I have a ~30 years old patient that had bloating/gas symptom for many years, here are some info that I got currently:
1. No significant symptom feature showed on colonoscopy test, gastroscopy test showed minor superficial gastritis and antral gastritis, not severe. Personally I don’t think it is Crohn's.
2. Gas is usually in small intestine, I suspected it to be SIBO, a 10-day treatment course with Rifaximin is given at a dosage of 1200mg/day, no significant improve has been found after.
3. Patient had H pylori history, cured many years ago, stool and blood antibody tests showed negative, breath test is not performed due to some limitation.
4. Regular stool tests and blood tests did not show any abnormality.
5. Gas is usually in small intestine according to patient’s description.
6. CT flat scan on small intestine was performed, no significant abnormality.
7. Celiac antibody test is negative.
8. Patient has anxiety disorder for many years.
I’m not very experienced, but my understanding to this case is that gas is generated by some fermentation process happened in small intestine by some microbial communities, I’m thinking if a stool culture in vitro will help to understand which type of bacteria is generating gas, but I don’t know if I can isolate them since they will mix with microbial communities in colon in stool sample.
More importantly, I’m not sure if I’m looking in the right direct, should I focus on bacteria fermentation or there are other better/more suitable test for this kind case.
Any suggestions will be appreciated, thank you!