Rifaximin: A Viable Treatment Option for IBS?

Irritable bowel syndrome is an extremely common disorder affecting approximately 10-15% of people worldwide. Unfortunately, the conventional treatments previously offered for IBS basically have ranged from stool softeners to pain-killers or antidepressants! Obviously, these medications are not offering patients treatment of the cause of their suffering or complete resolution of their symptoms. Patients are commonly told that it is all due to stress or anxiety or even worse, that there is nothing that can be done.
 
In studying IBS, scientists have determined a main cause of IBS to be an imbalance of bacteria in the small intestine called Small Intestinal Bacterial Overgrowth or SIBO. Normally, the small intestine has very small amounts of bacteria and these bacteria are flushed through the intestines very quickly. In SIBO cases, bacteria from the large intestine or bacteria from a gastroenteritis infection are able to move into the small intestine where they cause numerous problems. The bacteria feed on fiber called fructooligosaccharides (or FOS) and produce gas, which causes the bloating and pain commonly associated with IBS. The bacteria are also responsible for changing the motility of the gut, preventing proper digestion and absorption as well as creating inflammation in the intestinal walls, increasing susceptibility to food sensitivities.
 
Fortunately, recent studies have shown some success treating SIBO with antibiotic therapy, most commonly rifaximin. In several studies, a single course of rifaximin with no other interventions will treat IBS in about 50-60% of patients. In a single study this rate was as high as 92% by using a fiber supplement during treatment. These efficacy rates can be drastically increased by utilizing a combination of anti-microbials including conventional and herbal over a period of 1-3 months followed by a period of maintenance which helps to re-establish normal digestive function and motility. Rifaximin has been found to have a very low side effect profile compared to other common antibiotic drugs as it targets the bacteria that cause SIBO and is not absorbed systemically.
 
Many patients have been told that following a strict low FODMAPS diet can treat IBS. Unfortunately, this advice can actually cause more harm than good as the removal from FOS in the diet also starves the bacteria that resides in the large intestine and is crucial to human survival. It also is very difficult for patients to follow this diet indefinitely and when they begin to consume the foods after a period of time, often they are right back where they started.  By utilizing anti-microbial treatments first, we keep the bacteria active and feeding while killing them and we can prevent the relapse rates associated with diet alone.
 
If you believe that you may have IBS or SIBO and would like help with navigating your treatment, please contact the clinic closest to you and ask for an assessment with Dr. Katie Coombs, ND. IBS is no longer something you have to live with!
 
Momentum Health Westbrook 403-454-1600
Momentum Health Creekside 403-239-6773
 
Chedid V, Dhalla S, Clarke JO, et al. Herbal Therapy Is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth. Global Advances in Health and Medicine. 2014;3(3):16-24.
 
Furnari, M., Parodi, A., Gemignani, L., Giannini, E. G., Marenco, S., Savarino, E., Assandri, L., Fazio, V., Bonfanti, D., Inferrera, S. and Savarino, V. (2010), Clinical trial: the combination of rifaximin with partially hydrolysed guar gum is more effective than rifaximin alone in eradicating small intestinal bacterial overgrowth. Alimentary Pharmacology & Therapeutics, 32: 1000–1006.
 
Peralta S, Cottone C, Doveri T, Almasio PL, Craxi A. Small intestine bacterial overgrowth and irritable bowel syndrome-related symptoms: Experience with Rifaximin. World Journal of Gastroenterology : WJG. 2009;15(21):2628-2631.
 
Pimentel, M. & Lezcano, S. Curr Treat Options Gastro (2007) 10: 328.
 
Schoenfeld, P., Pimentel, M., Chang, L., Lembo, A., Chey, W. D., Yu, J., Paterson, C., Bortey, E. and Forbes, W. P. (2014), Safety and tolerability of rifaximin for the treatment of irritable bowel syndrome without constipation: a pooled analysis of randomised, double-blind, placebo-controlled trials. Aliment Pharmacol Ther, 39: 1161–1168.
 

---