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
 Second only to the common cold for
missed work days
Irritable Bowel Syndrome
 Symptoms
 A,
–
B, C, D, E
 Causes
 Genetic,
inflammation, neurological,
infectious, SIBO, other
 Treatment
 Symptom
based
Rule out other causes of Sx’s
 Celiac
Sprue
 Thyroid dysfunction
 C. Diff
 Crohn’s or ulcerative colitis
 Other warning signs not IBS
Small Bowel Bacterial
Overgrowth (SBBO or SIBO)
 Bacteria
and the gut
 Definition
 Symptoms
 Causes and conditions
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
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
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.
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
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
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
Conclusion and Questions