Untangling SIBO, IMO, and ISO: IBS Insights with Dr. Pimentel
The Gut Show
Exploring Antibiotic Treatments for SIBO and Microbial Overgrowth
This chapter explores the treatment of Small Intestinal Bacterial Overgrowth (SIBO) with antibiotics such as Rifaximin and Neomycin. It covers FDA approvals, ongoing research into combinations of therapies, and practical management tips for hydrogen sulfide production.
Still struggling with IBS symptoms, even after trying everything?
It might not be "just IBS."
In the first episode of The Gut Show, Season 8, Dr. Mark Pimentel breaks down the connection between SIBO, IMO, ISO, and IBS, and what patients need to know about testing, treatment, and what's actually causing your symptoms.
We talked about breath tests, stool tests, probiotics, antibiotics (like Rifaximin + Neomycin), the meds that cause SIBO, and more.
Covered in this episode:
Introducing Dr. Pimentel, MD [2:18]
What is SIBO, ISO and IMO? [3:18]
Should everyone with IBS do breath testing? [7:14]
New guidelines that have come out [9:50]
How should a patient navigate testing? [11:11]
What about stool testing? [13:16]
Negative test + symptoms or positive test without symptoms [16:50]
What does normal mean? [18:44]
Who does all 3 [20:39]
Glucose vs Lactulose for the test [21:05]
What causes these overgrowths? [21:52]
The medication that WILL make you have SIBO [23:53]
MAST cells, IBD, endometriosis [24:34]
Treatment [32:07]
Rifaximin [34:19]
Any Statin or seaweed based treatment updates? [37:51]
Neomycin [39:25]
Elemental diet [41:23]
What Dr. Pimentel wants for his patients [45:17]
Probiotics [46:40]
The role of metabolic disorders [48:22]
Rapid fire questions [50:59]
Mentioned in this episode:
Take the quiz: What's your poop personality?
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This episode is made possible with support from Ardelyx.
Gemelli Biotech offers trusted, science-backed at-home tests for conditions like SIBO, IMO, ISO, and post-infectious IBS.
Their Trio-Smart breath test measures all three key gases: hydrogen, methane, and hydrogen sulfide to detect different forms of microbial overgrowth. And for those with IBS symptoms, IBS-Smart is a simple blood test that can confirm post-infectious IBS with clinical accuracy.
You simply order the test, complete it at home, send it back, and get clinically backed results in about a week that you can take to your provider!
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About our speaker:
Mark Pimentel, MD, FRCP(C), is a Professor of Medicine at Cedars-Sinai and Professor of Medicine and of Gastroenterology through Geffen School of Medicine. Dr. Pimentel is also the Executive Director of the Medically Associated Science and Technology (MAST) program at Cedars-Sinai, an enterprise of physicians and researchers dedicated to the study of the gut microbiome in order to develop effective diagnostic tools and therapies to improve patient care.
As a physician and researcher, Dr. Pimentel has served as a principal investigator or co-investigator for numerous basic science, translational and clinical investigations of irritable bowel syndrome (IBS) and the relationship between gut flora composition and human disease. This research led to the first ever blood tests for IBS, ibs-smart™, the only licensed and patented serologic diagnostic for irritable bowel syndrome.
The test measures the levels of two validated IBS biomarkers, anti-CdtB and anti-vinculin. A pioneering expert in IBS, Dr. Pimentel's work has been published in the New England Journal of Medicine, Annals of Internal Medicine, American Journal of Physiology, American Journal of Medicine, American Journal of Gastroenterology and Digestive Diseases and Sciences, among others. Dr. Pimentel has presented at national and international medical conferences and advisory boards.
He is a diplomate of the American Board of Internal Medicine (Gastroenterology,) a fellow of the Royal College of Physicians and Surgeons of Canada and a member of the American Gastroenterological Association, the American College of Gastroenterology, and the American Neurogastroenterology and Motility Society.
Dr. Pimentel completed 3 years of an undergraduate degree in honors microbiology and biochemistry at the University of Manitoba, Canada. This was followed by his medical degree, and his BSc (Med) from the University of Manitoba Health Sciences Center in Winnipeg, Manitoba, Canada, where he also completed a residency in internal medicine. His medical training includes a fellowship in gastroenterology at the UCLA Affiliated Training Program.
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