Skip to main content

Hi guys,

I've had my pouch for about 7 months now, in the last 2 months I have experienced a sudden large amount of gas and fluctuating diarrea and constipation. However, the huge amount of gas is the main problem. I've been scoped with no sign of inflammation, which means no pouchitis. I've taken a 2 week course of metronidazole and that really helped.... The gas completely went. However, my symptoms came back after just 4 days being off the anti biotics. I've got a strong feeling it's SIBO and my question is will it ever go away ? Are there any people out there that antibiotics have worked for them and they haven't experienced a relapse ?
Original Post

Replies sorted oldest to newest

Thank you very much for your replies.

I went to see my GI again the tell him that these symptoms came back. He recommended to do a breath test and if things stay the same to go back on metronidazole. He also suggested it may be IBS but I don't agree. However, I spoke to him about rifaximin, but he was quite reluctant to use it for my case and said even if the breath test came back positive he wouldn't use rifaximin. What is the best drug for sibo and what reccomendations would any of you make if my doc doesn't want to prescribe it?

Jipalmer, please let me know how you get on, hope you get better soon and the symptoms don't come back!

There's probably no single "best drug" for SIBO. As I wrote, doxycycline worked for me. If you brought your doc a research article showing that Xifaxan showed promise in treating SIBO you'd possibly get a favorable response. I suspect that no such article exists, so it's worth considering why you feel so strongly about it. It's extremely expensive.

xifaxan or rifaxamin.. is often prescribed initially for sibo as its not a systemic antibiotic. It can often help with sibo and not cause other bad side effects. I am clueless why your doc won't prescribe it. I have chronic sibo. I have been through many many antibiotics. AT one point I was on xifaxan for about 6months straight.  Now I am on a xifaxan and bactrim rotation. (I am allergic to many antibiotics) Also.. try dietary changes. Look at FODMAP diet. ANd the basics.. cut out sugar.

hope you get some results



I also have heard that sometimes it just takes a longer, more sustained dose to get things under control.  Did you end up taking the second dose?  Overall, my symptoms are better on this second dose of xifaxan.  I will be on it for two more week so hopefully things just keep improving.  My doctor really likes xifaxan, he thinks it's one of the safer drugs to use in the long-term management of SIBO.  I guess there are going to be differing opinions regarding treatment.  As you'll see above, Scott did well on doxycycline whereas my doctor was really hesitant to put me on that.  I guess it just depends on who you're seeing and the experiences they've had with other patients.  Are you feeling any better?

Hey guys,

Done the SIBO breath test yesterday and came back negative. I also done a lactose breath test which also came back negative. However, I'm still having the terrible symptoms of gas and diarrhea. If it's not pouchitis and not SIBO than what can be causing me such terrible symptoms. Yesterday, I had terrible diarrhea all day and lost around 1kg as I kept having to go to the toilet but wasn't eating anything. However, I've been a little constipated today but the gas is still there. Another symptom I've also realised is Im fluctuating between terrible diarrhea and constipation. Any ideas what this could be ?

Jipalmer, great to see you are feeling better. I hope things will still be the same in 2 weeks. Keep me updated.

This might be an ugly case of Irritable Bowel Syndrome, I guess. You might try soluble fiber (e.g. Metamucil, Konsyl, Benefiber, Citrucel) for a few weeks to see if it helps. Or a different antibiotic, in case the SIBO breath test was incorrect.


Also, some people get gas from Metamucil, probiotics, or diet (e.g. beans, broccoli).

Last edited by Scott F
Hi Scott, thank you very much for your reply.

If it were IBS any suggestions why I felt so good on the antibiotics and was symptom free ? Apart from slight constipation but the horrible gas completely went. Furthermore, if this was IBS would the symptoms eventually subside? As I'm aware there is currently no treatment for IBS ?

IBS and IPS (irritable pouch syndrome) are pretty much the same. Antibiotics can help because the current thought is that there is some level of bacterial imbalance for many sufferers. This is why there are so many probiotics, yogurts, and the like, that are advertised to help treat IBS. While there may be no cure for IBS/IPS, there ARE treatments. Besides identifying diet triggers, there are probiotics, low dose tricyclic antidepressants (like Elavil), and antispasmodics (like Bentyl).


While lactose intolerance is common, it is not universal. You can also consider gluten intolerance, specific carbohydrates, and specific fruits and vegetables.


IPS is common.



Add Reply

Copyright © 2019 The J-Pouch Group. All rights reserved.
Link copied to your clipboard.