Copyright HD Scientific 2014-2105 All Rights Reserved 1 When Is Intestinal Gas Dangerous? Dangerous?

1Copyright HD Scientific 2014-2105 All Rights Reserved

When Is Intestinal GasDangerous?

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Chronic IBS-Like Symptoms

• Frequent cause of primary care visits• May be primary reason for visit or

co-morbid with other condition• Range of severity • From mild to severe

• Moderate-Severe cases affect QOL, high health care costs

• Often refractory/challenging• Poor response to conventional

therapies• May need referral to GI

Diarrhea

Loose stools

Pain/Discomfort

Gas

BloatingConstipation

Urgency

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Common Causes of IBS-Like Symptoms

1. Irritable Bowel Syndrome2. Small Intestinal Bacterial

Overgrowth (SIBO)3. Fructose Malabsorption4. Lactose Intolerance5. Inflammatory Bowel Disease6. Celiac Disease


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Problem: Accurate Diagnosis

Cannot make a symptom-based diagnosis for 5/6 Cannot make a correct diagnosis of IBS without first ruling out 5/6

1. IBS2. SIBO3. Fructose Mal.4. Lactose Intol.5. IBD6. Celiac Disease

Outcomes Depend on Accurate DiagnosisCopyright HD Scientific 2014-2105

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When is Intestinal Gas Dangerous?

The Seemingly Least Important Symptom is in Fact the Most

Important Clue• Intestinal gas production is caused

primarily by bacterial fermentation• The site of gas production is critical

• Small Intestine = SIBO• Large Intestine = carbohydrate

malabsorption


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Definition of SIBO

• Small Intestinal Bacterial Overgrowth (SIBO) is a disorder of either excessive growth or alteration of the types of bacteria present in the small intestine. • SIBO is one of the most common

gastrointestinal diseases, affecting approximately 30 million Americans


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“It is mandatory to consider SIBO in all cases of complex non-specific dyspeptic complaints (bloating, abdominal discomfort, diarrhea, abdominal pain), in motility disorders, anatomical abnormalities of the small bowel and in all malassimilation syndromes (malabsorption, maldigestion).”

Bures J, et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterology 2010 June 28; 16(24): 2978-2990

Why?

Managing SIBO is Mandatory


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SIBO Causes Enterocyte/Microvilli Damage

“Biopsies of the small bowel in bacterial overgrowth can mimic those of celiac disease, making the diagnosis more challenging.”

• Blunting of microvilli• Enterocyte damage

Toskes P, Giannella R, Jervis H, Rout W, Takeuchi A (1975). "Small intestinal mucosal injury in the experimental blind loop syndrome. Light- and electron-microscopic and histochemical studies". Gastroenterology 68 (5 Pt 1): 1193–203. PMID 1126607


http://en.wikipedia.org/wiki/PubMed_Identifier

http://www.ncbi.nlm.nih.gov/pubmed/1126607

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Wide Ranging Clinical Ramifications of Undiagnosed/Untreated SIBO

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SIBO• Bacterial Macro &

Micro Nutrient Consumption

• Bacterial Metabolic Byproducts

• Bacterial Endotoxins

• Inflammatory Response

GI Symptoms• Diarrhea• Loose stools• Urgency• Gas Production• Pain/Discomfort• Constipation

Gut Damage• Enterocyte

damage• Villous atrophy

Carbohydrate Malabsorption• Fructose• Lactose

Malnutrition• Macronutrients

– Carbs, Lipids, Proteins

• Fat soluble vitamins– Vitamin A, D, E

• B Vitamins, Iron– B-12, thiamine

• Minerals– Calcium,

magnesium

Extra-Intestinal Symptoms & Disease

• Osteoporosis• Rosacea • Anemia• Polyneuropathy• Fatigue• Brain fog• Malaise• Weight loss• Etc.

Bacterial Translocation

Leaky Gut

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Rosacea: SIBO-Related Bacterial Translocation?

Small intestinal bacterial overgrowth in rosacea: clinical effectiveness of its eradication. Parodi A1, Paolino S, Greco A, Drago F, Mansi C, Rebora A, Parodi A, Savarino V. Clinical Gastroenterology & Hepatology. 2008 Jul;6(7):759-64. doi: 10.1016/j.cgh.2008.02.054. Epub 2008 May 5.

• The prevalence of SIBO was higher in patients than controls (52/113 vs 3/60, P < .001).

• 10 day treatment with Rifaxamin – non-absorbable antibiotic• After eradication, cutaneous lesions cleared in 20 of 28 and greatly

improved in 6 of 28 patients, whereas patients treated with placebo remained unchanged (18/20) or worsened (2/20)

• Eradication of SIBO induced an almost complete regression of cutaneous lesions and maintained this excellent result for at least 9 months


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• Achlorhydria• Celiac disease• Crohn’s• Diabetes• Fibromyalgia• Gastroparesis• IBS

SIBO Associated Conditions• Immunodeficiency

syndromes• Liver cirrhosis• Chronic pancreatitis• Restless legs syndrome• Rosacea• Scleroderma• Short bowel syndrome

Range of Symptom SeverityMild Severe


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Carbohydrate Malabsorption

• Fructose Malabsorption– Poor absorption of fructose containing foods

• Colonic bacteria consume unabsorbed fructose leads to H2 production, bloating, gas & various GI symptoms

• Lactose Intolerance– Poor absorption of lactose due to lactase

deficiency• Colonic bacteria consume unabsorbed lactose

leads to H2 production, bloating, gas & various GI symptoms

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Breath H2 Testing is Best Method to Diagnose SIBO & Carbohydrate Malabsorption

• 40+ year history with lactose intolerance• 25+ years with fructose malabsorption• Used in virtually all research to diagnose SIBO and

carbohydrate malabsorption• Non-invasive• Highly accurate• Covered by virtually all insurance


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HydroStat Gives Critical Diagnostic Information

Assess target organ of bacterial metabolic activity Small Intestine:• SIBOLarge Intestine:• Fructose Malabsorption• Lactose Intolerance


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HydroStat Improves Diagnostic Ability

HydroStat accurately diagnoses 3 of 6 common causes of IBS-like symptoms leading to targeted treatment and significantly improved outcomes

1. SIBO2. Fructose

Malabsorption3. Lactose

Intolerance


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Diagnostic Workup for Moderate to Severe IBS-Like Symptoms

HydroStat• SIBO• Fructose

Malabsorption• Lactose

Intolerance

History• IBD (0.5%)• Celiac (0.75%)• Colorectal

Cancer• Travel Abroad

Blood Tests• CBC• Celiac Panel• Thyroid Panel

Stool Studies

• Occult Blood• Parasites• Pathogens

Alarm Signals

• Rectal Bleeding• Nocturnal

Diarrhea• Weight Loss• >50 Years Old + = >70%

TreatmentSuccess

Targeted Diagnostics Targeted Therapy Better Outcomes


Copyright HD Scientific 2014-2105 All Rights Reserved 1 When Is Intestinal Gas Dangerous? Dangerous?

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