How can I manage my chronic and recurrent gastrointestinal issues like GERD, SIBO, and IBD?

Hello,

Welcome to icliniq.com.

I have seen all your reports (attachments removed to protect the patient's identity). They all are normal. Considering your symptoms, you likely predominantly have IBS-D (irritable bowel syndrome diarrhea). IBS is a functional problem of the large bowel, making it more sensitive to pain stimuli, causing loose stools and excessive gas and flatus. It is not uncommon to have other functional abdominal problems when one has IBS. In your case, you probably have available gas and bloating.

SIBO (small-intestinal bacterial overgrowth) is otherwise common, and the primary reason behind it is the proximal migration of colonic type bacteria in the small bowel. This, in turn, occurs because of abnormal motility of the large bowel and is a common feature of IBS. Also, SIBO is often recurring since you have some large bowel, which is the problem. Therefore, SIBO needs antibiotic treatment.

IBS must be treated with lifestyle modification, including daily exercise (swimming) and avoiding junk foods (high fodmap diet). And then there comes the role of anti-spasmodic type medications such as Mebeverine-135 mg thrice daily. Finally, you can have acid proton-pump inhibitors, whatever suits you, because they all essentially work to reduce acid.

Hello,

Welcome back to icliniq.com.

You have very valid questions.

IBS does not cause GERD or gastritis. Gastritis you have is non-erosive or non-ulcerative type. In other words, it is called non-ulcer dyspepsia or functional dyspepsia. The functional dyspepsia is again a functional problem, but with the stomach. You remember I said it is not uncommon to have two to three functional disorders of the gut at one time. IBS with functional dyspepsia, and functional gas with bloating, are the three different presentations of the same metabolic pathway of gut motility impaired in patients. These metabolic pathways of the gut are autonomous and not in the control of humans. It is influenced by lifestyle, diet, medications, infection, and genetics. These all factors come into play to cause functional bowel problems at once. Once we correct the lifestyle and diet and avoid medications that impair gut motility, the condition will revert to a normal bowel.

The following are my suggestions.

• Rifaximin is good and should be taken 200 mg thrice daily for three weeks. The dose can be repeated more than once depending upon recurring symptoms of SIBO.
• Mebeverine is a short-lived medication with a half-life of 4 to 6 hours. It is an antispasmodic and anti-secretory agent. It reduces the pain and decreases the volume of stools, thus helpful in IBS-D, your predominant condition. You must take an intermittent course lasting for a few days to one week and again retake it if symptoms recur.
• The same with the PPI, but I do not think taking PPI for an intermittent duration, like days to one week, and then stopping for a week or so, would cause long-term complications. Or you can take it once a day, on the day where your symptoms are the worst. Meanwhile, you can take a simple antacid like alginate and milk of magnesia to control intermittent symptoms.
• Your symptoms are not due to hypochlorhydria meaning low stomach acid production. It is more like a myth than reality. Most individuals have sustained the production of stomach acid for a relatively long time. It is possible in very old age individuals or individuals with stomach surgery or some autoimmune disorder such as pernicious anemia or atrophic gastritis.