January 24th, 2011
A new way to treat IBS?
The more we look into the normal gut bacteria flora the more complex it becomes. We know these bugs that reside in our small and large intestines affect immunology, motor, sensory and a myriad of other gut functions. The ability to modulate this diverse population of bugs does seem to help some patients with IBS and inflammatory bowel disease. Most of the recent attempts at influencing the types of bugs in a patient’s GI tract have been through probiotics. More recently using antibiotics has garnered increased attention.
What I would like to know is:
-Who out there has been using antibiotics in patients with IBS?
-What types of IBS patients seem to respond and how often do you see a response?
-What antibiotics are you using?
-Have you seen any side effects?
Let us know what you think and what you are doing.
2 Responses to “A new way to treat IBS?”
M. Brian Fennerty, MD
Editor-in-Chief
NEJM Journal Watch Gastroenterology
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I treat IBS with large gas/bloat component with antibiotics. However, given the cost of xifaxan and the 10 NNT to get 1 improvement over placebo (like just about every IBS prescription drug out there, in part due to the large placebo effect), I use the following stepwise approach once I have established no malignancy or celiac:
1. Detailed anti-gas handout with diet and behavioral modification
2. Trial of PRObiotics, which are less costly and also seem to work best in this population (mainly anecdotally although there are data supporthing this.
3. Trial xifaxan
I would say I get about 1/3 of the pts to respond once I get to that point, at least temporarily. Few side effects that I can detect, certainly no irreversible ones.
I do not routinely obtain breath test. I wish there were a better test to establish bacterial overgrowth.
I have had success with post-infectious IBS by using metronidazole. If I can get a history of sudden onset but now chronic symptoms in any combination of diarrhea, gas, bloating, nausea, anorexia going on for months following acute gastroenteritis, I found 40% clearance of all symptoms without relapse in 460 patients with above syndrome. This fit about 6% of new patients seen over 10 year period. Some cases may have been Giardia that wasn’t diagnosed. The dose is 250mg tid for seven days.