Testing for IBS-C: Colonoscopy, Endoscopy and SIBO Breath Test

I chose to see the same gastroenterologist who had performed my "screening colonoscopy" just six months previous. I reasoned that any new doc would want to have their own look-see and it really wasn't an experience that I was eager to repeat. I also knew that six months ago everything had looked normal and I was hoping she'd give me a full pass so I could move my primary doc onto some other line of inquiry. But that's not what happened.

While the gastro didn't make me repeat the colonoscopy, she did order an endoscopy and a SIBO breath test. The endoscopy, like the former colonoscopy, did require anesthesia but it didn't require the icky prep — no drinking a vast amount of solution designed to clean me out before the procedure. I had to follow a light diet 12 hours beforehand. If I recall, I was allowed broth and some chicken breast the day before and nothing after 8pm. The endoscopy scope is inserted down your throat while you're "out." I had a slight sore throat afterward, but otherwise didn't feel a thing.

The SIBO breath test was absolutely painless. I just had to drink a lactulose solution, wait about 20 minutes for it to digest, then breath into a tube every 10 minutes over the course of a few hours while they measured levels of gasses my stomach was producing.

The endoscopy came back clear, which was a relief, however, the SIBO breath test came back positive for methane, which was a total surprise. Methane gas indicates an over colonization by an organism called archaea that naturally occur in the body but usually in the large intestine. This type of organism cause the constipation variety of SIBO. If hydrogen gas had been present, that would indicate an overgrowth of a type of bacteria that causes the diarrhea version of SIBO.

So, I had SIBO. It felt good to have a diagnosis, but what did it really mean? How could SIBO be causing my kind of symptoms?

Well, like most people who have SIBO, I have leaky gut. The erosion of the mucus lining that's the barrier that normally keeps food we eat from getting into our bloodstream has become permeable, allowing food particles into my blood. When my immune system detects these, it treats them like an invader and a cascade of events is triggered. One of these is histamine production. The same histamine involved in allergy attacks, for which many people take over the counter antihistamine tablets. Things like skin rashes and other autoimmune reactions like joint pain may very well be attributed to this.

Other symptoms like numbness and tingling and leg cramps are likely due to vitamin deficiencies caused by SIBO. Because bacteria have colonized the small intestine, where they don't belong, they are able to get to our nutrients earlier in the digestive process, depleting us of vitamins. And some vitamin deficiencies can mimic the symptoms of very serious health ailments.

So, what now? A combo of antibiotics xifaxin and erythromycin had been the forward thinking treatment for the past few years, formulated by SIBO pioneers Dr. Mark Pimentel and Dr. Allison Siebecker. But I was dismayed to read about the dismal failure rate of antibiotic treatment for my type of SIBO, SIBO-C (40-50% recurrence rate, according to many studies). Even those who are initially "cured" by the antibiotic duo are likely to relapse and require rounds and rounds of more antibiotics, which can eventually lead to antibiotic resistance and even bigger problems such as C-dif. Studies showed herbal antimicrobials are sometimes more effective than antibiotics. I was further encouraged by the accounts of bloggers at Hollywood Homestead and Animal Pharm/The Gut Institute, who eradicated SIBO using botanical medicines. I did my research on the various botanicals and was just about to purchase a slew of herbal antibiotics, prebiotics and probiotics when I came across this Chris Kresser podcast and learned about a new herbal drug called Atrantil that targeted the archaea that cause SIBO-C. 

I changed track and started formulating a treatment protocol, and prepared to discuss it intelligently with my gastro.