May 15, 2015

Is IBS an Antibiotic Responsive Disease?

Dr. Pimentel and his group have just launched a new blood test called “IBS (check)” that they claim identifies an IBS diagnosis and, with this new diagnostic tool, that IBS is now a disease – quote, “IBS is an antibiotic responsive disease.” Here is the announcement on You Tube:

HERE IS WHAT THEY ARE TESTING

The test looks for antibodies to the Cdt-b toxin and antibodies to vinculin. When a food poisoning event occurs, some people will get exposed to a toxin that is produced by E. coli, Salmonella, Shigella or Campylobacter, called Cdt-B toxin (Cytolethal Distending Toxin B). When exposed to this toxin – the Cdt-b toxin, people experience watery diarrhea. The antibodies produced by some people to attack the Cdt-b toxin will also attack a protein within the lining of the intestinal tract call vinculin. This creates an autoimmune reaction, where antibodies that you create are attacking self. Dr. Pimentels’ group believes that around 20% of people exposed to this toxin will go onto develop SIBO, with ongoing IBS symptoms and that this takes about three months to develop.

Here is what it looks like: There is a food poisoning event and exposure to Cdt-B toxin which triggers gastritis. 20% of people will create an antibody to the toxin. They will recover from the food poisoning event – gut symptoms will return to normal. The antibodies created to address the toxin start to attack vinculin. Over time, your gut motility slows, leading to a highly fermentable environment in the small intestine and setting the stage for SIBO and IBS symptoms that appear around the three month mark.

Vinculin is a protein that connects a network of cells within the pacemaker of the gut, called the Interstitial Cells of Cajal. The pacemaker of the gut does exactly what you think it would, it is the signaling network that signals the coordinated wave like contractions of peristalsis; it sets the pace.

Vinculin helps these cells connect and communicate electrical signals to contract your smooth muscle. If vinculin is damaged or destroyed, it can’t link the cells within the pacemaker and you then can’t transmit the electrical signal to contract your smooth muscle. This stalls gastric motility during meals and in between meals.

ON A POSITIVE NOTE

This test will identify if you have been exposed to the Cdt-b toxin and if you have produced antibodies to it. It will also identify if your body has produced antibodies to vinculin WHICH will then inhibit gut motility. This information is good to know.

You can have chronic diarrhea AND inhibited gut motility. Chronic loose, watery stool does not mean that you have ‘too much’ gut motility. What is happening is that your small intestine is being flooded with water, driving diarrhea. So, again, knowing if your gut symptoms are in part due to the damage done to vinculin, this is good to know.

This test will help distinguish between IBD (Inflammatory Bowel Disease) and IBS patients.

HERE IS MY ISSUE WITH THE CLAIM: That this is an “IBS diagnostic test”

This test will only identify a very small subset of people experiencing IBS symptoms. Only 20% of people who are exposed to a food poisoning event will produce antibodies to the Cdt-b toxin. Not everyone that has IBS symptoms, has them as a result of an autoimmune issue with vinculin antibodies.

This isn’t an IBS diagnostic test. It is a autoimmunity test, testing to see if vinculin antibody levels are present.Specifically, this test diagnoses a form of IBS called Post-Infectious IBS (SIBO).

In this short video, introducing this test to the world, Dr. Pimentel makes the claim at the 1.29 minute mark that “IBS IS AN ANTIBIOTIC RESPONSIVE DISEASE”

IBS is now Antibiotic Responsie Disease

This is a BIG leap, going from identifying 20% of people who have produced antibodies to the Cdt-b toxin, to stating that “IBS is an antibiotic responsive disease.”

From the slide here – gut motility slows and if SIBO becomes an issue then they are labeling this as ‘IBS’ and tying the entire community of IBS patients to needing treatment with antibiotics. If gut motility is affected, inhibited, or disrupted, this will create a great level of imbalance with the gut.

The idea that 100% of people, of whom, test positive for antibodies to vinculin NEED to be place on an antibiotic is ludicrous (I know, tell you how I really feel). It will tip an already imbalanced gut, into even more imbalance. Antibiotics don’t fix gut motility disorders. They knock all micro-organisms down at once. The gut motility issue is still there and this will simply increase the ‘need’ for more rounds of antibiotics.

Now, let’s take the leap from here to say that “IBS is an antibiotic responsive disease” and you have just plain lost me. Antibiotics do not ‘cure’ SIBO or IBS. This test is going to lead to more and more overuse of antibiotics in a population that needs to work on rebalancing their gut health and reinstating gut motility.

The only way to regain balance with the gut it to look for ways to reinstate gut motility, support healthy flora balance, reduce the fermentable load in the diet and work, over time, to heal the gut.

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Comments

from 17 people

Angela

Hi Ken,

There are supplements you can use for nerve regeneration. Knowing you have antibodies to vinculin, then this will take longer to treat, you will need to be on a modified plan longer and yes more sensitive to recurrence. It takes time to recover these nerves, but this should heal over time. Special attention needs to be paid to the IC valve. This is heavily innervated by the ICC and vinculin and the integrity of the IC valve will be an issue during this time (this is one reason why vinvulin antibodies make a person more prone to recurrence).

Warmly
Angela

Angela | July 23, 2016

Im afraid sibo cannot be solved for people with the anti bodies against vinculin. Dr pimental is doing his first rabbit tests on real persons by extractin the vinculin anti bodies out of the blood and put the blood back into the body. Plasmapheresis. This is by now the only way to get rid of sibo if u have tested positive for the ibscheck test. Hopefully pharmacy are working on a medicine that will hold on the vinculin problem. U can treat sibo and feel better. But when u have vinculin immune attack.. sibo will always come back. There is not an answer to this question yet. The closest answer is Plasmapheresis by pimental at the moment.

kenvh | May 5, 2016

They are already using antibiotics on SIBO and the relapse rate is really high, i.e. it doesn't work.

Cheryl | January 22, 2016

Angela

Hi Rajiv,

I don't recommend yogurt as a good probiotic source to get probiotics in at therapeutic levels. I am sorry to hear about your continued rifaximin use. Over time, this has to be affecting your gut organism levels as well. I realize that this is very hard to unravel.

Warmly

Angela

Angela | July 23, 2016

i have been taking rifaximin for many years. And whenever i try to wean off, IBS symptoms namely diarrhea, bloating, cramps flare up.
I am also a lacto-vegetarian and rice/wheat, vegetables, dairy products & lentils constitute as staples.
Is taking plain yogurt without sugars or additives good for gut flora ?
More over i take VSL#3 probiotics, prebiotics & PPI for management of gastritis.

Rajiv | December 23, 2015

Angela

Hi Sarah,

I always recommend supporting the MMC when treating SIBO and beyond. SIBO is a motility disorder, brought about and influenced by many things. It is wonderful that you do not have antibody production to vinculin. There is more to be done here to work with you on either maintenance, or to further treat SIBO to a negative breath test and then work on gut healing and immune modulation, etc.

Warmly

Angela

Angela | July 23, 2016

I tested positive for Cdt-B toxin but negative to vinculin antibodies. My doctor recommended I still treat the Migrating Motor Complex to see if I benefit from treatment, but says I in theory shouldn't have an issue with MMC because the vinculin portion of the test was negative. I've had recurring SIBO for three years so if it's not the MMC, does that mean there could be another underlying issue (illeocecal valve, adhesions, etc), or does that mean I just have the autoimmune version of SIBO and need to figure how to keep the inflamatuon and bacteria levels down as best I can?

Sarah | December 22, 2015

Angela

...and you said, because I want to know if I have post infectious IBS (SIBO)!

Angela

Angela | July 23, 2016

I was so excited when I saw this, I emailed my GI doc and asked if we could do the test! She replied, "Why would we do the test? We already know you have IBS." :/

Teresa | November 24, 2015

Angela

Hi Jay - yes, I completely agree. He is a very GOOD doctor and I really respect him. I simply do not want this antibiotic to be the new 'purple pill' (where PPIs were overprescribed to the point that they now carry a black box warning). IBS is not an antibiotic treatable disease. SIBO is an antibiotic treatable disease (but only once the person has tried everything else to recover their gut -let's use the antibiotics as a last result and not the first hair trigger decision). I am now seeing Xifaxan commercials playing, suggesting to the public that if they have IBS symptoms then they can now go to their doctor to get this antibiotic.

I thought we were in a culture of trying to reduce the amount of antibiotics being prescribed!

Angela

Angela | November 7, 2015

Since IBS is just a name given to a collection of symptoms that occur to varying degrees, it goes without saying that there are many causes and treatment is individual. The good Dr. may have been more accurate in saying "IBS **may** be an antibiotic treatable disease as part of an ongoing therapy tailored to the individual whose IBS **may** have been caused by an autoimmune response to vinculin." I think that would satisfy me, and likely you.

Jay | October 1, 2015

Angela

Hi Kristy,

Each person's case needs to be approached on an individual basis - it is really hard to comment on this. I feel that this may be too strong of an approach AND it may be a great first step (yes, I know how contradictory that sounds!!). It depends on your case, your symptoms, what you have tried... etc. I wish you the best of luck with your treatment!!

Angela

Angela | July 31, 2015

I have Sibo that I'm going to start treating soon with the Elemental Diet and herbal antibiotics. I also have a systemic bacterial infection that is 5 years old. Working with two different doctors, they say to do IV antibiotics first for the infection, and then treat the Sibo. Do you agree?

Kristy | July 17, 2015

Angela

Hi Jean,

Not directly - not yet. Indirectly, the goal is to allow the body time to heal and to address the gut imbalances, motility and dysbiosis.

Angela

Angela | June 12, 2015

Is there a way to restore vinculin??

Jean | June 3, 2015

Angela

Hi Sue, Every SIBO/ IBS post infectious patient treatment is different. It depends on the contributing factors, deficiencies, digestive insufficiencies, what you react to/ what you don't, the level of healing that you need. I recommend that you find a practitioner to work with...

Warmly,
Angela

Angela | May 27, 2015

what do we do to correct this condition? I have tried different foods and nothing yet seems to help. any suggestion besides tranquillizers. I was encouraged by your article. Finally maybe someone has the answer.

sue lebario | May 27, 2015


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