Irritable Bowel Syndrome (IBS) is the most common gastrointestinal assessment or diagnosis based on the fact that no pathology was discovered. The symptoms of IBS are considered to be linked to mental or emotional stressors, in certain cases to food triggers such as spices and with alternating diarrhea with constipation without any pathology evident. IBS symptoms are similar to those experienced by patients with Small Intestinal Bacterial Overgrowth (SIBO). There are mechanisms in the body to help prevent naturally occurring colon bacteria from backing-up into the small intestine.

Small Intestinal Bacterial Overgrowth (SIBO)  As much as 30% of Patients suffering from IBS appear to have a high prevalence of SIBO and treatment with antibiotics (natural or synthetic) appears to significantly improve symptoms. A specialized breath test exists to assess this overgrowth, called a lactulose hydrogen breath test, or LHBT for short.  It is important to stress that antibiotics may only help those IBS patients who were positive for SIBO with a lactulose hydrogen breath test. Generally, IBS is not treated with antibiotics.  it would be irresponsible to treat IBS patients with antibiotics without first confirming bacterial overgrowth.

Top 5 Symptoms of SIBO

1. Abdominal bloating and distension
2. Constipation alternating with Diarrhea (similar to IBS)
3. Abdominal pain or discomfort
4. Acid reflux or heartburn
5. Excessive gas or belching

Unlike Crohn’s or Colitis (UC) with IBS or SIBO there is no inflammation and the usual inflammatory markers are negative (Fecal Calprotectin, Serum CRP)

Both Crohn’s disease and ulcerative colitis are considered inflammatory bowel diseases (IBD)

Crohn’s disease:

Crohn’s disease is an inflammatory bowel disease (IBD). Parts of the digestive system get swollen and have deep sores called ulcers. Crohn’s disease usually is found in the last part of the small intestine and the first part of the large intestine. But it can develop anywhere in the digestive tract, from the mouth to the anus. The main symptoms of Crohn’s disease are abdominal pain and diarrhea (sometimes with blood). Some people may have diarrhea 10 to 20 times a day. Losing weight without trying is another common sign. Less common symptoms include mouth sores, bowel blockages, anal tears (fissures), and openings (fistulas) between organs.

Ulcerative Colitis:

Ulcerative colitis is a chronic disease of the large intestine, also known as the colon, in which the lining of the colon becomes inflamed and develops tiny open sores, or ulcers, that produce pus and mucous. The combination of inflammation and ulceration can cause abdominal discomfort and frequent emptying of the colon, in some cases up to 20 times per day.  Ulcerative colitis is the result of an abnormal response by your body’s immune system. Normally, the cells and proteins that make up the immune system protect you from infection. In people with IBD, however, the immune system mistakes food, bacteria, and other materials in the intestine for foreign or invading substances. When this happens, the body sends white blood cells into the lining of the intestines, where they produce chronic inflammation and ulcerations.

It’s important to understand the difference between ulcerative colitis and Crohn’s disease. Crohn’s disease can affect any part of the gastrointestinal (GI) tract, but ulcerative colitis affects only the colon. Additionally, while Crohn’s disease can affect all layers of the bowel wall, ulcerative colitis only affects the lining of the colon.

Inside our bellies, we have an extensive intestinal lining covering more than 4,000 square feet of surface area. When working properly, it forms a tight barrier that controls what gets absorbed into the bloodstream. An unhealthy gut lining may have large cracks or holes, allowing partially digested food, toxins, and bugs to penetrate the tissues beneath it. This may trigger inflammation and changes in the gut flora (normal bacteria) that could lead to problems within the digestive tract and beyond. The research world is booming today with studies showing that modifications in the intestinal bacteria and inflammation may play a role in the development of common chronic diseases.

What contributes to Leaky Gut or Intestinal Permeability ?

The list of contributing factors are many from poor dietary choices,  inflammatory foods, dairy, refined sugars and processed foods, antibiotics, and unfiltered tap water, Most NSAIDS (Aspirin, Ibuprofen), chemotherapy, chronic stress to lack of proper sleep and more…

Dr. Levy will recommend lifestyle modifications and will help discover and address the triggers of your intestinal permeability.

After the initial assessment which includes a detailed history and a full head to toe physical exam. Dr. Levy will recommend specific conventional and functional lab(s) in order to determine the root cause of your digestive dysfunction.

Common conventional tests might include inflammatory markers such as CRP and Fecal Calprotectin in order to evaluate severity of the IBD. H.Pylori test might be ordered as well in order to rule out H.Pylori infection of the stomach.

Certain individuals might benefit from a specific breath test in order to determine if this is a case of SIBO, others might benefit more from an intestinal permeability test (Lactulose Mannitol Test), while some might require a more comprehensive stool analysis with mycology in order to evaluate the status of their gut microbiome.