The world is a small place these days with many people heading overseas for business and pleasure, but sometimes people can return with unwanted travelers that impact their life severely. 

Case History

A 42 year old male presented five months after visiting Thailand and India with severe gastrointestinal symptoms including abdominal bloating, cramping, unformed explosive stools six to eight times a day with uncompromising urgency. He was also fatigued and suffering anxiety for the first time, his anxiety was triggered by the bowel urgency when he had to leave the house. Treatment so far consisted of 3 courses of metronidazole, as well as taking a retail probiotic for the last 3 months.

Treatment 

My treatment focus was to reduce his gastrointestinal inflammation and support gut membrane integrity for 2 weeks before starting antimicrobial treatment. To achieve this I prescribed saccharomyces cerevisiae (boulardii) with vitamin D and vitamin A as well as an herbal combination of boswellia (Boswellia serrata) and turmeric (Curcuma longa). At the end of the two weeks he reported that the cramping was improved and he did not feel as sore.

For the second stage of treatment I pulsed 3 weeks of antimicrobial therapy consisting of saccharomyces cerevisiae (boulardii) with vitamin D and vitamin A alongside the potent antimicrobial combination of phellodendron (Phellodendron amurense), andrographis (Andrographis paniculata) and essential oils. Following the 3 weeks of antimicrobial therapy, treatment consisted of one week of gut repair using slippery elm as a demulcent and prebiotic with a multi-strain probiotic. I expected to pulse this procedure for three or four cycles. I also modified his diet, withdrawing processed foods, gluten and dairy and focusing on whole foods including lean protein and a wide variety of vegetables.

After feeling some improvement during the initial two weeks, he experienced a worsening of symptoms four days into the antimicrobial treatment, the treatment was stopped for 3 days and restarted at half the initial dosage, which he tolerated with no adverse issues. At the end of 2 treatment cycles, he had no bloating and cramping and was passing formed stools. Importantly his anxiety had resolved as his gut function had improved and the urgency had settled. Despite this improvement, we kept the antimicrobial treatment protocol going for one more cycle to ensure resolution and then moved his treatment to the gut repair phase. This stage was continued for another 2 months to further improve his gut terrain and build his microbial diversity.