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Dr. David
Dr. David, Board Certified Physician
Category: Medical
Satisfied Customers: 42825
Experience:  Experienced Physician trained in New York City. I'm ready to help.
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I have had on/off diarrhoea last 8 months. Mild abdominal

Customer Question

I have had on/off diarrhoea for the last 8 months. Mild abdominal pain, slight nausea and wind. My bowel habits vary between once a day, twice a day, no times a day to diarrhoea. Sometimes diarrhoea once a month and sometimes once a week. I have had blood tests, which were all normal, a colonoscopy with biopsies take, which were normal and an MRI to look at the small bowel and the rest of the abdomen. This was normal too. My consultant thinks the symptoms are due to IBS, but suggested a lactulose hydrogen breath test for small intestine bacterial overgrowth, which I had today. I fasted for 12 hours ad only ate the food I was told to yesterday. When I arrived I had my baseline tested and it was already high at 54ppm. The doctor told me to sit for 12 hour before drinking the lactulose and then she tested again. It was still high, but hadn't increased. After drinking the lactulose there was an increase in levels to 15-114ppm above baseline at 60 minutes. Hydrogen values continued to rise , peaking a 232ppm at 120 minutes. I did have stomach cramps, needed to go to the toilet and had very loud stomach grumbling throughout. The diagnosis is small intestine bacterial overgrowth. What I don't understand is why my baseline levels were so high. I followed the diet instructions and I don't drink. I did have a 20 minute walk to the clinic. Can you please explain. Thank you.
Submitted: 11 months ago.
Category: Medical
Expert:  Dr. David replied 11 months ago.

This is Dr. David

the idea is that you have too much bacteria in your small bowels which could be producing too much gas and may not be helping you properly with your digestion.

the way to treat SIBO is often with a course of antibiotics such as Rifaximin which has been shown to be most effective

you can read more here

http://www.medscape.com/viewarticle/555634

some patients also benefit from additional of probiotics into their diet during or after antibiotic therapy to add more "good" bacteria into their bowels to help with proper digestion

also drinking more water and regular exercise can help your bowels work better

for some patients, avoiding milk and lactose can help

for some patients, avoiding gluten wheat protein in pasta, breads, pizza dough can help

keeping a food diary of what you eat and seeing what foods cause worse symptoms can help as well

let me know if you have other questions.

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Customer: replied 11 months ago.
Thank you. Yes I understand that, but what I don't understand is why my baseline level was so high even before I drank the lactulose.
Expert:  Dr. David replied 11 months ago.

Too much bad bacteria already in your small bowels making hydrogen gas

They can be killed down with antibiotics

We all have bacteria in our small bowels

If you have IBS symptoms this could be due to too much bad bacteria there

let me know if you have other questions.

If done for now please leave positive feedback below.

You can always reach me as Dr David.

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Expert:  Dr. David replied 11 months ago.

do you have other questions?