Moodle at CCNM

SIBO is a common condition and with great overlap between SIBO and IBS. In fact, SIBO may be the cause of IBS in up to 70% of cases. We also know that food poisoning (acute gastroenteritis) can be a trigger for IBS/SIBO but the mechanisms for this have been unknown. Recent data suggest that food poisoning creates an autoantibody that can cause IBS and SIBO based on animal and human studies. This presentation explores the data around how autoimmunity is triggered after food poisoning and in the development of IBS and SIBO. We will also explore how this could change the prognosis of IBS and SIBO. Pharmaceutical agents discussed include rifaximin and neomycin. There is also discussion of prokinetics such as prucalopride and erythromycin.

It is becoming increasingly clear that SIBO is in some cases due to previous exposure to gastroenteritis. Through a series of interesting studies, it is now understood that this singe food poisoning event can lead to long term changes in the microbiome. The most important of these is the development of antibodies to vinculin. In this presentation, we will update the audience on the latest developments on this topic and how the future is shaping up to treat SIBO and IBS as an autoimmune condition.

In the last decade, the understanding of clinical breath testing in the evaluation of SIBO has evolved. We have come to know that methane on breath testing is highly associated with constipation and requires a different approach to treatment. Hydrogen on the other hand is not related to any specific symptom. The missing gas has been hydrogen sulfide and this gas is of great importance to the symptom diarrhea. Not having this gas in the breath test profile leaves a missing piece of the puzzle out. In this presentation we will examine the interaction of all three gases and the importance they play in the evolving microbiome story of SIBO. Rifaximin will be discussed which is FDA approved, neomycin a drug not yet approved for SIBO and SYN-010 which is not yet approved by FDA for methane.