Small Bowel Bacterial Overgrowth

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Small Bowel Bacterial Overgrowth

• Another Cause for IBS Symptoms
• Karenn Hall, BSN, RN,CGRN

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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

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Irritable Bowel Syndrome

• Symptoms
• A, B, C, D, E
• Causes
• Genetic, inflammation, neurological, infectious,
  SIBO, other
• Treatment
• Symptom based

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Rule out other causes of Sxs

• Celiac Sprue
• Thyroid dysfunction
• C. Diff
• Crohns or ulcerative colitis
• Other warning signs not IBS

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Small Bowel Bacterial Overgrowth (SBBO or SIBO)

• Bacteria and the gut
• Definition
• Symptoms
• Causes and conditions

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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

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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

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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.

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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

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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

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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

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Conclusion and Questions