests are normal he/she is labelled to have IBS.
IBS is a syndrome which is an umbrella term use to cover abdominal symptoms when all possible tests are normal.
An interesting fact is that most of the tests like colonoscopy etc in itself depleted the gut Flora and worsens the symptoms.
What I mean to say is that IBS is a diagnosis of exclusion and therefore. it can not be treated as till date no one knows the exact cause of the symptoms.However Hit and Trail method is usually used in which Gastro uses a combination of antispasmodics,Probiotics etc.Usually every medication is not effective but some medication is effective on every patient; As in your case it's probiotic which plays the role of game changer.
Moving on to SIBO.
Stool test is the best way to rule this out.
SIBO can be a cause of IBS.
Patient who usually respond to probiotics have SIBO.
Best way is that if you feel comfortable with probiotics keep on having them.
Simple carbohydrates and sugar are best food for bad bacteria's and yeast to grow inside intestines. Sugar is fermented and large amount of toxins are released causing inflammation of intestines leading to pain.
Take a high fiber diet.
Avoid Simple carbohydrates.
Take Complex carbohydrayes,Lean protein and Good fats in your diet.
Hope I was helpful.
Follow ups are welcome.
Stool test.
Detailed Answer:
Hello and thanks for choosing"Ask a Doctor" service for your query,
Have seen your details.
IBS is usually a diagnosis of exclusion which means that when a person have symptoms but all tests are normal he/she is labelled to have IBS.
IBS is a syndrome which is an umbrella term use to cover abdominal symptoms when all possible tests are normal.
An interesting fact is that most of the tests like colonoscopy etc in itself depleted the gut Flora and worsens the symptoms.
What I mean to say is that IBS is a diagnosis of exclusion and therefore. it can not be treated as till date no one knows the exact cause of the symptoms.However Hit and Trail method is usually used in which Gastro uses a combination of antispasmodics,Probiotics etc.Usually every medication is not effective but some medication is effective on every patient; As in your case it's probiotic which plays the role of game changer.
Moving on to SIBO.
Stool test is the best way to rule this out.
SIBO can be a cause of IBS.
Patient who usually respond to probiotics have SIBO.
Best way is that if you feel comfortable with probiotics keep on having them.
Simple carbohydrates and sugar are best food for bad bacteria's and yeast to grow inside intestines. Sugar is fermented and large amount of toxins are released causing inflammation of intestines leading to pain.
Take a high fiber diet.
Avoid Simple carbohydrates.
Take Complex carbohydrayes,Lean protein and Good fats in your diet.
Hope I was helpful.
Follow ups are welcome.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Hey doctor,
Thanks for the follow up the info is much appreciated however I just had a few more questions regarding SIBO.
How exactly does it occur in the first place can PPI and antibiotics create an environment for bacteria to thrive in the small intestine especially with the lowered stomach acid?
I’ve read about a SIBO breath test which measures Lactulose or Glucose but how accurate is this I didn’t even know it could be diagnosed via a stool test?
With probiotics as well I’ve found Yakult to be really helpful but I’m a little confused as I would of thought adding more bacteria to the small intestine would make things a lot worse would you not be overpopulating it more? Digestive enzymes seem to really help for me as well so there’s definitely something going on and I’ve had IBS for a while but none of the treatments work for me.
Can bad breath, burping after meals also be a symptoms of SIBO along with the others I mentioned as well because I get them every day?
Thanks again!
Thanks for the follow up the info is much appreciated however I just had a few more questions regarding SIBO.
How exactly does it occur in the first place can PPI and antibiotics create an environment for bacteria to thrive in the small intestine especially with the lowered stomach acid?
I’ve read about a SIBO breath test which measures Lactulose or Glucose but how accurate is this I didn’t even know it could be diagnosed via a stool test?
With probiotics as well I’ve found Yakult to be really helpful but I’m a little confused as I would of thought adding more bacteria to the small intestine would make things a lot worse would you not be overpopulating it more? Digestive enzymes seem to really help for me as well so there’s definitely something going on and I’ve had IBS for a while but none of the treatments work for me.
Can bad breath, burping after meals also be a symptoms of SIBO along with the others I mentioned as well because I get them every day?
Thanks again!
Sugar from sweets, candy, cakes etc definitely seems to make things a lot worse but I find my body craves it quite a bit.
This was the breath test that I found for SIBO in my area
https://www.gastrolab.com.au/patients/hydrogenmethane-breath-tests/
https://www.gastrolab.com.au/patients/hydrogenmethane-breath-tests/
Brief Answer:
SIBO needs extensive research.
Detailed Answer:
Hello again,
Yes basically any external agent which you put into your body changes the inner atmosphere of the body causing various effects and side effects.For e.g Proton pump inhibitors reduces the excessive as well as baseline secretion of acid. Now when ever you eat anything the acid inside your stomach kills off the bacterias and other toxic agents which reaches the body along with food or water or any thing. Now if acid quantity is less chances are that these bacteria reaches the intestinal part and kills off good bacteria's forming colonies of bad bacterium and yeast.
Same is true with antibiotics. Most of them kills off good bacteria of gut and intestines. Therefore antibiotic therapy is always supplemented with large doses of probiotics.
Stool culture shows colonies of bad bacteria's and yeast in intestines as stool is formed by food digested along the way therefore if there are toxic bacteria's in intestine in very large number they would be reflected in stool culture test.
Breath test etc are not very accurate. See SIBO is something overlooked by medical community till date and much more research is needed. You can go for these breath tests but sensitivity is not much.
Yakult contain strains of good bacteria's.Your problem is related to bad colonies of bacteria's living inside your intestines. Now once these good bacteria's reaches the intestine they kills bad bacteria and repletes colonies of good bacteria which are important for proper food digestion. So by taking probiotic you are not over polluting rather improving and helping your gut.
Burps are a result of excessive gas formed while digestion. Whenever food ferments in your intestine large amount of toxic gases are released. Food is fermented by bad bacterial colonies. Therefore the gas formed would leave body either in form of farts or burps. These gases mostly hydrogen sulphide smells very bad giving foul taste and smell to mouth.
Definitely you can go for breath test along with stool culture. Though not fully accurate by combining these tests a picture can be drawn.
If you carve a lot for sweets then have them in small amount. Take double the amount of probiotic and activated charcoal tablets that day.
Hope I was helpful.
Please feel free to follow up.
Do rate the answer.
Thank you.
SIBO needs extensive research.
Detailed Answer:
Hello again,
Yes basically any external agent which you put into your body changes the inner atmosphere of the body causing various effects and side effects.For e.g Proton pump inhibitors reduces the excessive as well as baseline secretion of acid. Now when ever you eat anything the acid inside your stomach kills off the bacterias and other toxic agents which reaches the body along with food or water or any thing. Now if acid quantity is less chances are that these bacteria reaches the intestinal part and kills off good bacteria's forming colonies of bad bacterium and yeast.
Same is true with antibiotics. Most of them kills off good bacteria of gut and intestines. Therefore antibiotic therapy is always supplemented with large doses of probiotics.
Stool culture shows colonies of bad bacteria's and yeast in intestines as stool is formed by food digested along the way therefore if there are toxic bacteria's in intestine in very large number they would be reflected in stool culture test.
Breath test etc are not very accurate. See SIBO is something overlooked by medical community till date and much more research is needed. You can go for these breath tests but sensitivity is not much.
Yakult contain strains of good bacteria's.Your problem is related to bad colonies of bacteria's living inside your intestines. Now once these good bacteria's reaches the intestine they kills bad bacteria and repletes colonies of good bacteria which are important for proper food digestion. So by taking probiotic you are not over polluting rather improving and helping your gut.
Burps are a result of excessive gas formed while digestion. Whenever food ferments in your intestine large amount of toxic gases are released. Food is fermented by bad bacterial colonies. Therefore the gas formed would leave body either in form of farts or burps. These gases mostly hydrogen sulphide smells very bad giving foul taste and smell to mouth.
Definitely you can go for breath test along with stool culture. Though not fully accurate by combining these tests a picture can be drawn.
If you carve a lot for sweets then have them in small amount. Take double the amount of probiotic and activated charcoal tablets that day.
Hope I was helpful.
Please feel free to follow up.
Do rate the answer.
Thank you.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Hey doctor thanks for the follow up one additional thing that I just tried which I’ve attached images of is Betaine HCL capsules. This morning I tried it for the first time with not the best results, I would of thought it may help digest protein but I’ve had a stomach ache the entire day from it and I’ve stopped taking it now. How long would the effect of this tablet last do you think and would one tablet have done any damage?
Brief Answer:
Follow up.
Detailed Answer:
Hello again my dear patient,
In your initial query you had written that you were on PPI'S.Role of PPI is to reduce acid secretion.Now you had taken Betaine HCL capsule which would definitely increase the acid levels of your gut and would irritate the inner lining of stomach hence causing pain.It effect would last for 1 to 2 days.However i would suggest you to take Ranatidine 300mg(over the counter) one tablet to nullify its effect.Please don't try medications on your own or by reading on internet.This might increase your problems.
Take one glass of chilled milk right now its alkaline in nature and would nullify effect of acid.
In case you are feeling bit nervous about your problem.I would suggest you to take Lactium capsule(a natural nerve soothner).
If you are trying any product you are free to consult me every time.Hope you can understand dear that trying products on your own may actually worsen up things.You can follow up on this link any time you are puzzled whether to take a medication or not in future.
http://doctor.healthcaremagic.com/doctors/dr-ramesh-kumar/72660
Just take on tablet Ranitidine with a glass of chilled(crushed ice) milk and you would feel better in 6 hours.
Hope i was helpful,
Follow ups are welcome.
Do rate the answer!
Any suggestions to make answers better is welcome.
Get well soon.
Follow up.
Detailed Answer:
Hello again my dear patient,
In your initial query you had written that you were on PPI'S.Role of PPI is to reduce acid secretion.Now you had taken Betaine HCL capsule which would definitely increase the acid levels of your gut and would irritate the inner lining of stomach hence causing pain.It effect would last for 1 to 2 days.However i would suggest you to take Ranatidine 300mg(over the counter) one tablet to nullify its effect.Please don't try medications on your own or by reading on internet.This might increase your problems.
Take one glass of chilled milk right now its alkaline in nature and would nullify effect of acid.
In case you are feeling bit nervous about your problem.I would suggest you to take Lactium capsule(a natural nerve soothner).
If you are trying any product you are free to consult me every time.Hope you can understand dear that trying products on your own may actually worsen up things.You can follow up on this link any time you are puzzled whether to take a medication or not in future.
http://doctor.healthcaremagic.com/doctors/dr-ramesh-kumar/72660
Just take on tablet Ranitidine with a glass of chilled(crushed ice) milk and you would feel better in 6 hours.
Hope i was helpful,
Follow ups are welcome.
Do rate the answer!
Any suggestions to make answers better is welcome.
Get well soon.
Above answer was peer-reviewed by :
Dr. Kampana
Hey doctor I tried the Ranitidine but I’m still feeling sick, it hasn’t really done much. I’m just getting bad cramps and a really bad burning feeling my stomach/epigastric in the centre plus nausea. I haven’t had a flare up this bad in months. Is there anything else that might help any pain killers that won’t make it worse or maybe even natural supplements that help soothe the stomach? Should I be avoiding certain foods I’m struggling to figure out what to eat that won’t make it worse?
Ive got this product which I’ve had in the past and it had helped but I’m scared to try it with this flare up:
https://www.nutritioncare.com.au/retail_products/nc-gut-relief-150g-powder/
Ive got this product which I’ve had in the past and it had helped but I’m scared to try it with this flare up:
https://www.nutritioncare.com.au/retail_products/nc-gut-relief-150g-powder/
Brief Answer:
Severe gastritis recurrence. No pain killer's they would make gastritis severe.If you want to use take Tramadol 50 mg with antispasmodic like Dicyclomin 10 mg.
Detailed Answer:
Hello and thanks for follow up,
Problem is that i could only suggest you over the counter medication.
Ranitidine is among the weakest antacid and is therefore over the counter.
Don't take any pain killers they would make acidity and other symptoms worse.
Infact pain killers are contraindicated in people with acid peptic disorders.
NG gut its a natural healthcare product.If specifically formulated medicines like ranitidine are not helping then chances of you feeling well on taking NG gut are quiet less.However you may give it a try.
In case you can get a prescription-
I would like to start you on
Tablet Nexium 40 mg twice daily(30 minutes empty stomach) for 3 days
Tab Acogut(Acotiamide 100mg twice daily for 5 days).
Combination of Magnesium and aluminium hydroxide 2tsf thrice daily.
Tablet Domperidon 10 mg thrice daily(for heart burn and epigastric area pain).
Keep on taking probiotic.
Discuss the answer with your local doctor and try to get a prescription for the same.
If not relieved follow up with your primary doctor.He may give you few shots of antacids parentrally(i/m) to provide you with immediate relief. Injectable therapy does not effect gut flora too.
Thanks!
Severe gastritis recurrence. No pain killer's they would make gastritis severe.If you want to use take Tramadol 50 mg with antispasmodic like Dicyclomin 10 mg.
Detailed Answer:
Hello and thanks for follow up,
Problem is that i could only suggest you over the counter medication.
Ranitidine is among the weakest antacid and is therefore over the counter.
Don't take any pain killers they would make acidity and other symptoms worse.
Infact pain killers are contraindicated in people with acid peptic disorders.
NG gut its a natural healthcare product.If specifically formulated medicines like ranitidine are not helping then chances of you feeling well on taking NG gut are quiet less.However you may give it a try.
In case you can get a prescription-
I would like to start you on
Tablet Nexium 40 mg twice daily(30 minutes empty stomach) for 3 days
Tab Acogut(Acotiamide 100mg twice daily for 5 days).
Combination of Magnesium and aluminium hydroxide 2tsf thrice daily.
Tablet Domperidon 10 mg thrice daily(for heart burn and epigastric area pain).
Keep on taking probiotic.
Discuss the answer with your local doctor and try to get a prescription for the same.
If not relieved follow up with your primary doctor.He may give you few shots of antacids parentrally(i/m) to provide you with immediate relief. Injectable therapy does not effect gut flora too.
Thanks!
Above answer was peer-reviewed by :
Dr. Yogesh D
Hey doctor,
Should I try the ranitidine for longer before going onto PPIs I never have luck with those, does it take a while to work I’ve only one dose? And as for the NC gut relief I might give it a shot before bed and see how it goes would something like Gaviscon Dual Action in liquid or tablet form give me any relief or would it make it worse? With pain killers is something like Panadol(paracetamol) 500mg x2 okay to have it would that also make things worse?
Thanks again for your help
Should I try the ranitidine for longer before going onto PPIs I never have luck with those, does it take a while to work I’ve only one dose? And as for the NC gut relief I might give it a shot before bed and see how it goes would something like Gaviscon Dual Action in liquid or tablet form give me any relief or would it make it worse? With pain killers is something like Panadol(paracetamol) 500mg x2 okay to have it would that also make things worse?
Thanks again for your help
How exactly do acid reducers help with gastritis as well? One thing I also remembered was on Friday night I kind of overate and had a lot of chicken and I felt it just sat in my stomach all the way into the next day, which is what made me try the HCL tablet in the first place as I felt the food was just festering in my stomach and it kind of just made me feel sick that I could still taste it it’s like my body didn’t digest it at all.
Brief Answer:
Follow up.
Detailed Answer:
Hi again,
Ranitidine is the weakest drug in it's category. Ask your pharmacist if Famotadine is over the counter. It belong to the same class of medication with better effects then Ranitidine.However in case you have no choice take Ranitidine.
Yes Gaviscon dual action would have an additive effect you can take 2 tsf thrice daily.
Keep off from all NSAIDS including Paracetamol. In patients with gastritis even milder drugs may cause severe heart burn. Take any antispasmodics or Tramadol.
Chicken and other non vegetarian products are hard to digest.I would suggest you to try home cooked vegetarian food for few days(If available at your place).Avoid heavy proteins like nonveg and eggs etc. You can take high complex carbohydrate based diet( Multigrain flour like wheat ragi barley etc).Take lots of fruits. Avoid packaged and citic fruits.
Grilled and sauted vegetables would be excellent for you.
Gastritis means inflammation of inside of stomach as a result of excessive acid production. Proton pump inhibitors blocks this acid secretion hence inflammed lining of gut gets time to recover.
One question-
Are you an anxious person.
On a scale of 0 to 10 mark your anxiety levels.10 being maximum.
Waiting.
Follow up.
Detailed Answer:
Hi again,
Ranitidine is the weakest drug in it's category. Ask your pharmacist if Famotadine is over the counter. It belong to the same class of medication with better effects then Ranitidine.However in case you have no choice take Ranitidine.
Yes Gaviscon dual action would have an additive effect you can take 2 tsf thrice daily.
Keep off from all NSAIDS including Paracetamol. In patients with gastritis even milder drugs may cause severe heart burn. Take any antispasmodics or Tramadol.
Chicken and other non vegetarian products are hard to digest.I would suggest you to try home cooked vegetarian food for few days(If available at your place).Avoid heavy proteins like nonveg and eggs etc. You can take high complex carbohydrate based diet( Multigrain flour like wheat ragi barley etc).Take lots of fruits. Avoid packaged and citic fruits.
Grilled and sauted vegetables would be excellent for you.
Gastritis means inflammation of inside of stomach as a result of excessive acid production. Proton pump inhibitors blocks this acid secretion hence inflammed lining of gut gets time to recover.
One question-
Are you an anxious person.
On a scale of 0 to 10 mark your anxiety levels.10 being maximum.
Waiting.
Above answer was peer-reviewed by :
Dr. Prasad
Hey doctor thanks for the follow up I used to be a bit of an anxious person but these days I’m a lot calmer so probably a 4/5 out of 10. A couple of other things I’ve been experiencing are a lot of gas and diarrhoea also, could this be the gastritis or could I have possibly misread this and actually have a stomach bug or maybe both?
Brief Answer:
Follow up.
Detailed Answer:
Hello again my dear patient,
Gastritis has no association with diarrhea.
If diarrhea is there persistently I would suggest you to go for stool culture test to rule out presence of bacteria or protozoa in gut.
Have you ever had a colonoscopy or fecal calprotecfin test done?
Follow up.
Detailed Answer:
Hello again my dear patient,
Gastritis has no association with diarrhea.
If diarrhea is there persistently I would suggest you to go for stool culture test to rule out presence of bacteria or protozoa in gut.
Have you ever had a colonoscopy or fecal calprotecfin test done?
Note: For further follow up on digestive issues share your reports here and Click here.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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