Irritable Bowel Syndrome/Intestinal dysbiosis


Dear Dr, Thatcher,

Not sure if you can help me but here goes...I have had GI problems for 10 years...all started after i contracted Giardia from a river in Oregon and was also on a 5 month course of antibiotics prior. After that developed gluten and dairy intolerance, IBS, constipation and numerous food sensitivities. Right now i take high quality probiotics and digestive enzymes but still have problems. I also started testing positive for parasites on Metametrix tests a year ago but my main concern is low bifido and lactobacilli. i feel these low levels are preventing me from recovering and getting normal bowel function. a few months ago i took rifaximin to treat bacterial overgrowth and followed it up with 1 month of probiotic megadosing (400 billion a day and kept alternating brands...used VSL3, HLC and custom probiotics) but my recent stool test again showed low levels of beneficial bacteria as well as 3 parasites (hookworm, unknown and endolimax nana). Can anyone help? ive been battling this for years and just cant get better and my quality of life has been progressively going downhill. ANy help would be appreciated



Russ, thanks for asking me about bacterial overgrowth. Iíve got to say, I am really pleased you asked me this question as I havenít had any experience with Metametrix tests to date, but will certainly look in to this more having done some research on it. In the UK, it isnít a standard testing method  that we use in the investigation of bacterial overgrowth.

Bacterial overgrowth is a really interesting area of gastroenterology and has many underlying causes including previous gut infection, antibiotic use, previous gut surgery and many more. In your case, the problem seems to have been brought about by your antibiotic usage which has changed the composition of your bowels bacterial flora and also appears to have created problems with intestinal parasites including hookworm and endolimax nana.

The treatment of bacterial overgrowth is still uncertain. There are many recommendations on ways to treat this, but I will hone this to your specific problems Russ. The issue here is your mix between intestinal parasitic infections including Hookworm, an intestinal worm infection, Endolimax nana which is an amoebic infection like your previous Giardia and also bacterial overgrowth. The first two contenders can usually be treated with Albendazole 400mg twice a day for 2 to 4 weeks. If this isnít effective it can be reintroduced for a further 4 weeks with a maximum cycle of 3 courses usually.

You have already had Rifaximin which has not been effective for you. You may need to consider 2 to four week cycles of tetracycline 250mg four times a day or a 4-quinilone antibiotic such as Ciprofloxacin 250-750mg twice a day. Sometimes I alternate my patients between the 2 with off periods of 2 weeks to allow intestinal recovery. It is during this time that you should take the high dose probiotics and I think VSL#3 is a good choice normally and provides both bifidobacteria and lactobacilli.

Something else you might like to consider is Manuka Honey. This has evidence base in gastroenteritis and there have been some isolated reports of benefit in IBS. You can read more about this on my web site, IBS Help Online.

Certainly it would be worth considering Manuka Honey in your situation as it may help boost the effect of the VSL#3 during your off periods from antibiotics. You might like to consider your diet too Russ.

I really hope this works out for you Russ and allows you to get your life back on track.

Irritable Bowel Syndrome

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Dr Peter Thatcher MBBS, MRCPI. IBS Physician & Gastroenterologist


I can answer questions on all aspects of IBS or the Irritable Bowel Syndrome, Medicine and Gastroenterology. This would include aspects of diagnosis, investigation and management of IBS and other gastroenterology or medical conditions.


I am a Consultant Physician and Gastroenterologist in the United Kingdom. I qualified as a physician in 1993 and have been practicing Medicine and Gastroenterology ever since. I regularly run gastroenterology clinics and 1:4 patients have IBS. I am also the web master of IBS Help Online, an Irritable Bowel Syndrome help site.

British Society of Gastroenterology Member of the Royal College of Physicians of Ireland Consultant Physician and Gastroenterologist, Royal Cornwall Hospital, Truro, Cornwall. UK

Consultant Physician and Gastroenterologist, Fully UK Trained Medical Degree at Kings College School of Medicine & Dentistry 1993 Membership of the Royal College of Physicians of Ireland Examinations 1997

Awards and Honors
MBBS 1993 MRCPI 1997

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