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.comwww.quintron-usa.com  Measures both hydrogen and methane  Mail-in kit option  MicroDirect: www.breathh2.comwww.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

13. 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

15. 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

16. Conclusion and Questions