Is IBS an Antibiotic Responsive Disease?

Dr. Pimentel and his group have just launched a new blood test called “IBS (check)” that they claim identifies an IBS diagnosis and, with this new diagnostic tool, that IBS is now a disease – quote, “IBS is an antibiotic responsive disease.” Here is the announcement on You Tube:

HERE IS WHAT THEY ARE TESTING

The test looks for antibodies to the Cdt-b toxin and antibodies to vinculin. When a food poisoning event occurs, some people will get exposed to a toxin that is produced by E. coli, Salmonella, Shigella or Campylobacter, called Cdt-B toxin (Cytolethal Distending Toxin B). When exposed to this toxin – the Cdt-b toxin, people experience watery diarrhea. The antibodies produced by some people to attack the Cdt-b toxin will also attack a protein within the lining of the intestinal tract call vinculin. This creates an autoimmune reaction, where antibodies that you create are attacking self. Dr. Pimentels’ group believes that around 20% of people exposed to this toxin will go onto develop SIBO, with ongoing IBS symptoms and that this takes about three months to develop.

Here is what it looks like: There is a food poisoning event and exposure to Cdt-B toxin which triggers gastritis. 20% of people will create an antibody to the toxin. They will recover from the food poisoning event – gut symptoms will return to normal. The antibodies created to address the toxin start to attack vinculin. Over time, your gut motility slows, leading to a highly fermentable environment in the small intestine and setting the stage for SIBO and IBS symptoms that appear around the three month mark.

Vinculin is a protein that connects a network of cells within the pacemaker of the gut, called the Interstitial Cells of Cajal. The pacemaker of the gut does exactly what you think it would, it is the signaling network that signals the coordinated wave like contractions of peristalsis; it sets the pace.

Vinculin helps these cells connect and communicate electrical signals to contract your smooth muscle. If vinculin is damaged or destroyed, it can’t link the cells within the pacemaker and you then can’t transmit the electrical signal to contract your smooth muscle. This stalls gastric motility during meals and in between meals.

ON A POSITIVE NOTE

This test will identify if you have been exposed to the Cdt-b toxin and if you have produced antibodies to it. It will also identify if your body has produced antibodies to vinculin WHICH will then inhibit gut motility. This information is good to know.

You can have chronic diarrhea AND inhibited gut motility. Chronic loose, watery stool does not mean that you have ‘too much’ gut motility. What is happening is that your small intestine is being flooded with water, driving diarrhea. So, again, knowing if your gut symptoms are in part due to the damage done to vinculin, this is good to know.

This test will help distinguish between IBD (Inflammatory Bowel Disease) and IBS patients.

HERE IS MY ISSUE WITH THE CLAIM: That this is an “IBS diagnostic test”

This test will only identify a very small subset of people experiencing IBS symptoms. Only 20% of people who are exposed to a food poisoning event will produce antibodies to the Cdt-b toxin. Not everyone that has IBS symptoms, has them as a result of an autoimmune issue with vinculin antibodies.

This isn’t an IBS diagnostic test. It is a autoimmunity test, testing to see if vinculin antibody levels are present.Specifically, this test diagnoses a form of IBS called Post-Infectious IBS (SIBO).

In this short video, introducing this test to the world, Dr. Pimentel makes the claim at the 1.29 minute mark that “IBS IS AN ANTIBIOTIC RESPONSIVE DISEASE”

This is a BIG leap, going from identifying 20% of people who have produced antibodies to the Cdt-b toxin, to stating that “IBS is an antibiotic responsive disease.”

From the slide here – gut motility slows and if SIBO becomes an issue then they are labeling this as ‘IBS’ and tying the entire community of IBS patients to needing treatment with antibiotics. If gut motility is affected, inhibited, or disrupted, this will create a great level of imbalance with the gut.

The idea that 100% of people, of whom, test positive for antibodies to vinculin NEED to be place on an antibiotic is ludicrous (I know, tell you how I really feel). It will tip an already imbalanced gut, into even more imbalance. Antibiotics don’t fix gut motility disorders. They knock all micro-organisms down at once. The gut motility issue is still there and this will simply increase the ‘need’ for more rounds of antibiotics.

Now, let’s take the leap from here to say that “IBS is an antibiotic responsive disease” and you have just plain lost me. Antibiotics do not ‘cure’ SIBO or IBS. This test is going to lead to more and more overuse of antibiotics in a population that needs to work on rebalancing their gut health and reinstating gut motility.

The only way to regain balance with the gut it to look for ways to reinstate gut motility, support healthy flora balance, reduce the fermentable load in the diet and work, over time, to heal the gut.