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Small Bowel Bacterial Overgrowth

Small Bowel Bacterial Overgrowth . Another Cause for IBS Symptoms Karenn Hall, BSN, RN,CGRN. IBS Facts. Women 3.2 times more likely than men Whites 5.3 times more often than blacks 20% of Americans, 54 million Accounts for between 2.4 million and 3.5 million visits to a provider per year

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Small Bowel Bacterial Overgrowth

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  1. Small Bowel Bacterial Overgrowth Another Cause for IBS Symptoms Karenn Hall, BSN, RN,CGRN

  2. IBS Facts • Women 3.2 times more likely than men • Whites 5.3 times more often than blacks • 20% of Americans, 54 million • Accounts for between 2.4 million and 3.5 million visits to a provider per year • Second only to the common cold for missed work days

  3. Irritable Bowel Syndrome • Symptoms – • A, B, C, D, E • Causes • Genetic, inflammation, neurological, infectious, SIBO, other • Treatment • Symptom based

  4. Rule out other causes of Sx’s • Celiac Sprue • Thyroid dysfunction • C. Diff • Crohn’s or ulcerative colitis • Other warning signs not IBS

  5. Small Bowel Bacterial Overgrowth (SBBO or SIBO) • Bacteria and the gut • Definition • Symptoms • Causes and conditions

  6. Hydrogen Breath Testing • QuinTron: 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, reimbursement • GI Pathology: offers mail-in kit

  7. 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

  8. Testing Instructions • Baseline breath sample • Substrate (lactulose 10 grams) mixed in 6-8 ounces of water. • Additional breath samples taken at 20 minute intervals for at least 5 additional samples.

  9. Interpreting Results • Look for bi-phasic peaks in true positives • Early increase of at least 12 ppm • Investigate interferences to accurate results: • Smoking, laxative use, last meal, antibiotic use, previous surgeries, COPD

  10. Treatment Options The goal is to treat the underlying cause(s), eradicate the bacterial overgrowth, and nutritional support • Antibiotic therapy • Prokinetic agents • Probiotics • Nutritional support

  11. 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

  12. Conclusion and Questions

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