Amid Meds And A New Diet, Sibo Symptoms Fail To Improve

DEAR DR. ROACH: I was diagnosed with small intestinal bacterial overgrowth (SIBO) by my gastroenterologist over three years ago. I was tested using the tube method. (I followed a diet the day before, then blew into tubes the day of.) I am so bloated that I cannot wear any of my clothes because I look as though I'm ready to deliver a baby any minute.

I was put on several antibiotics, including rifaximin, none of which helped. I also followed the low-FODMAP diet. I was only supposed to follow it for six weeks, then wean myself off. However, I'm still following the diet. I am glucose- and lactose-free, and I still have absolutely no relief. I am taking pantoprazole.

I have been tested for celiac disease, but I'm OK there. I'm at my wits' end and was wondering if there was anything you could recommend. -- Anon.

ANSWER: SIBO is when large amounts of bacteria from the mouth and colon are present in the small intestine. This can cause the primary symptom of bloating, but can also cause excess gas, diarrhea and abdominal discomfort in some people. In severe cases, it can stop the person from being able to absorb nutrients, leading to weight loss and nutritional deficiencies. The diagnosis is most commonly made by a breath test (the "tube method" you mentioned), which looks for hydrogen and methane.

Antibiotics will usually improve symptoms. Since it didn't in your case, reconsideration of the diagnosis is appropriate, and either a repeat breath test or a different diagnostic test (such as a duodenal aspirate to look at bacteria counts) should be considered.

If the diagnosis remains SIBO, but there isn't any improvement in symptoms, there are additional treatments (such as an elemental diet). But most importantly, your doctor should try to understand why you have SIBO in the first place.

An abnormal intestinal anatomy, from surgery or a condition like Crohn's disease, is one big cause of SIBO. Abnormal GI motility from conditions that affect the nervous system of the intestine, like long-standing diabetes or scleroderma, is another.

The pantoprazole you are taking prevents your stomach from making acid. Without acid, mouth bacteria can go into the intestine. I would certainly ask your gastroenterologist about re-treatment and stopping the pantoprazole, if possible. Finally, medicines to enhance the movement of the intestine can be helpful for some people whose underlying cause is poor intestinal movement.

DEAR DR. ROACH: I am an 83-year-old female. I broke my left hip 14 months ago and received a hemiarthroplasty. Right now, my legs are so weak, and my balance is so bad. I have started to do beginners yoga, and the results are terrific. I walk better and have less pain.

So, my question is: Is it safe to do yoga at an advanced age? I am especially thinking about the inverted positions and folds. Could these give me a stroke? I do lean one leg against the sofa for balance. -- V.S.

ANSWER: Yoga is a terrific way of improving strength and flexibility. Although it is possible to injure oneself while doing yoga, having a teacher who understands your limitation (in your case, the recent hip surgery) is critical. The most common injuries are due to overstretching, but a stroke would be incredibly rare. Men are at a higher risk than women for injuries in yoga, and participants as well as teachers need to understand the differences in male anatomy that predispose men to yoga-related injuries.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.