GI Issues - SIBO or something else. Need ideas.

[star0210]

This is probably going to be long.
Had VSG to DS revision last November. Everything was great for the first 8 months except constipation. I changed from calcium citrate to hydroxyapatite and it got somewhat better for a little while. Then it started getting worse and I was having to go to ridiculous lengths to get cleaned out every few days. I also had increasing tummy distention and it didn't matter what I ate.
I saw a GI doc and he put me on Linzess. That helped some. I started going every morning but I wasn't going enough. Still had to take stuff to go more every few days. GI doc ordered colonoscopy. That came back fine. Hubby had been doing some research and came up with SIBO. We brought that up to my GI doc at my follow up appt and he agreed that it was very likely so he prescribed Xifaxan. He didn't test me for it...said if the RX worked, then we pretty much had our answer. That first round of Xifaxan worked great. The distention and bloating went away and I was going regularly and feeling emptied out when I went. That lasted 4-6 weeks and then the symptoms returned. He put me on another round of Xifaxan and that time it didn't work hardly at all. Now I'm on a 10 day course of Augmentin since last Wednesday and it's not doing anything. Since that day, as a test, I've been off all gluten and all dairy. I've had nothing but fresh meat and a few veggies. I'm getting worse now and not better.
The distention is so uncomfortable. I have little to no appetite. There is a lot of pressure on my chest and upper back. I've been running low grade fever...(fever for me anyway...my normal temp when I wake is usually 98.2 or 98.3) it's been consistently anywhere from 99.2-99.7. Just enough to make me feel like crap. I don't DO nausea or vomiting. I simply don't allow it to happen but Saturday was pretty close to my will being overridden. I ate boiled shrimp and snow crab for lunch. I had the same thing the day before for lunch with no issue. These are both regular staples of my diet. After I ate Saturday it felt like the food was stuck on top of my stomach. It was very uncomfortable. I was burping like crazy and spitting up liquids but the food itself wouldn't come up. I looked 8 months pregnant. It lasted about 30 minutes before it eased up. The distention has not lessened since then. My insides feel bruised and sore. I also feel like my Prilosec isn't working as well anymore. I have a bit of burning feeling in my tummy.
I called the doc yesterday and said I'm miserable. Can we do a CT scan and make sure nothing weird is going on in there. I'm worse than ever and so uncomfortable. He said yes so hopefully I'll be having that today.
I'm passing gas and pooping but not much.

I'm at my wits end here.
What other possibilities could this be? Maybe a different type of small bowel infection? H. Pylori?
The first image shows a pic of what I normally look like with no distention and then with the distention. The second was last night...excuse the sports bra.

Any ideas?

 

[Pacifica]

@star0210 so sorry you are dealing with this, it sounds really uncomfortable. I have no info, but I'm sure the vets will weigh in with good ideas. Hoping good things for you.

 

[star0210]

Thank you!

 

[Clematis]

I have no clue either but was curious and googled a few articles. I found that they think stomach acid is what keeps normal people from developing this... so PPIs, necessary for those with gastric restriction, are not a good thing in this case. Here's a paragraph from an article by an MD suggesting a pro kinetic agent:

Why SIBO can be difficult to treat
Antibiotics are often used to treat SIBO. However, studies show that despite treatment with antibiotics, recurrence develops in almost half of all patients within one year. One study comparing treatment with rifaximin (the most commonly used antibiotic for SIBO) and botanical antimicrobials showed slightly better outcomes with the botanical protocol, but still with successful treatment in close to only half of all patients after one course of treatment.

These finding suggests that treatment of the overgrowth alone is not enough for most people. An additional piece of successful treatment must include addressing the underlying cause, or predisposing factor.

Though there are many identified associations between SIBO and other diseases as described above, abnormalities in gut motility are recognized as one of the most common associations. One study published this month demonstrated that patients with SIBO do have significant delays in small bowel transit time (the amount of time it takes something to move through the small bowel). This finding suggests that patients with SIBO, who do not recover after a standard course of antibiotics, or botanical antimicrobial protocol (which we prefer), may benefit from the addition of a prokinetic agent, which increases the muscular contractions of the small bowel. Octreotide and low dose naltrexone are two such options that are being investigated, and may help treat some cases of SIBO that don’t respond to antimicrobials alone.

I hope you get this sorted out. Your distention looks quite uncomfortable.

 

[Jbandmmomma]

i'm wondering if you have an intermittent obstruction going on, with some ascites fluid accumulation? hopefully the CT scan will help figure this out. Any severe pain?

 

[star0210]

No severe pain, just discomfort.
I have a pretty high tolerance for pain I think though and tend to dismiss most things. What I'm feeling might be pain for someone else.
I do know something isn't right though.

 

[star0210]

I have no clue either but was curious and googled a few articles. I found that they think stomach acid is what keeps normal people from developing this... so PPIs, necessary for those with gastric restriction, are not a good thing in this case. Here's a paragraph from an article by an MD suggesting a pro kinetic agent:

Why SIBO can be difficult to treat
Antibiotics are often used to treat SIBO. However, studies show that despite treatment with antibiotics, recurrence develops in almost half of all patients within one year. One study comparing treatment with rifaximin (the most commonly used antibiotic for SIBO) and botanical antimicrobials showed slightly better outcomes with the botanical protocol, but still with successful treatment in close to only half of all patients after one course of treatment.

These finding suggests that treatment of the overgrowth alone is not enough for most people. An additional piece of successful treatment must include addressing the underlying cause, or predisposing factor.

Though there are many identified associations between SIBO and other diseases as described above, abnormalities in gut motility are recognized as one of the most common associations. One study published this month demonstrated that patients with SIBO do have significant delays in small bowel transit time (the amount of time it takes something to move through the small bowel). This finding suggests that patients with SIBO, who do not recover after a standard course of antibiotics, or botanical antimicrobial protocol (which we prefer), may benefit from the addition of a prokinetic agent, which increases the muscular contractions of the small bowel. Octreotide and low dose naltrexone are two such options that are being investigated, and may help treat some cases of SIBO that don’t respond to antimicrobials alone.

I hope you get this sorted out. Your distention looks quite uncomfortable.

Yes, I've done a ton of research on it for the last few months and belong to a few SIBO groups on fb.
I tried switching from Prilosec to Zantac but that didn't last long. Couldn't deal with the burning tummy.
I am taking a prokinetic called Motilpro. It's herbal not RX.

 

[Soontobelovely]

Thinking about from VS to DS and this is making me more nervous. I don't think that this is common but does anyone know of this being a trend with VS to DS in any way?

 

[Jo777]

So sorry to hear you are still having issues with this- that sucks! I don't have much else to offer than what was already posted.. my family has had their share of gut issues over the years, and operations on them, so similar things came to my mind. I hope you find an answer, that just isn't right to feel so uncomfortable and be unable to fix it!

 

[Elizabeth N.]

Someone on the FB group had a terrible time with this. @southernlady do you remember who that was?

 

[star0210]

Someone on the FB group had a terrible time with this. @southernlady do you remember who that was?

Probably me! Lol

 

[Larra]

Could be partial small bowel obstruction. Hopefully the CT scan will provide an answer for you.

 

[Soontobelovely]

Someone on the FB group had a terrible time with this. @southernlady do you remember who that was?

Hi
What is the fb page name?

 

[star0210]

So this is interesting....because it's so abnormal. I've had diarrhea exactly once since surgery and it was last week for one day when I started on the augmentin. Since then it's been normal but less.
Today I had a normal bm and I've had diarrhea since.
My tummy is not happy.

 

[star0210]

Could be partial small bowel obstruction. Hopefully the CT scan will provide an answer for you.

Unfortunately they can't get me in until Friday.