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I had a dozen prompt and helpful replies to my post about treating possible bacterial overgrowth (SIBO) with antibiotics.  As usual with anything relating to drug treatments, American listservers were generous and helpful in sharing knowledge and experiences, some of which were quite specific, which is what I requested. Many thanks.
My medical update is that Flagyl stopped the diarrhoea miraculously within 24 hours.  It did return 3 days later (as was predicted by some) so by the end of the week's course of antibiotics I was back at the doctor's, who has suggested a course of Cipro, which I have not yet started since then things have improved again. More tests are being done but the upshot is that I am sure that some form of SIBO is the problem and antibiotics were effective (taken with probiotics and following some advice about diet). If the problem recurs I would also certainly consider Rifaximin (if I could get it and with my doctor's consent) as it sounds a useful alternative antibiotic.

My own conclusion is that SIBO can clearly start from "nowhere" and should be considered by celiacs in cases of unexplained diarrhea: a trial week of antibiotics may help diagnose as well as treat the problem.

Charlotte, Oxford, UK

NB I have read Why Stomach Acid is Good for You

ORIGINAL POST

I have suggested to my GP that, after 2 weeks or so of unexplained diarrhoea, bacterial overgrowth be investigated, since there is some  evidence, in research** & anecdotally, that it is common in treated coeliacs. While I wait for other standard tests to be done, I have been offered a week of the antibiotic Flagyl (metronidazole) as a trial.I have read the useful previous postings on bacterial overgrowth but would be interested to hear of anyone who has taken Flagyl (does it work without Cipro?) - or other antibiotics for this, especially anyone who has taken Rifaximin, which has been used recently in Europe for diarrhoea**and is now licensed in the US (though not in the UK so this is not an option for me at present).

 Most of the "evidence" on SIBO* and CD is from coeliacs with continuing symptoms in the months immediately after diagnosis. This is not quite my situation since I have been mainly well the last 7 years. Has anyone  been OK and then "developed" diagnosed SIBO some years later? I should mention that I am a healthy middle-aged woman, with CD/GF diet well-controlled. The onset of diarrhoea was sudden and I do not normally suffer from this or any IBS type symptoms nor do I get this reaction from gluten contamination.  The standard gut bugs (food poisoning etc) have been ruled out and I have no pain or other symptoms of illness (though some signs of malabsorption). My appetite is good and I have been advised to continue eating normally since trying limited changes in diet (eg avoiding dairy) do not seem to make a difference. I will of course be investigated further if it continues (but i feel malignancy is unlikely). My hunch about bacterial overgrowth is based really on ruling other things out. 

*(small) intestinal (bowel) bacterial overgrowth (aka SIBO, IBO, SBBO)

**High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal.

Tursi A, Brandimarte G, Giorgetti G. Department of Emergency, "L.Bonomo" Hospital, Andria (BA), Italy.Am J Gastroenterol. 2003 Apr;98(4):839-43 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=3DRetrieve&db=3Dpubmed&=dopt=3DAbstract&list_uids=3D12738465

 


REPLIES (on order of relevance to my own situation: others may be different)

 1) Several years ago I had an encounter with a gut parasite, giardia, that caused progressively nasty diarrhea.  Flagyl alone was prescribed and it took care of the problem. I have since had a couple of gut "infections" that have been successfully treated with the combination of Flagyl and Cipro, although after the last treatment I needed to take a couple of probiotics to normalize my gut.

2) I was diagnosed with SIBO last Feb after complaining about lower GI cramping, severe flatulence and diarrhea. I took rifaximin for a month (can't remember the dose, just remember   4 tabs a day) then I took VSL#3 to repopulate the gut with friendly flora. My flatulence got much worse during the treatment and then resolved.   All my GI problems resolved and better yet I had fewer food sensitivities.

3) My situation is not completely like yours but I am susceptible to ghiardia.  I first got it when I was in Mexico when I was 21.  I've had it probably 5 times since then.  My last bout was after being diagnosed celiac and my immune system probably wasn't at its best.  I went to a local water park that shares some areas with a local river.  I was immediately sick the next day and for about two weeks with cramping and diarrhea.  Luckily I was seeing a naturopath and she knew my history and my fecal sample had come back negative.  She suggested a course of Flagyl.  One thing that really helped was after I was done with the Flagyl, she had me take large doses of probiotics for about a month and I also started on digestive enzymes to help my stomach out.  I stayed on a small dose of probiotics and digestive enzymes for about a year. It really helped.  

So keep pushing your doctors on the bacterial overgrowth issue because you may be on the right rack.  

4) Both of my children, one celiac and one not, have taken flagyl for  bacterial overgrowth...it does work well.

5) Nearly a year after beginning the GF diet, I became sicker than I ever had.  The problem was caused by bacterial overgrowth.  It nearly wiped me out.  If you're going to get over this, you will need to understand the basics of intestinal health that your doctor hasn't explained to you.  (Often times, conventional doctors really don't get it!)  I was so desparately ill, that my GI specialist finally referred me to a naturopath who helped educate me so that I could make the choices that healed me & have kept me well for the past 5 years.  Please read below:

 Flagyl & other antibiotic treatments for bacterial overgrowth (BO) are only temporary fixes.  Unless the underlying problem causing this disorder is addressed & remedied, BO will come back over & over again.  So what conditions contribute to the development of BO?  Several things:  

(a) Antibiotic use.  Taking antibiotics kills everything in the gut indiscriminately, both good guys & bad guys.  Unfortunately the bad guys (candida albicans, citrobacter & many other pathogenic bacteria) take over & proliferate.

(b) A diet high in refined carbohydrates.  Sugar & refined starches incourages the over growth of pathogentic microorganisms.  A diet high in unrefined foods, fresh fruits & fresh vegetables, meats, fiber, etc encourages growth of the good guys.

(c) Hypochlorhydria, the underproduction of stomach acid.  Celiac disease, food allergies, chronic inflammation & irritation, and age (above 40) all cause the under production of stomach acid & all digestive enzymes.  When the foods we eat are not properly digested, the BAD guys feast, proliferate & OVER GROW making us sick as dogs! 

(d) Sterile diet.  When everything we eat is cooked, we don't ingest a healthy amount of good bacteria.  Also cooked foods encourage the growth of bad bacteria.  Good bacteria thrive on raw foods.

 What to do to fix this situation?

 (e) Always take a high quality source of beneficial bacteria during & after antibiotic use.  Kefir, yogurt, buttermilk, raw authentic sauerkraut & pickles (the kind you buy at the health food store), cottage cheese, etc.  A daily dose of fermented foods keeps the good guys strong & supresses the overgrowth of the bad guys.  (My personal favorite is home make kefir.  It's cheap, easy, requires no special equipment to make.  Search the web for Dom's kefir website for more info on kefir.)

(f) A whole food diet, low in refined carbohydrates & sugars.  

(g) Supplemental hydrochloric acid & digestive enzymes.  (I take Soloray HCl super strength and Soloray pancreatin 1300X at each meal.)   

(h)  Include raw fruits & vegetables in the diet every day.  The bacteria found on raw fruits & vegetables is important for our digestive health.

 For more information on this, I suggest you read WHY STOMACH ACID IS GOOD FOR YOU by Jonathan Wright MD and NOURISHING TRADITIONS by Sally Fallon.  These two books changed my life.

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