Have read here about sibo have had a look on google on symptoms of this, I am not sure if it apples to me , have had bouts of pouchitus, last time doing a 3 month course of antibiotics, I am having a lot of pain spasams loud gurgling noises when this happens I need to go to the toilet. Passing lots of gas when I go I find I am constantly going but not liquidly like when I have pouchitus. How have you found out is by the breath test or stool sample??? I would appreciate some advise. Thanks
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See the attached link, I would also send a PM to poster vanessavy:
http://en.wikipedia.org/wiki/S...bacterial_overgrowth
"The diagnosis of bacterial overgrowth can be made by physicians in various ways. Malabsorption can be detected by a test called the D-xylose test. Xylose is a sugar that does not require enzymes to be digested. The D-xylose test involves having a patient drink a certain quantity of D-xylose, and measuring levels in the urine and blood; if there is no evidence of D-xylose in the urine and blood, it suggests that the small bowel is not absorbing properly (as opposed to problems with enzymes required for digestion).
The gold standard for detection of bacterial overgrowth is the aspiration of more than 10(5 exp) bacteria per millilitre from the small bowel. The normal small bowel has less than 10(4 exp) bacteria per millilitre. Biopsies of the small bowel in bacterial overgrowth can mimic celiac disease, with partial villous atrophy.
Breath tests have been developed to test for bacterial overgrowth, based on bacterial metabolism of carbohydrates to hydrogen and/or methane, or based on the detection of by-products of digestion of carbohydrates that are not usually metabolized. The hydrogen breath test involves having the patient fast for a minimum of 12 hours then having them drink a substrate usually glucose or lactulose, then measuring expired hydrogen and methane concentrations typically over a period of 2-3 hours. It compares well to jejunal aspirates in making the diagnosis of bacterial overgrowth. 13C and 14C based tests have also been developed based on the bacterial metabolism of D-xylose. Increased bacterial concentrations are also involved in the deconjugation of bile acids. The glycocholic acid breath test involves the administration of the bile acid 14C glychocholic acid, and the detection of 14CO2, which would be elevated in bacterial overgrowth.
Some patients with symptoms of bacterial overgrowth will undergo gastroscopy, or visualization of the stomach and duodenum with an endoscopic camera. Biopsies of the small bowel in bacterial overgrowth can mimic those of celiac disease, making the diagnosis more challenging. Findings include blunting of villi, hyperplasia of crypts and an increased number of lymphocytes in the lamina propria.
However, some physicians suggest that if the suspicion of bacterial overgrowth is high enough, the best diagnostic test is a trial of treatment. If the symptoms improve, an empiric diagnosis of bacterial overgrowth can be made."
http://en.wikipedia.org/wiki/S...bacterial_overgrowth
"The diagnosis of bacterial overgrowth can be made by physicians in various ways. Malabsorption can be detected by a test called the D-xylose test. Xylose is a sugar that does not require enzymes to be digested. The D-xylose test involves having a patient drink a certain quantity of D-xylose, and measuring levels in the urine and blood; if there is no evidence of D-xylose in the urine and blood, it suggests that the small bowel is not absorbing properly (as opposed to problems with enzymes required for digestion).
The gold standard for detection of bacterial overgrowth is the aspiration of more than 10(5 exp) bacteria per millilitre from the small bowel. The normal small bowel has less than 10(4 exp) bacteria per millilitre. Biopsies of the small bowel in bacterial overgrowth can mimic celiac disease, with partial villous atrophy.
Breath tests have been developed to test for bacterial overgrowth, based on bacterial metabolism of carbohydrates to hydrogen and/or methane, or based on the detection of by-products of digestion of carbohydrates that are not usually metabolized. The hydrogen breath test involves having the patient fast for a minimum of 12 hours then having them drink a substrate usually glucose or lactulose, then measuring expired hydrogen and methane concentrations typically over a period of 2-3 hours. It compares well to jejunal aspirates in making the diagnosis of bacterial overgrowth. 13C and 14C based tests have also been developed based on the bacterial metabolism of D-xylose. Increased bacterial concentrations are also involved in the deconjugation of bile acids. The glycocholic acid breath test involves the administration of the bile acid 14C glychocholic acid, and the detection of 14CO2, which would be elevated in bacterial overgrowth.
Some patients with symptoms of bacterial overgrowth will undergo gastroscopy, or visualization of the stomach and duodenum with an endoscopic camera. Biopsies of the small bowel in bacterial overgrowth can mimic those of celiac disease, making the diagnosis more challenging. Findings include blunting of villi, hyperplasia of crypts and an increased number of lymphocytes in the lamina propria.
However, some physicians suggest that if the suspicion of bacterial overgrowth is high enough, the best diagnostic test is a trial of treatment. If the symptoms improve, an empiric diagnosis of bacterial overgrowth can be made."
I suspect that empiric diagnosis of bacterial overgrowth is rather unreliable in J-pouchers, since the successful treatment could just as easily suggest pouchitis.
True, but you can easily rule out pouchitis through pouchoscopy. Not the case for bacterial overgrowth.
So, if pouchitis is ruled out but antibiotics alleviate symptoms, the assumption is bacterial overgrowth. I suppose you'd need more symptoms than just diarrhea, though. Because functional diarrhea could improve with antibiotics. This is where good history taking is essential.
I am just glad they are accepting it as a diagnosis, since it was not always considered in the differential.
Jan
So, if pouchitis is ruled out but antibiotics alleviate symptoms, the assumption is bacterial overgrowth. I suppose you'd need more symptoms than just diarrhea, though. Because functional diarrhea could improve with antibiotics. This is where good history taking is essential.
I am just glad they are accepting it as a diagnosis, since it was not always considered in the differential.
Jan
I blew a positive breath test for SIBO before I had my colectomy. Treatment with Xifaxan didn't really do anything (it was more of a last ditch guess that perhaps resolving the SIBO would improve the UC flare, so I suspect even if it successfully treated the SIBO I wouldn't have noticed).
I think a breath test is easier than having a pouchoscopy, if you can find a place to administer it.
I think a breath test is easier than having a pouchoscopy, if you can find a place to administer it.
If you are on antibiotic then the breath test doesn't work. You have to be off of them for 6 weeks to be tested for SIBO.
Shen put me on Tindamax since xifacin never worked for me in the past. I did 3 courses of it. 14 days on and 14 days off and have been off antibiotics for about 2 months now. I cleaned up my diet big time though.
Shen put me on Tindamax since xifacin never worked for me in the past. I did 3 courses of it. 14 days on and 14 days off and have been off antibiotics for about 2 months now. I cleaned up my diet big time though.
Vanessa nice to here from you have been following your blog so will keep an eye out for your book, I would like to ask about the systems you had for sibo is it related to people who have pouchitus? I have not been tested for gluten and lactos intolerance but by keeping a diary have noticed a change .should I have proper testing for these or just be guided by my own testing. I eat gluten free and lactos free now but am having a hard time with the pain and associated problems Ian not sure what to do next, so thought about checking the sibo route to see if this is this problem any suggestions. Susan
I know SIBO symptoms are similar to pouchitis. My idiot doctor's nurse kept swearing I had pouchitis and had me on 3 antibiotics for a year. I even had surgeons scope me locally who said I had no sign of pouchtis. Yet nobody had an answer so said maybe the "lighting was off in the pouch photos", what a crock of crap.
I didn't know any better and with my symptoms I just went along with it. I then went to a new GI who was pretty good and she said she believed I must have c.diff or SIBO. She was running out of ideas since antibiotics were not doing much after awhile. I saw Shen at CC and he diagnosed me with SIBO based on symptoms and not seeing anything wrong with my pouch.
I then saw him for a follow up 4 months later and was diagnosed with c.diff due to all the crap antibiotics I was on for "pouchitis" that I never had.
I know people post on my BCIR message board that with diet change and upping their fat content with different olive oil and oregano oil that after a year they were off antibiotics. I was so hesitant when Shen told me to get off sugar asap or I would be on antibiotics for life since sugar makes my pouch super runny and I need that. I also LOVE to eat cookies, cake and ice cream :-)
But after almost booking surgery to take this pouch out and going on and off a primal diet with no real commitment for 3 years I buckled down and threw out all my antibiotics and got my diet under control.
I use coconut milk instead of almond milk because I personally notice almond causes me more gas and gurgling guts.
Certain things I pay a lot of attention to since cleaning up my diet if I introduce something and my pouch is turning over itself with super slick stool that comes out and bad SIBO gurgles, I eliminate it. I love LOVE love oatmeal but I get serious gut gurgles if I eat it. So I avoid oats.
I never had UC so I never had issues prior to getting rectal cancer and having my colon removed. This is all new to me. But after doing research about SIBO and talking to Shen I believe I had SIBO far before getting a pouch. I ate really crappy most of my teen life.
The thing about diet change for SIBO is it can take a full year for it to be really under control, so I think some people get fed up after awhile and don't stick to it. I saw a big difference after a month of a clean diet. In the end diet is always the answer IMO.
I don't eat anything too processed. I say that because canned coconut milk and tomato paste I get at whole foods is still processed in some way. What I do not eat is fast food, boxed or frozen dishes. I buy local at an organic butcher and try to get my produce at whole foods or another local market.
If you have a diary I would say shoot me a PM with a week of what you eat and I can comment if any of it messes me up personally. I can't say that we are the same but it is trial and error with this pouch.
FYI I get irritated by canned chicken stock even because of the cane juice that is in there so I now make my own.
A SIBO test can help and an antibotic like Tindamax that finally got mine under control might help you. I would rule out c.diff to start since that was my main issue. I had it for about a year and suffered greatly.
I didn't know any better and with my symptoms I just went along with it. I then went to a new GI who was pretty good and she said she believed I must have c.diff or SIBO. She was running out of ideas since antibiotics were not doing much after awhile. I saw Shen at CC and he diagnosed me with SIBO based on symptoms and not seeing anything wrong with my pouch.
I then saw him for a follow up 4 months later and was diagnosed with c.diff due to all the crap antibiotics I was on for "pouchitis" that I never had.
I know people post on my BCIR message board that with diet change and upping their fat content with different olive oil and oregano oil that after a year they were off antibiotics. I was so hesitant when Shen told me to get off sugar asap or I would be on antibiotics for life since sugar makes my pouch super runny and I need that. I also LOVE to eat cookies, cake and ice cream :-)
But after almost booking surgery to take this pouch out and going on and off a primal diet with no real commitment for 3 years I buckled down and threw out all my antibiotics and got my diet under control.
I use coconut milk instead of almond milk because I personally notice almond causes me more gas and gurgling guts.
Certain things I pay a lot of attention to since cleaning up my diet if I introduce something and my pouch is turning over itself with super slick stool that comes out and bad SIBO gurgles, I eliminate it. I love LOVE love oatmeal but I get serious gut gurgles if I eat it. So I avoid oats.
I never had UC so I never had issues prior to getting rectal cancer and having my colon removed. This is all new to me. But after doing research about SIBO and talking to Shen I believe I had SIBO far before getting a pouch. I ate really crappy most of my teen life.
The thing about diet change for SIBO is it can take a full year for it to be really under control, so I think some people get fed up after awhile and don't stick to it. I saw a big difference after a month of a clean diet. In the end diet is always the answer IMO.
I don't eat anything too processed. I say that because canned coconut milk and tomato paste I get at whole foods is still processed in some way. What I do not eat is fast food, boxed or frozen dishes. I buy local at an organic butcher and try to get my produce at whole foods or another local market.
If you have a diary I would say shoot me a PM with a week of what you eat and I can comment if any of it messes me up personally. I can't say that we are the same but it is trial and error with this pouch.
FYI I get irritated by canned chicken stock even because of the cane juice that is in there so I now make my own.
A SIBO test can help and an antibotic like Tindamax that finally got mine under control might help you. I would rule out c.diff to start since that was my main issue. I had it for about a year and suffered greatly.
Vanessavy I hope a lot of posters pay some good hard attention to your last post. Unfortunately the more old school thinking or brainwash is that with a J Pouch you can eat anything, and short term, in most cases, you can. Posters need to focus on the long term and not short term what agrees with them. We see lots of posts from people who say they do not want to give up sugary foods or carbs because they "want to enjoy life." Since those foods are not immediately bothering them, it is no big deal. But with more recent thinking from Dr. Shen and others following his lead, we are seeing that cleaning up the diet is a big help to people who have long term SIBO/pouchitis. The SIBO and pouchitis people who do not clean up their diet will see that over time with consistent indulgent eating of sugar and carbs, SIBO will get worse. There are reasons why the SCD, FODMAP and Paleo Diets are powerfully gaining acceptance among the long term pouchitis and SIBO sufferers. Those reasons are mostly common sense, but some people do not want to accept what is common sense. Unfortunately they are likely to learn the hard way like I did.
Makes a lot of sense if you are having chronic issues that are solved through diet.
But, what about people like me, with a long term pouch (18 years), and only the occasional bout of pouchitis? I honestly don't think we can be lumped into the same basket.
If I eat too many carbs I get problems like high blood sugar, occasional diarrhea, etc., but they all are resolved by moderation. Mindful eating, I call it. Gone are my days of mindless snacking while watching TV. But, if I want a piece of cake, I eat it and know there is a limit.
Jan
But, what about people like me, with a long term pouch (18 years), and only the occasional bout of pouchitis? I honestly don't think we can be lumped into the same basket.
If I eat too many carbs I get problems like high blood sugar, occasional diarrhea, etc., but they all are resolved by moderation. Mindful eating, I call it. Gone are my days of mindless snacking while watching TV. But, if I want a piece of cake, I eat it and know there is a limit.
Jan
I'm with you Jan, I can't be tossed in that group. I've had pouchitis once in 12 years; I eat everything and feel great. I have the typical pouch reaction with sugar, looser stool, but outside of that no specific food induced reaction. I see no reason for me to follow and eating plan for those with SIBO or chronic pouchitis.
Sue
Sue
Yeah, I just didn't want people to assume that a carb rich diet would lead to SIBO in the long run for everyone with a pouch, and restrict their diet unnecessarily. This is especially true in those early months when there can be so many foods that are not tolerated.
But, certainly, if you develop chronic pouchitis symptoms I think that dietary control is a good, if not better, approach than continuous antibiotic use. Even if it only reduces the antibiotic dose, it is worth the effort.
I imagine the knowledge base will continue to grow with time. The conventional wisdom has changed quite a bit since I had my surgery in 1995. So, I expect this to continue to evolve also.
Jan
But, certainly, if you develop chronic pouchitis symptoms I think that dietary control is a good, if not better, approach than continuous antibiotic use. Even if it only reduces the antibiotic dose, it is worth the effort.
I imagine the knowledge base will continue to grow with time. The conventional wisdom has changed quite a bit since I had my surgery in 1995. So, I expect this to continue to evolve also.
Jan
I think most people can't be tossed into tht group. I have two family members with j pouches...no diet restrictions and they have no issues. My sister has a 21 year pouch and never had pouchitis yet. I eat everything (try to keep it healthy!) and knock wood no pouchitis yet. I'm sure if you could take a poll of j pouchers in general, the people who do not get pouchitis would outweigh the people that do. If you are someone who get it frequently then obviously diet will play a big role.
Twenty two years here, only about 3 cases of pouchitis (only one documented, others were guesses).
I eat a varied diet, and I don't have theses extreme issues either, but I'm certain that it can benefit everyone to eat less sugar, less processed foods, less carbs, more veggies, ... Pouch or no pouch. It's not rocket science, but it IS hard for some, without education, and of course, life and stress can influence our imperfect human ways, allowing us to eat the "wrong" thing or even too much of the "right" thing. I do think I'm affected by sugar... Less so with carbs. Not, again, to such extremes, though, but I've noticed a "Christmas" correlation, when I'm baking more than normally. I've decided this year to cut waaaay back on holiday baking and toffee making, to see if it makes a difference.
Those of us who have had pouches longest are certainly trailblazers in what to expect as you grow and age with a pouch. I had my surgery when no one could tell me the long term mortality and morbidity... People today with IBD are luckier to have more medical options than I had. I'm not sad to have had my surgery, but it would have been nice to have had other options. I'm quite happy with my pouch.... Now if this damnable fistula would just disappear!
I eat a varied diet, and I don't have theses extreme issues either, but I'm certain that it can benefit everyone to eat less sugar, less processed foods, less carbs, more veggies, ... Pouch or no pouch. It's not rocket science, but it IS hard for some, without education, and of course, life and stress can influence our imperfect human ways, allowing us to eat the "wrong" thing or even too much of the "right" thing. I do think I'm affected by sugar... Less so with carbs. Not, again, to such extremes, though, but I've noticed a "Christmas" correlation, when I'm baking more than normally. I've decided this year to cut waaaay back on holiday baking and toffee making, to see if it makes a difference.
Those of us who have had pouches longest are certainly trailblazers in what to expect as you grow and age with a pouch. I had my surgery when no one could tell me the long term mortality and morbidity... People today with IBD are luckier to have more medical options than I had. I'm not sad to have had my surgery, but it would have been nice to have had other options. I'm quite happy with my pouch.... Now if this damnable fistula would just disappear!
quote:SIBO
Just to comment on diet. I have been on a primal diet way before this pouch came along. I fell back on eating crappy once I got it since carbs went through me with ease. Since I olympic lift, powerlift and crossfit I have been into the science of a primal/paleo diet. In general it benefits everyone with a pouch or not. More to it than just GI issues.
As for SIBO. It is bacteria of the small intestine. My SIBO is not in my pouch it is in the upper part of my tract. In my case my gut forms SIBO from not digesting the food properly. I would like to think Shen and other doctors who say eliminate certain foods know what they are talking about. In my case it works. It is night and day. I eat bread maybe once a month when I really crave a sandwich but the next 2 days following I notice my pouch is angry as hell.
You do not have to have a breath test to diagnose sibo. Most docs will give you a course of rifaxamin and if you improve, then its probably sibo. But if they think it might be pouchitis, then a scope is probably in order.
And yes, Shen definitely knows what he's talking about. I no longer have a jpouch. But a week after a hospitalization in which I had serious doses of two types of iv antibiotics I started having serious gut problems, extreme belching, distended abdomen, pain, and most importantly significant weight loss, etc...one of the warning signs of extremely serious SIBO. Shen told me it was sibo, simply based my symptoms.
He put me on an antibiotic it sort of worked. Told me to cut out sugar and reduce carbs. It sort of worked. But then things got worse, even more weight loss. Told me to try a FODMAP diet. And within 2 months I was a new person. So it doesn't necessarily take a year to get things reorchestrated in your gut. And definitely diet can make a difference. Many of the things that are ok on paleo are not ok on fodmap elimination. And some of those are defintiely problematic for me. However, I am ok with certain carbs.. rice pasta, rice bread, etc. So to each his own. But the main message here is diet does make a difference.
And yes, Shen definitely knows what he's talking about. I no longer have a jpouch. But a week after a hospitalization in which I had serious doses of two types of iv antibiotics I started having serious gut problems, extreme belching, distended abdomen, pain, and most importantly significant weight loss, etc...one of the warning signs of extremely serious SIBO. Shen told me it was sibo, simply based my symptoms.
He put me on an antibiotic it sort of worked. Told me to cut out sugar and reduce carbs. It sort of worked. But then things got worse, even more weight loss. Told me to try a FODMAP diet. And within 2 months I was a new person. So it doesn't necessarily take a year to get things reorchestrated in your gut. And definitely diet can make a difference. Many of the things that are ok on paleo are not ok on fodmap elimination. And some of those are defintiely problematic for me. However, I am ok with certain carbs.. rice pasta, rice bread, etc. So to each his own. But the main message here is diet does make a difference.
I WISH I had weight loss issues! I can't lose a pound and gain weight just looking at food. Shen doesn't get it since the way I eat and not having most of my gut and no large bowel I am not losing. The transit of my food is 5-8 minutes after eating it. Madness. I am super absorbent lol
@vanessavy posted:I know SIBO symptoms are similar to pouchitis. My idiot doctor's nurse kept swearing I had pouchitis and had me on 3 antibiotics for a year. I even had surgeons scope me locally who said I had no sign of pouchtis. Yet nobody had an answer so said maybe the "lighting was off in the pouch photos", what a crock of crap.
I didn't know any better and with my symptoms I just went along with it. I then went to a new GI who was pretty good and she said she believed I must have c.diff or SIBO. She was running out of ideas since antibiotics were not doing much after awhile. I saw Shen at CC and he diagnosed me with SIBO based on symptoms and not seeing anything wrong with my pouch.
I then saw him for a follow up 4 months later and was diagnosed with c.diff due to all the crap antibiotics I was on for "pouchitis" that I never had.
I know people post on my BCIR message board that with diet change and upping their fat content with different olive oil and oregano oil that after a year they were off antibiotics. I was so hesitant when Shen told me to get off sugar asap or I would be on antibiotics for life since sugar makes my pouch super runny and I need that. I also LOVE to eat cookies, cake and ice cream :-)
But after almost booking surgery to take this pouch out and going on and off a primal diet with no real commitment for 3 years I buckled down and threw out all my antibiotics and got my diet under control.
I use coconut milk instead of almond milk because I personally notice almond causes me more gas and gurgling guts.
Certain things I pay a lot of attention to since cleaning up my diet if I introduce something and my pouch is turning over itself with super slick stool that comes out and bad SIBO gurgles, I eliminate it. I love LOVE love oatmeal but I get serious gut gurgles if I eat it. So I avoid oats.
I never had UC so I never had issues prior to getting rectal cancer and having my colon removed. This is all new to me. But after doing research about SIBO and talking to Shen I believe I had SIBO far before getting a pouch. I ate really crappy most of my teen life.
The thing about diet change for SIBO is it can take a full year for it to be really under control, so I think some people get fed up after awhile and don't stick to it. I saw a big difference after a month of a clean diet. In the end diet is always the answer IMO.
I don't eat anything too processed. I say that because canned coconut milk and tomato paste I get at whole foods is still processed in some way. What I do not eat is fast food, boxed or frozen dishes. I buy local at an organic butcher and try to get my produce at whole foods or another local market.
If you have a diary I would say shoot me a PM with a week of what you eat and I can comment if any of it messes me up personally. I can't say that we are the same but it is trial and error with this pouch.
FYI I get irritated by canned chicken stock even because of the cane juice that is in there so I now make my own.
A SIBO test can help and an antibotic like Tindamax that finally got mine under control might help you. I would rule out c.diff to start since that was my main issue. I had it for about a year and suffered greatly.
Almost 10 years late haha, but I was wondering if you had any advice for treating sibo? I eat meat, sweet potatoes and white rice. I take AG and liver pills. Thanks!
Hello! I haven’t been active here for awhile, I stumbled across this thread googling long term SIBO pouch solutions-looking for something that works besides endless rounds of Xifaxan-is there a specific plan or protocol specific for J-pouchers I could download or read? So much conflicting information & searching online just turns into instagram ads promising gut health with weight loss & clear skin…I’d love some real advice with a plan & timeline if it exists! @vanessavy is your blog active or book available?
I have SIBO 2x/year. First time confirmed with breath test, subsequent times by symptoms.
i could never get xifaxin approved by private insurance and Medicare part d cost is prohibitive.
I have discovered that 14-21 days of bactrim will reset my microbiome imbalance.
my GI is comfortable with the 2x / year antibiotic treatment, so…
wash, rinse, repeat.
I guess if I gave up sugar I would probably avoid it, but since sweets are the only real food pleasure in my life these days, I’m not giving it up!