Hi All,
Luce sent me a link to this site which describes a research project in which Celiacs on a GF diet were still experiencing symptoms after 6 to 8 months of dieting. It was discovered that two thirds of them had small intestinal bacterial overgrowth, (SIBO). After treatment, all problems were resolved.
http://tinyurl.com/mckeg
Tex
Small Intestinal Bacterial Overgrowth in Celiacs
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Small Intestinal Bacterial Overgrowth in Celiacs
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
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Thanks Lucy and Wayne!
I did a search on the antibiotic that was used in this study, rifaximin (named also xifaxan), and I thought you might be interested in this and other sites about it's use:
I'm so sorry, I tried to just link you to the page, but MedScape doesn't allow that without registering, so I'm cutting and pasting the article here, and taking up a lot of space. Sorry . . .
Several GI Disorders May Respond to Rifaximin
Paula Moyer, MA
Nov. 2, 2005 (Honolulu) — Several gastrointestinal disorders beyond traveler's diarrhea respond to rifaximin (Xifaxan), according to investigators who presented their findings here at the 70th annual meeting of the American College of Gastroenterology.
Patients with irritable bowel syndrome (IBS) often get relief from one 10-day course of rifaximin (Xifaxan), according to principal investigator Mark Pimentel, MD. And in other research investigators found that patients with hepatic encephalopathy who take rifaximin have fewer, shorter hospitalizations and less severe disease.
Rifaximin is currently approved for the treatment of traveler's diarrhea. It is an oral antibiotic that is treated to resist absorption until it passes to the colon.
"This is the first treatment I've seen for IBS with which the benefit is sustained when the treatment is stopped," Dr. Pimentel told Medscape. He is the director of the GI Motility Program at Cedars-Sinai Medical Center in Los Angeles, California. "To me, this means that we're onto something." He pointed out that some IBS experts think that one underlying cause may be an overgrowth of bacteria, and that this development may explain why an antibiotic would resolve the condition.
Dr. Pimentel and coinvestigators recruited 91 patients with IBS to participate in a trial comparing rifaximin to placebo. The patients met the Rome I criteria for IBS. For seven days, the patients kept a stool diary and also responded to a questionnaire and a lactulose breath test, with the results blinded to both subjects and investigators.
The investigators then randomized 87 patients to receive either placebo (n = 44) or rifaximin (n = 43) for 10 days. The patients in the treatment group received 400 mg of rifaximin orally three times daily for 10 days. For seven days after treatment ended, subjects repeated the stool diary and then responded to a symptom questionnaire and lactulose breath test.
Patients in the rifaximin group had an average overall symptom improvement of 37.7% compared with 23.4% for patients in the placebo group (P < .05). In the treatment group, 37% of the participants were classified as clinical responders compared with 16% of those in the placebo group. The study design defined responders as those who had at least a 50% overall improvement.
Subjects with diarrhea were the most likely to respond to treatment, Dr. Pimentel said. With neomycin, the response is more often seen in patients whose predominant symptom is constipation. The clinical response rate among those with diarrhea was 49% for those receiving rifaximin compared with 23% of those receiving placebo (P < .05). Bloating was also improved, but not in a statistically significant manner, and the investigators documented no difference in patients with constipation.
The shift to antibiotic therapy is an important direction for physicians to watch, said Patricia Raymond, MD, in an interview seeking outside comment. She is an associate professor of clinical internal medicine at Eastern Virginia Medical School in Norfolk.
"What's come to light this year [at the annual meeting] is that a subset of IBS patients may suffer from bacterial overgrowth in the small intestine," Dr. Raymond said. "The notion that some IBS patients will respond to an antibiotic opens up the whole question: what is IBS? We have those with diarrhea, those with constipation, and those who flip between. But we always had those we couldn't treat. Now we have one more avenue, one more possible treatment. It's one more thing to do — not the first thing, but it's one more thing to do after ruling out other conditions with similar symptoms."
In other research, Carroll Leevy, MD, and colleagues found that patients with hepatic encephalopathy had a stronger response to rifaximin than to lactulose. Dr. Leevy is an associate professor of medicine at the New Jersey Medical School Liver Center in Newark, where he is the associate director for clinical affairs at the Sammy Davis, Jr., National Liver Institute.
In a crossover, retrospective chart review involving 145 patients, the patients initially received lactulose at a dose of 30 cc twice daily for at least six months and then rifaximin at a dose of 400 mg three times daily for at least six months. The investigators then evaluated the patients' responses to the last six months of lactulose compared with the first six months of rifaximin.
During the rifaximin treatment period, patients were hospitalized an average of 0.5 times compared with an average of 1.6 times during the lactulose treatment period (P < .001). The hospitalizations during the rifaximin period were an average of 3.14 days compared with an average of 12.52 days in the lactulose period (P < .001).
In addition, the hepatic encephalopathy grade was lower in the rifaximin period, and fewer patients had asterixis, a tremor associated with advanced liver disease. Patients also reported less diarrhea, flatulence, and abdominal pain while receiving rifaximin (P < .001 for all). Patients were also more likely to comply with medication while receiving rifaximin, Dr. Leevy said (P < .001). The Healthcare Cost Utilization Project (HCUP) data showed that rifaximin was associated with a cost savings of $67,559 per patient, he said.
The studies were funded by Salix Pharmaceuticals, Ltd., which manufactures Xifaxan.
ACG 70th Annual Meeting: Abstracts 42 and 44. Presented Nov. 1, 2005.
Reviewed by Gary D. Vogin, MD
Related Links:
Conference Coverage - American College of Gastroenterology 70th Annual Scientific Meeting and Postgraduate Course
Isn't that interesting???
Love, Marsha
P.S. I've since read more of the scholarly articles on this, including those from "Medical Matrix-the largest peer-reviewed med directory on the net", "Medscape", and "Medpage Today", all dated in the last 4 months, and I'm going to ask my doctor about a trial. It can't hurt.
I did a search on the antibiotic that was used in this study, rifaximin (named also xifaxan), and I thought you might be interested in this and other sites about it's use:
I'm so sorry, I tried to just link you to the page, but MedScape doesn't allow that without registering, so I'm cutting and pasting the article here, and taking up a lot of space. Sorry . . .
Several GI Disorders May Respond to Rifaximin
Paula Moyer, MA
Nov. 2, 2005 (Honolulu) — Several gastrointestinal disorders beyond traveler's diarrhea respond to rifaximin (Xifaxan), according to investigators who presented their findings here at the 70th annual meeting of the American College of Gastroenterology.
Patients with irritable bowel syndrome (IBS) often get relief from one 10-day course of rifaximin (Xifaxan), according to principal investigator Mark Pimentel, MD. And in other research investigators found that patients with hepatic encephalopathy who take rifaximin have fewer, shorter hospitalizations and less severe disease.
Rifaximin is currently approved for the treatment of traveler's diarrhea. It is an oral antibiotic that is treated to resist absorption until it passes to the colon.
"This is the first treatment I've seen for IBS with which the benefit is sustained when the treatment is stopped," Dr. Pimentel told Medscape. He is the director of the GI Motility Program at Cedars-Sinai Medical Center in Los Angeles, California. "To me, this means that we're onto something." He pointed out that some IBS experts think that one underlying cause may be an overgrowth of bacteria, and that this development may explain why an antibiotic would resolve the condition.
Dr. Pimentel and coinvestigators recruited 91 patients with IBS to participate in a trial comparing rifaximin to placebo. The patients met the Rome I criteria for IBS. For seven days, the patients kept a stool diary and also responded to a questionnaire and a lactulose breath test, with the results blinded to both subjects and investigators.
The investigators then randomized 87 patients to receive either placebo (n = 44) or rifaximin (n = 43) for 10 days. The patients in the treatment group received 400 mg of rifaximin orally three times daily for 10 days. For seven days after treatment ended, subjects repeated the stool diary and then responded to a symptom questionnaire and lactulose breath test.
Patients in the rifaximin group had an average overall symptom improvement of 37.7% compared with 23.4% for patients in the placebo group (P < .05). In the treatment group, 37% of the participants were classified as clinical responders compared with 16% of those in the placebo group. The study design defined responders as those who had at least a 50% overall improvement.
Subjects with diarrhea were the most likely to respond to treatment, Dr. Pimentel said. With neomycin, the response is more often seen in patients whose predominant symptom is constipation. The clinical response rate among those with diarrhea was 49% for those receiving rifaximin compared with 23% of those receiving placebo (P < .05). Bloating was also improved, but not in a statistically significant manner, and the investigators documented no difference in patients with constipation.
The shift to antibiotic therapy is an important direction for physicians to watch, said Patricia Raymond, MD, in an interview seeking outside comment. She is an associate professor of clinical internal medicine at Eastern Virginia Medical School in Norfolk.
"What's come to light this year [at the annual meeting] is that a subset of IBS patients may suffer from bacterial overgrowth in the small intestine," Dr. Raymond said. "The notion that some IBS patients will respond to an antibiotic opens up the whole question: what is IBS? We have those with diarrhea, those with constipation, and those who flip between. But we always had those we couldn't treat. Now we have one more avenue, one more possible treatment. It's one more thing to do — not the first thing, but it's one more thing to do after ruling out other conditions with similar symptoms."
In other research, Carroll Leevy, MD, and colleagues found that patients with hepatic encephalopathy had a stronger response to rifaximin than to lactulose. Dr. Leevy is an associate professor of medicine at the New Jersey Medical School Liver Center in Newark, where he is the associate director for clinical affairs at the Sammy Davis, Jr., National Liver Institute.
In a crossover, retrospective chart review involving 145 patients, the patients initially received lactulose at a dose of 30 cc twice daily for at least six months and then rifaximin at a dose of 400 mg three times daily for at least six months. The investigators then evaluated the patients' responses to the last six months of lactulose compared with the first six months of rifaximin.
During the rifaximin treatment period, patients were hospitalized an average of 0.5 times compared with an average of 1.6 times during the lactulose treatment period (P < .001). The hospitalizations during the rifaximin period were an average of 3.14 days compared with an average of 12.52 days in the lactulose period (P < .001).
In addition, the hepatic encephalopathy grade was lower in the rifaximin period, and fewer patients had asterixis, a tremor associated with advanced liver disease. Patients also reported less diarrhea, flatulence, and abdominal pain while receiving rifaximin (P < .001 for all). Patients were also more likely to comply with medication while receiving rifaximin, Dr. Leevy said (P < .001). The Healthcare Cost Utilization Project (HCUP) data showed that rifaximin was associated with a cost savings of $67,559 per patient, he said.
The studies were funded by Salix Pharmaceuticals, Ltd., which manufactures Xifaxan.
ACG 70th Annual Meeting: Abstracts 42 and 44. Presented Nov. 1, 2005.
Reviewed by Gary D. Vogin, MD
Related Links:
Conference Coverage - American College of Gastroenterology 70th Annual Scientific Meeting and Postgraduate Course
Isn't that interesting???
Love, Marsha
P.S. I've since read more of the scholarly articles on this, including those from "Medical Matrix-the largest peer-reviewed med directory on the net", "Medscape", and "Medpage Today", all dated in the last 4 months, and I'm going to ask my doctor about a trial. It can't hurt.