06/16/2026
They told you your stomach problems were stress. A gastroenterologist says that for most people with IBS, there is an actual cause, and an actual treatment.
Mark Pimentel, MD, a gastroenterologist who studies the gut, says roughly 60 percent of irritable bowel syndrome is something with a real name: small intestinal bacterial overgrowth, or SIBO. The same condition medicine spent decades blaming on stress, anxiety, and your personality.
He compares it to a 1972 story about a CEO who had a heart attack and was told his stressful job caused it. It wasn't the job. It was the ci******es and the steak dinners. IBS got the same treatment. We called it stress because we did not understand it, and we treated the symptoms one bandaid at a time: a laxative for the constipation, an antidiarrheal for the diarrhea, never the cause.
The tell most people miss is bloating after eating. When the wrong bacteria set up in your small intestine, your gut can ferment a meal up to 63 times faster than normal. You eat, and ten minutes later you are bloated. Pimentel says if that is you, it is worth asking about a breath test, which can now even be done at home, instead of cycling through repeat colonoscopies that keep coming back normal and still leave you without an answer.
And the cause is stranger than most people expect. Food poisoning, especially campylobacter, can trigger this for life. One in five people who get that kind of food poisoning develop lasting IBS, because the infection leaves the body attacking the nerves of its own gut.
Pimentel's point is the one we keep getting wrong:
"We shouldn't be focusing on symptom treatment in IBS. We should be focused on treating the cause."
The good news is that is finally where things are heading, with new tests, a short two-week course of an antibiotic called rifaximin, and treatments in the pipeline that may one day stop it at the source.
Listen to the full conversation on The Podcast by KevinMD. Link in the comments.
