Gastroenterologist Questions

“acid reflux and sibo/imo”

I have had heartburn and lpr symptoms for 12 weeks now and now diagnosed with sibo/imo and on 40mg ppis once daily and twice daily 400mg per day of cimetidine . This dose is not adequate to control my acid mouth problems and chest pain is coming back after dropping ppi s from 80mg omperazole .It has caused ppi rebound .But do not really want to increase dose as i am starting sibo/imo treatment . I also have issues with chronic constipation. Do you think the sibo/imo and chronic constipation could be one of the reason for my worsening lpr and return of symptoms.What I want is full symptom relief as I cannot carry out normal activities now at all this is not a feasable outcome longterm for me as I am normally fit and active eg walking 4- 10 miles a day and going to lift heavy weights every day for 35 years. 12 weeks ago it started and within 6 weeks I am chair bound really? This is with specialist gps and drs from private sector. Can you provide a REALISTIC LONG TERM PLAN plan forwards to reduce PREFERABLY GET RID OF the symptoms especially the worsening mouth symptoms which I hope are possibly cuased by sibo? on acid relief medication. What I really want is to eradicate sibo/imo and slowly redcue acid suppression IF symptoms improve withs ibo treament ( Is this likley to happen? or am I get too hopeful. I am looking at getting rid of the root cuases eg ppis and h2 anatagonists which can increase sibo and getting rid sibo/imo and increasing gut and bowel motility in the hope I find a more PERMANENT CURE (if possible) IS THIS REALISTIC OR WILL I HAVE WORSENING LPR AND ACID PROBLEMS IF i CANNOT GET OUT OF THIS VISCIOUS CYCLE . I do not want to go backwards anymore with treatment acid suppression has not really worked for me I think I am partially ppir refractory and h2 antagonists are probabaly not pwerful enough to control symptoms long term. The drs so far are only looking at each month as they gtreat me and each month I AM GETTING WORSE . Do you think increasing motility of guts eridicating sibo/iom and either getting control of acid suppression? or droppin acid suppression will have positive outcomes EG REDUCING OR GETTING RID OF SYMPTOMS

Female | 25 years old
Complaint duration: 12 WEEKS
Medications: omeprazole 40mg cimtetidine 800mg rispiridone 2mg amytriptiline 10 mg
Conditions: LPR HEART BURN CONSTIPATION SIBO AND IMO

1 Answer

Your case sounds a bit complicated, and you may not like my opinion on this, but in my experience, most diagnoses of LPR and SIBO are erroneous. This is because 1) acid suppression is generally excellent with PPIs and full acid control can be proven by doing a Bravo pH study while on PPI; and 2) the testing for SIBO is notoriously unreliable with many false positives.

In short, your mouth/chest problems are probably neither reflux nor SIBO. I would look for another cause, the most common being visceral hypersensitivity.