I'm on a 10-day regimen of Xifaxen for severe IBS and recurring flu-type symptoms. Has the bacteria in my intestine caused the IBS symptoms I've suffered for 9 years? How long can bacteria live in the intestine? If Xifaxen doesn't help, what next?
10 Sep 2009
It is possible that you once had a bacterial intestinal infection that has triggered your irritable bowel syndrome. Xifaxan seems to provide relief for some people with IBS, especially those who have "diarrhea-predominant IBS." Xifaxan is not actually FDA approved for the treatment of IBS, though it is used "off-label."
Irritable bowel syndrome (IBS) refers to a complex disorder of the lower intestinal tract. It is mainly characterized by a pattern of symptoms that is often worsened by emotional stress.
IBS involves a combination of abdominal pain and alternating constipation and diarrhea. There are many possible causes. For instance, there may be a problem with muscle movement in the intestine or a lower tolerance for stretching and movement of the intestine. There is no problem in the structure of the intestine.
It is not clear why patients develop IBS, but in some intances, it occurs after an intestinal infection. This is called postinfectious IBS. There may also be other triggers.
IBS can occur at any age, but often begins in adolescence or early adulthood. It is more common in women. The condition is the most common intestinal complaint that leads to referral to a gastroenterologist.
Xifaxan is an antibiotic that fights bacterial infection only in the intestines. It is approved by the FDA to treat treat travelers' diarrhea caused by E. coli. It is commonly used "off label" for the treatment of irritable bowel syndrome.
New guidelines for the treatment of irritable bowel syndrome were issued recently by the American College of Gastroenterology
Most IBS treatments relieve symptoms rather than resolve the condition itself.
The new guidelines encompass existing evidence on conventional treatments for IBS as well as new therapies (probiotics, for example) and alternative therapies (acupuncture and more). In summary, the updated guidelines say:
* Fiber products -- including psyllium, anti-spasmodic medications and peppermint oil -- may be effective, at least in some people.
* More data is needed on probiotics, live microorganisms (usually bacteria) similar to the "good" organisms found normally in the gut.
* Non-absorbable antibiotics -- those targeted to the gut only, such as rifaximin (Xifaxan) -- also seem to help some people, especially those who have "diarrhea-predominant IBS."
* Tricyclic antidepressants as well as the antidepressants known as selective serotonin reuptake inhibitors (SSRIs) benefit a broad range of people with IBS. This is backed up by quality studies, although with small numbers of participants, and could change as research on larger numbers of people is evaluated. Psychological counseling may also provide some relief.
* Selective C-2 chloride channel activators, notably lubiprostone (Amitiza), are effective for "constipation-predominant IBS."
* 5HT 3 antagonists such as alosetron (Lotronex) relieve symptoms of diarrhea but can cause constipation and colon ischemia, a restriction of blood flow.
* 5HT 4 agonists, though effective against constipation, are not available in North America because of a heightened risk of cardiovascular problems.
* There is yet to be conclusive evidence on Chinese herbal mixtures, and the mixtures run the risk of causing liver failure and other problems. Differences in the content of compounds and the purity of ingredients complicate evaluation of benefits.
* Similarly, the evidence on acupuncture remains inconclusive.
* There is no evidence at this point that testing for food allergies or following diets that exclude certain foods alleviates IBS symptoms.
* Routine diagnostic testing for IBS is not recommended, although some testing should be performed in certain subgroups of patients.
15 Jul 2012
The last year I have suffered greatly from IBS. I was miserable - diarrhea, nausea, cramping, especially in the mornings, and EVERY time I ate. Could not go anywhere without an episode. I lost 30 lbs. I began researching other treatments and meds because whatever the doctor gave me did little to combat. Found Pro-Biotics. Cost me less than $6 for 30 tabs - a one month supply - and you can buy them almost in any store over the counter. I take one about 1/2 hr before I eat at supper time. After one week I noticed a difference - episodes down from 7-8 x day to 4-6 x day. After 2 weeks nausea & cramping very minimal, episodes down 3-4 x day. After 3 weeks I am off ALL other meds. Stool is almost back to normal - has not been that way for over 2 years !! I am now going to give canine pro-biotics to my dog suffering from acute pancreatis and hopeful for the same results. I SWEAR by this !!!
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