Dr. Shaver reviews the top ten highlights from the SIBO Symposiums of 2014 and 2015. We look at the underlying causes of SIBO and the resultant carbohydrate malabsorption. We glance at the approval of Rifaximin for IBS-D and the new test for IBS: IBSchek. The various herbal antibiotic protocols and the Johns Hopkins herbal study will be explored. We examine the basic antibiotic protocols and prokinetics commonly used. Finally we study the associated diseases and syndromes and briefly review the elusive hydrogen sulfide.

SIBO is a challenging clinical condition. Its etiology is usually complex and multifactorial and the syndrome is often misdiagnosed and generally under-diagnosed. Clinical symptoms may be subtle and non-specific, which makes diagnosis difficult without objective testing. The availability of poorly absorbed antimicrobials (i.e. rifaximin) has been an advance in treatment, which needs to be refined to identify the best dose and duration to maximize eradication and prevent recurrence. The global management of patients with SIBO will be, however, multifactorial (including nutritional support and dealing with the underlying abnormalities) and long-term care.

A “generic drug” has been designated by the World Health Organization as a medicinal product, which is interchangeable with the “original drug”, covered by patent (designated also as “branded drug”), in terms of both formulation (pharmaceutical interchangeability/ equivalence) and utilization in the clinical practice (therapeutic interchangeability/equivalence). Although the development and approval process of generic medicinal products is driven by specific and very detailed guidelines, some uncertainties do exist, stemming from the issue that the procedures, dictated by guidelines to get license for producing and marketing generic drugs, do not enforce the performance of efficacy clinical trials for the intended therapeutic indications. Rifaximin is an antibiotic, locally acting in the gastrointestinal tract, which may exist in different crystal as well as amorphous forms. The branded rifaximin formulation contains the polymorph rifaximin-α, whose systemic bioavailability is very limited. Recent studies demonstrate different systemic bioavailability of generic and branded formulations of rifaximin. As a consequence, the therapeutic results obtained with rifaximin-α should not be translated sic et simpliciter to the generic formulations of rifaximin, which do not claim containing only rifaximin-α and will display significantly higher systemic absorption in both health and disease.

Includes a case presentation by Lisa Shaver, ND, MSOM, LAc.

The effective treatment of SIBO requires certain dietary restrictions that are based on the low FODMAP diet. In this talk, Dr. Jacobi reviews her Bi-phasic diet that focuses specifically on timed pre-treatment and treatment diet strategies to maximize patient outcomes. Practitioners in Australia use the Bi-Phasic Diet successfully in conjunction with conventional and/or herbal treatments.

Additionally, she discusses novel herbal approaches for the treatment of SIBO and SIFO.

Over the past decades, the poorly absorbed antibiotic rifaximin has gained popularity for SIBO eradication, despite that its use is not evidence based. To bridge this gap, a systematic review and meta-analysis of randomized and non-randomized studies was performed to evaluate the clinical efficacy and safety of rifaximin to eradicate SIBO in adult patients. 32 studies involving 1321 patients were included. The overall eradication rate according to intention to treat analysis was 67.8% (95% CI: 59.2 to 75.7). Meta-regression identified three covariates (namely the drug dose, the study design and co-therapy) independently associated with an increased eradication rate. The overall rate of adverse events was low (i.e. 5.6%). These data show that rifaximin therapy is effective and safe for the treatment of SIBO. However, since the quality of the available studies is generally poor, well-designed RCTs are needed to substantiate these findings and to establish the optimal regimen (i.e. daily dose and duration of rifaximin) for the treatment of this increasingly common condition.

Includes case presentation by Megan Taylor, ND and Allison Siebecker, ND, MSOM, LAc.

Adhesions are the internal scars that commonly form whenever and wherever the body heals from surgery, infection,

inflammation or trauma. When they form in the abdomen or pelvis, adhesions can act like internal straitjackets, slowing or totally

stopping intestinal motility.

In the case of bowel strictures or obstructions, adhesions can be threaten life as they prevent food from passing through the

digestive tract. In this presentation Larry Wurn looks at research in this area, then moves on to the effect of bowel adhesions on SIBO.

Recent clinical data indicates that adhesions in the bowel can decrease the effectiveness of medications or cause SIBO to

recur, because treated bacteria cannot exit the digestive tract.

This lecture looks at the mechanical properties of adhesions, research in this area, how they form and whether they can be

deformed without surgery. It also examines new data about diagnosing and treating adhesions in cases of recurring SIBO