Restless Legs Syndrome in Patients with Irritable Bowel Syndrome: Response to Small Intestinal Bacterial Overgrowth Therapy
Background Small intestinal bacterial overgrowth (SIBO) occurs in irritable bowel syndrome (IBS) and fibromyalgia. Since restless legs syndrome (RLS) occurs with fibromyalgia, a link between IBS, SIBO, and RLS was studied. Methods BS patients with abnormal lactulose breath tests received rifaximin 1,200 mg day−1 for 10 days, followed by tegaserod 3 mg, long-term, and 1 month of zinc 220 mg day−1 and once-daily probiotic (N = 11) or rifaximin monotherapy (N = 2). IBS symptom improvement was assessed after rifaximin. RLS symptoms, IBS symptoms, and overall IBS global improvement were assessed at last posttreatment visit: 8/10 patients were followed long-term (mean, 139 days; range, 54–450 days). Results Ten of 13 patients exhibited ≥80% improvement from baseline in RLS symptoms. Five maintained complete resolution of RLS symptoms. Global gastrointestinal symptom improvement was great (n = 6), moderate (n = 5), or mild (n = 2). Conclusion This study suggests that SIBO associated with IBS may be a factor in some RLS patients and SIBO therapy provides long-term RLS improvement.
KeywordsAntibiotic Irritable bowel syndrome Restless legs syndrome Rifaximin
Financial disclosure: Partial funding provided by a grant from Salix Pharmaceuticals, Inc.
- 18.Barbara G, Stanghellini V, de Giorgia R, Cremon C, Cottrell GS, Santini D, Pasquinelli G, Morselli-Labate AM, Grady EF, Bunnett NW, Collins SM, Corinaldesi R (2004) Activated mast cells in proximity to colonic nerves correlate with abdominal pain in irritable bowel syndrome. Gastroenterology 126:693–702PubMedCrossRefGoogle Scholar
- 21.Lupascu A, Gabrielli M, Lauritano EC, Scarpellini E, Santoliquido A, Cammarota G, Flore R, Tondi P, Pola P, Gasbarrini G, Gasbarrini A (2005) Hydrogen glucose breath test to detect small intestinal bacterial overgrowth: a prevalence case-control study in irritable bowel syndrome. Aliment Pharmacol Ther 22:1157–1160PubMedCrossRefGoogle Scholar
- 24.Weinstock LB, Todorczuk JR, Fern SE, Thyssen EP (2006) Comprehensive small intestinal bacterial (SIBO) therapy for irritable bowel syndrome (IBS). Am J Gastroenterol 101(Suppl 2):S470–S471Google Scholar
- 31.Hening WA, Allen RP, Thanner S, Washburn T, Heckler D, Walters AS, Earley CJ (2003) The Johns Hopkins telephone diagnostic interview for the restless legs syndrome: preliminary investigation for validation in a multi-center patient and control population. Sleep Med 4:137–141PubMedCrossRefGoogle Scholar
- 36.Pimentel M, Lin HC. Response to Dr. Parisi, et al. (2003) Am J Gastroenterol 98:2573–2574Google Scholar
- 40.Alpers DH, Klein S (2003) Approach to the patient requiring nutritional supplementation. In: Yamada T, Alpers DH, Laine L, et al (eds) Textbook of gastroenterology, 2nd edn. Lippincott, Williams, & Wilkins, Philadelphia, pp 1056–1084Google Scholar