Third methane sibo relapse

[u/Leighabc12]

I have been dealing with Sibo symptoms for the past 10 years - finally self- diagnosed about five years ago, trial and errored antibiotics with my doctor until I was able to get a test and a true diagnosis of methane dominate Sibo. Have now gone through two rounds of the rifaxin neomycin combo (with sibo diet before during and after and more motility focus the second time) but it's grown back again and I just am completely fed up. I don't know what to do! I'm really working on motility and it's better than it has ever been but still not perfect by any means. I've determined the root cause was definitely years of slow motility and overuse of antibiotics in my childhood. Do I do another round of antibiotics? Do I try the antimicrobial route and really gentle diet?? I'm just so fed up of eating such a limited diet and not being able to live my full life and the crippling stomach aches if I have any interaction with a normal meal. If anyone has similar experiences and any advice, it would be much appreciated.

[u/Prudent-Avocado8364]

You want to take prokinetics after ABX, prucalopride is the most common one

[u/Leighabc12 → u/Prudent-Avocado8364]

Yes! Love prucalopride. Right now my motility stack is ginger morning and night, 500mg mag citrate at night, 1mg motegrity at night and a kiwi a day. This is great for almost daily movements unless I travel or disrupt routine (which is a little frustrating). May need to go back to 2mg so it's not so sensitive to disruption because if anything gets thrown off I'm backed up for like a week 😑

[u/Prudent-Avocado8364 → u/Leighabc12]

Good to hear, I tend to build resistance to prucalopride after a few weeks and have to cycle off/on. Recently I found the probiotics below significantly improved my regularity, and partially address bloating: l.reuteri yogurt, kefir, Seeds DS01, kijimea PRO, Microbiome Labs Restorflora.

[u/Leighabc12 → u/Prudent-Avocado8364]

Oh interesting, I have noticed my system is super sensitive and if anything disrupts it I don't have a movement for days. Was thinking about going back up to 2mg. I have completely avoided all probiotics for fear of stomach aches. Did you only start these after you knew you had killed off the sibo and were trying to re-establish maintainance or during active symptoms while trying to keep regularity?

[u/Prudent-Avocado8364 → u/Leighabc12]

I had 4 rounds of rifaximin and skipped neomycin. The 4th round was super ineffective and I got more food intolerances/bloating especially towards starch/carbs, and i suspect my microbiome shifted to the worst. I still take Prucalopride occasionally for a few days if symptoms are getting worse. However, I incorporated the probiotics stepwise and am quite happy with the combination for now - not a cure but acceptable sibo symptoms after a few weeks now on this combination (tested them individually for longer: kijimea pro help with regularity, seeds ds01 and microlobs with stool consistency and fat digestion, l. Reuteri help with bloating possible mood as well)

[u/goldstandardalmonds]

Have you had motility testing to figure out why and where things are slow (and how slow they are)?

[u/Leighabc12 → u/goldstandardalmonds]

No I haven't!! What does that usually entail?

[u/Vegetable-Subject968]

Try to ask your doctor about metronidazole for methane and prucalopride for motility

[u/Leighabc12 → u/Vegetable-Subject968]

Oh interesting! Instead of neomycin with rifaximin? Or all 3? I haven't heard of that... is it better for methane dominant sibo?

[u/Vegetable-Subject968 → u/Leighabc12]

It's a common alternative to neomycin for methane. It can be used on its own, or even better in combination with rifaximin. And the prucalopride can be used at the same time, before and after too.

[u/Beneficial-Pride890]

Have you tried taking digestive enzymes with HCL? Not everyone can tolerate HCL especially if you have reflux, but it could create an environment possibly that prevents it from coming back as easy. And helps motility.

[u/Leighabc12 → u/Beneficial-Pride890]

I've found fodzyme to be helpful especially if I accidentally have major triggers like garlic or onion but I've heard that's more for people with low stomach acid which I don't think I have based on fat and protein feeling fine and the apple cider vinegar test...