Other Conditions to Consider When IBD Symptoms Flare

Todd Eisner Health Guide
  • I have Crohn's Disease and have been doing fairly well of late. My only significant symptom is increased gas and bloating associated with mild diarrhea. My doctor feels that I might have bacterial overgrowth. What is this and what is the treatment?


    The gastrointestinal tract is not sterile. There are large amounts of bacteria present normally. This is known as the bacterial flora. There is both good and bad bacteria present in the gastrointestinal tract. If there is an excess of bad bacteria, or a lack of good bacteria, this leads to an overgrowth of bacteria. Bacterial overgrowth can lead to symptoms of diarrhea, increased gas, bloating and abdominal cramping. In addition to making symptoms of both Crohn's disease and ulcerative colitis worse, bacterial overgrowth can also be responsible for symptoms in patients with irritable bowel syndrome as well. The diagnosis of bacterial overgrowth can be made with a breath test. To perform the test, the patient takes a drink containing the sugar lactulose. If there is bacteria overgrowth in the small intestine, lactulose will ferment, producing the gases hydrogen and methane. Some of the gas is reabsorbed into the bloodstream and brought to the lungs. The breath test involves blowing into a mouthpiece, which collects the breath into vacuum-sealed collection tubes. It looks for increased hydrogen and methane in the exhaled breath. The more of these gases present, the greater the degree of bacterial overgrowth.

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    The treatment of bacterial overgrowth is two-fold. Bacterial overgrowth can be treated or even possibly prevented with the use of probiotics. Probiotics are pills containing large amounts of good bacteria that help to restore and maintain a normal gastrointestinal flora. The most common available probiotics are Align, Flora Q and Florastar. If probiotics fail, or if symptoms are significant and more rapid results are sought, treatment with an antibiotic, Xifaxan, can be used to kill the overgrowth of bad bacteria. Studies have shown Xifaxan to be better than placebo in reducing symptoms in patients with Crohn's disease. You should check with your physician to see if you should be evaluated or even empirically treated for bacterial overgrowth.


    I have heard much about clostridium difficile and diarrhea. Is there an increased incidence in patients with inflammatory bowel disease?


    When the normal flora of the gastrointestinal tract is altered, clostridium difficile bacteria can flourish and multiply. The bacteria produces a toxin that causes a watery diarrhea. While the mostly likely etiology of clostridium difficile occurs when antibiotics have been used, it is more common in patients with inflammatory bowel disease than in the general population. It should therefore be considered in patients who are felt to be experiencing a flare of their inflammatory bowel disease. This is particularly important in patients with severe colitis, as if steroids or other immunisuppressives are used to treat a flare, and patients actually have clostrium difficile colitis, the disease can worsen and even lead to a need for surgical intervention, It is very common in hospitalized and nursing home patients with diarrhea. The toxin produces a colitis that can be very severe. Treatment classically was with the antibiotic Flagyl, but recently, strains of clostridium difficile have developed that have been resistant to Flagyl. Vancomicin is used as second line treatment. You should check with your doctor if you are experiencing symptoms of worsening diarrhea to see if clostridia difficile needs to be ruled out.

Published On: May 15, 2008