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Research suggests that low FODMAP diets reduce IBS symptoms in 85% of people. Learn how to implement a low FODMAP diet for IBS or SIBO, low FODMAP product options, and conventional and alterative treatments for IBS on this podcast sponsored by Casa de Sante with Onikepe Adegbola, MD on The Perfect Stool Podcast with host Lindsey Parsons, EdD. Listen below or find the podcast version at: https://link.chtbl.com/theperfectstool-IBS

Improving Gut Health – CBS San Francisco CBS San Francisco CBS News Bay Area anchor Elizabeth Cook talks with Cedars Sinai Gastroenterologist Dr. Mark Pimentel about all things IBS, SIBO, gut health and the microbiome.

Small Intestinal Bacterial Overgrowth in Irritable Bowel Syndrome A Systematic Review and Meta-Analysis of Case-Control Studies Shah, Ayesha MBBS, FRACP1,2,3,*; Talley, Nicholas J. MBBS, MD, PhD, FRACP, FRCP, FACP FAHMS4,*; Jones, Mike BsC, PhD, A.Stat, C.Stat5,*; Kendall, Bradley J. MBBS, FRACP, PhD1,2; Koloski, Natasha PhD1,4,*; Walker, Marjorie M. MBBS, FRCPath, FRCPA, AGAF4,*; Morrison, Mark PhD1,2,6,*; Holtmann, Gerald J. MD, PhD, MBA, FRACP, FRCP, FAHMS1,2,3,* The American Journal of Gastroenterology: January 6, 2020 - Volume Publish Ahead of Print - Issue - p doi: 10.14309/ajg.0000000000000504 https://journals.lww.com/ajg/Abstract/publishahead/Small_Intestinal_Bacterial_Overgrowth_in_Irritable.99456.aspx Abstract INTRODUCTION: We conducted a systematic review and meta-analysis to compare the prevalence of small intestinal bacterial overgrowth (SIBO) in patients with irritable bowel syndrome (IBS) and controls. METHODS: Electronic databases were searched up to December 2018 for studies reporting SIBO prevalence in patients with IBS. Prevalence rates, odds ratios (ORs), and 95% confidence intervals (CIs) of SIBO in patients with IBS and controls were calculated. RESULTS: We included 25 studies with 3,192 patients with IBS and 3,320 controls. SIBO prevalence in patients with IBS was significantly increased compared with controls (OR = 3.7, 95% CI 2.3–6.0). In studies using only healthy controls, the OR for SIBO in patients with IBS was 4.9 (95% CI 2.8–8.6). With breath testing, SIBO prevalence in patients with IBS was 35.5% (95% CI 33.6–37.4) vs 29.7% (95% CI 27.6–31.8) in controls. Culture-based studies yielded a SIBO prevalence of 13.9% (95% CI 11.5–16.4) in patients with IBS and 5.0% (95% CI 3.9–6.2) in controls with a cutoff value of 105 colony-forming units per milliliter vs 33.5% (95% CI 30.1–36.9) in patients with IBS and 8.2% (95% CI 6.8–9.6) in controls with a cutoff value of 103 colony-forming unit per milliliter, respectively. SIBO prevalence diagnosed by lactulose breath test is much greater in both patients with IBS (3.6-fold) and controls (7.6-fold) compared with glucose breath test. Similar difference is seen when lactulose breath test is compared with culture methods. OR for SIBO in patients with IBS-diarrhea compared with IBS-constipation was 1.86 (95% CI 1.83–2.8). Methane-positive breath tests were significantly more prevalent in IBS-constipation compared with IBS-diarrhea (OR = 2.3, 95% CI 1.2–4.2). In patients with IBS, proton pump inhibitor was not associated with SIBO (OR = 0.8, 95% CI 0.5–1.5, P = 0.55). DISCUSSION: This systematic review and meta-analysis suggests a link between IBS and SIBO. However, the overall quality of the evidence is low. This is mainly due to substantial “clinical heterogeneity” due to lack of uniform selection criteria for cases and controls and limited sensitivity and specificity of the available diagnostic tests. © The American College of Gastroenterology 2020. All Rights Reserved.

Fructan can cause symptoms in non celiacs ingesting wheat products Another important slide to understand mechanisms why we have symptoms by ingesting wheat and have negative diagnosis of celiac #ACG2019 by @umfoodoc Ironwood Pharmaceuticals, Inc. (IRWD), a GI-focused healthcare company, today announced the presentation of clinical data for linaclotide and MD-7246, as well as results from a survey for patients with persistent gastroesophageal reflux disease (GERD), from Ironwood and its collaborators during the American College of Gastroenterology (ACG) 2019 Annual Scientific Meeting being held in San Antonio, TX, October 25 through October 30, 2019. A linaclotide poster at the meeting was recognized by the ACG as a Presidential Poster Award recipient. Every year less than 5% of accepted abstracts receive this distinction for high quality, novel, unique, and interesting research. The abstract features safety and efficacy data from a Phase II trial of linaclotide in pediatric patients aged six to 17 with functional constipation. Linaclotide, a guanylate cyclase‐C (GC‐C) agonist, is activated by a mechanism pioneered by Ironwood scientists. Phase I data demonstrating the limited effect of MD-7246 on bowel frequency and stool consistency in healthy volunteers will be presented in a poster session. MD-7246, an investigational product, is being evaluated as an oral, intestinal, non-opioid, pain-relieving agent for patients suffering from abdominal pain associated with certain GI diseases, including IBS with diarrhea (IBS-D). MD-7246 is a delayed-release formulation of linaclotide designed to provide targeted delivery of linaclotide to the colon, where the majority of the abdominal pain associated with IBS-D is believed to originate, and to limit fluid secretion in the small intestine resulting in minimal impact on bowel function. Salix Pharmaceuticals to Present New Clinical Data at the American College of Gastroenterology (ACG) Annual Meeting Published: Oct 28, 2019 TRULANCE® (plecanatide) Poster Presentation Recognized with Presidential Poster Award Distinction TRULANCE® (Plecanatide) Darren M. Brenner, MD. "Impact of Plecanatide on Symptoms and Quality of Life for Patients with Chronic Idiopathic Constipation: Analysis of PAC-SYM and PAC-QOL From Two Phase III Clinical Trials." Poster #P0341; Sunday, Oct. 27, 3:30 p.m. – 7:00 p.m. CT; Exhibit Halls 3 and 4 (street level); Recipient of the Presidential Poster Award Gregory Sayuk, MD. "Plecanatide for Patients with Chronic Idiopathic Constipation and Irritable Bowel Syndrome-Constipation: Analysis of Abdominal Bloating from Four Randomized Phase 3 Clinical Trials." Poster #P2157; Tuesday, Oct. 29, 10:30 a.m. – 4:00 p.m. CT; Exhibit Halls 3 and 4 (street level) XIFAXAN® (Rifaximin) Brian Lacy, PhD, MD. "Impact of Colonoscopy Timing on Rifaximin in Patients with Irritable Bowel Syndrome with Diarrhea (IBS-D)." Poster #P2164; Tuesday, Oct. 29, 1:00 p.m. – 2:15 p.m. CT; Exhibit Halls 3 and 4 (street level) PLENVU® (polyethylene glycol 3350, sodium ascorbate, sodium sulfate, ascorbic acid, sodium chloride and potassium chloride for oral solution), also known as NER1006 Michael S. Epstein, MD, FACG; "Electrolyte Shifts of NER1006 Bowel Preparation for Colonoscopy in the Elderly Are Transient and Well-Tolerated." Poster #P0368; Sunday, Oct. 27, 3:30 p.m. – 7:00 p.m. CT; Exhibit Halls 3 and 4 (street level) Michael S. Epstein, MD, FACG, "1 L NER1006 Improves High-Quality Colon Cleansing and Mean Polyp Detection versus Oral Sulfate Solution and 2 L Polyethylene Glycol Plus Ascorbate." Poster #P2030; Tuesday, Oct. 29, 10:30 a.m. – 4:00 p.m. CT; Exhibit Halls 3 and 4 (street level) Michael S. Epstein, MD, FACG; "In Patients with an Overall Cleansing Success the 1L Polyethylene Glycol NER1006 Achieves More High-Quality Cleansed Segments per Patient Than Three Standard Bowel Preparations." Poster #2031; Tuesday, Oct. 29, 10:30 a.m. – 4:00 p.m. CT; Exhibit Halls 3 and 4 (street level) Brooks D. Cash, MD, FACG. "Patient Experience with NER1006 as a Bowel Preparation for Colonoscopy: A Prospective, Multicenter U.S. Survey." Poster #P0372; Sunday, Oct. 27, 3:30 p.m. – 7:00 p.m. CT; Exhibit Halls 3 and 4 (street level) Avoidant/Restrictive Food Intake Disorder May Be Underdiagnosed Gastroenterology patients with avoidant/restrictive food intake disorder (ARFID) are less likely to be taking psychotropic medications, have less-severe body image concerns, and are frustrated with being unable to eat what they want compared with patients without ARFID, according to study findings presented at the American College of Gastroenterology (ACG) 2019 Annual Scientific Meeting and Postgraduate Course. The findings suggest the need to appropriately screen gastroenterology patients for ARFID and the importance of a using a multidisciplinary treatment approach. >> https://www.consultant360.com/exclusive/gastroenterology/insights-american-college-gastroenterology-2019/avoidantrestrictive-food >> https://www.healio.com/gastroenterology/nutrition/news/online/{eda3e067-5b29-40d5-90bd-8f999c2a1c9f}/avoidant-food-intake-disorder-rarely-connected-with-body-image-concerns Plenary Session at ACG 2019 Conference Reports Unique Blend of HMOs Significantly Improves IBS Symptoms A nationwide multi-center, open label trial on human milk oligosaccharides (HMOs) found that daily intake of a unique formulation of glycans can significantly improve patients' IBS symptoms. “Human Milk Oligosaccharides Improve All the Central Symptoms of Irritable Bowel Syndrome: A Multi-Center, Open Label Trial” will be presented by Magnus Simrén, MD, PhD, Professor and Senior Consultant at the Department of Internal Medicine & Clinical Nutrition for the Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden. Dr. Simrén is also an adjunct professor of medicine at the University of North Carolina School of Medicine in Chapel Hill. Patients were given daily doses of a proprietary blend of HMOs — 2’-FL (2’-fucosyllactose) and LNnT (lacto-N-neotetraose) — found in Holigos® (hōly-gōs) IBS, a medical food to be taken under medical supervision, available without a prescription. The trial results demonstrated significant improvement in overall symptoms (fecal consistency, abdominal pain, and bloating) as well as improved quality of life as measured by IBS Severity Scoring System (IBS-SSS). The findings in this new study support the growing acceptance in the medical community of microbiota-directed therapies, such as the inclusion of prebiotic HMOs in IBS dietary planning. Glycom is a global biotechnology company dedicated to the scientific, clinical, and commercial development of human milk oligosaccharides (HMOs) for a broad range of health applications. Glycom, headquartered in Hørsholm, Denmark, is the world’s leading supplier of HMOs and has a U.S. facility located in Covington, La. Glycom is privately held. For more information about Glycom, visit glycom.com. Additional info from MD Magazine >> https://www.mdmag.com/conference-coverage/acg-2019/human-milk-oligosaccharides-may-help-ease-irritable-bowel-syndrome-symptoms >> https://www.prnewswire.com/news-releases/study-shows-human-milk-oligosaccharides-significantly-improve-ibs-symptoms-300947860.html >> https://www.gastroenterologyadvisor.com/irritable-bowel-syndrome-ibs/effects-of-human-milk-oligosaccharides-on-gastrointestinal-symptoms-in-ibs-qa-with-dr-magnus-simren/ >> https://www.medpagetoday.com/meetingcoverage/acg/83031 Celiac disease patients diet is perceived to be higher burden than patients with HTN, DM2, GERD, IBD or IBS. #ACG2019

Medical Management of IBS is Improving With Time Healio Gastroenterology, October 2019 Mark Pimentel, MD In my clinic, it still feels like we get countless referrals for irritable bowel syndrome. We have gained so much knowledge and obtained so many new treatments in our arsenal over the years, but we are still going to need more solutions going forward if we are going to successfully serve all our patients. We need to build on this knowledge and keep making strides to ensure our patients are getting adequate care. Full story >> https://bit.ly/34d7Ziz

Chey: Small Intestinal Bacterial Overgrowth: Fact or Fiction? Chey: Small bowel Aspiration & Culture - an imperfect gold standard. Chey: Breath Testing has pros and cons based on the test used, ie: glucose or lactulose Chey: Which test is right? We don’t know. Exciting data coming from Mark Pimentel MD and Cedar-Sinai about this. Chey: Antibiotic regiment for SIBO with Rifaximin is recommended with a positive breath test Chey: Regardless of antibiotic employed for SIBO, a positive breath test seems to return Chey: Probiotics for SIBO - not statistically significant. Note that side effects were present from the probiotic treatment. Not entirely benign. Chey: Rifaximin vs herbal for SIBO. Results are similar and surprising. Need good research. Chey: IBS and SIBO? Cause and Effect? We don’t know. Chey: 50% of patients will have recurrence of SIBO 9 months after treatment Chey: Maybe we should be using a diet which provides essential prebiotics that have the benefits of a probiotic for IBS patients instead of an actual probiotic.