I have been on proton pump inhibitors for at least twenty-five years. When my hematologist refused to give me an iron infusion despite my iron levels being barely above the cut-off of normal, I took an iron supplement. That caused gastritis. So I ate a bland diet of oatmeal and buckwheat for a few weeks. A nutritionist said to try my usual vegetarian dinner. That caused torturous hunger pangs in the middle of the night. My Gastroenterologist did an endoscopy and only found mild inflammation at my lower esophageal sphincter (LES). So, for two years I subsisted on oatmeal, buckwheat, walnut oil, and milk. Because of that diet, I developed symptoms of SIBO.

After four years, I was finally conclusively diagnosed as having SIBO and was put on the antibiotic Xifaxan at a low dose for 10 days. Other than side effects apart from C. diff, I tolerated Xifaxan. The dose was increased, which helped some, but I found that taking an OTC bacteriophage to be helpful. Despite doing much better with the bacteriophage, I still had SIBO symptoms, though much less than before. Consequently, when my GI doctor suggested Xifaxan at three per day for two weeks, then taper down to one per day for a few months, I agreed. I wanted my SIBO symptoms gone! But after two days and one morning of Xifxan at 3/day, I ended up with new, albeit mild, symptoms. I researched, and it seemed I had a C. diff infection. My general practitioner agreed at my annual physical that month to have me tested for C. diff. I tested positive, but at a low level. I researched more and started taking S. boulardii. That quelled my symptoms, except that my C. diff continued to worsen my GERD-related pain. My GI doctor wanted to wait to have me on a C. diff-specific antibiotic. I was glad, as it saved me $200.00 at a local pharmacy. But my symptoms persisted.

Clearly, I was not someone whose C. diff infection was going to resolve on its own. I researched more and found that Dificid was more effective in preventing a C. diff-infection recurrence. Despite being daunted by the cost, and worn out by having to do doctors’ work for them, I researched again and stumbled on the MerckHelps program for those who need Dificid but are under a certain income level. My GI doctor somewhat reluctantly prescribed the Dificid so I could get it from Merck. He also wanted me to wait to take it until my upcoming appointment with the infection disease physician. Why he wanted me to wait, I have no idea. But after living with this infection and taking S. boulardii every day for five weeks and counting, with LES pain all but robbing me of my ability to eat anything other than milk, I went ahead, got the Dificid and have started taking it.

The Dificid should be effective, and I will continue to take the S. boulardii yeast supplement (that targets C. diff toxins to deter the infection from expanding) during and for four weeks after the Dificid treatment. Then I will be tested for C. diff again and hope my toxin levels are below the cut-off for infection and only show asymptomatic colonization. I don’t know how I contracted C. diff. Despite handling stool samples for biomedical research that were apparently prescreened for hazards ten years ago, or accidentally getting dirt in my mouth causing week-long watery diarrhea (with no adverse aftereffects) several months before my diagnosis, or just from living life in general. But my hope is to qualify for GERD surgery (e.g., non-incision TIF procedure) or some means to get off proton pump inhibitors to help prevent a reccurence of C. diff infection.

The main point I want to make with all of this is that doctors should have all patients tested for C. diff who are on PPIs, are older, or have any likely reason they might be C. diff colonized before putting them on antibiotics for none urgent reasons. Had I been tested before being given Xifaxan and seen that I was colonized, known what the risk was of taking Xifaxan in causing C. diff infection, I would have said no thanks and continued attentuating the dose of my bacteriophage to find the right dose to reduce or eliminate SIBO symptoms w/o causing side-effects from the bacteriophage. Doctors have be to more preventative. GI doctors know the risks of C. diff they should test before prescribing Xifaxan.