Hi @retiredbabe ,

Sounds like you want an idea of whether Mayo could help you with your ongoing GI symptoms, a reasonable request since a trip to Mayo can cost more than Disneyland and is slightly less fun.

I did visit Mayo and my SIBO has become manageable, but that was largely due to a combination of lifestyle choices and constant effort on my part. I had / have diarrhea-dominant SIBO due to a surgery in my intestines, and you appear to have constipation-dominant SIBO with no obvious cause (besides perhaps being older in age).

The benefits of going to Mayo are as follows: you are going to have your case reviewed by a team of top GI doctors who see many different "hard" GI cases all the time, and they will offer their second opinion as to whether your symptoms are likely due to SIBO or something else. If they think something else is wrong, they can usually schedule you immediately for the corresponding test. If they feel compelled to prove that you have SIBO, they can have you do a breath test + stomach endoscopy with aspirations (especially since you have stopped responding to antibiotics, it appears). From this point of view, it would seem prudent to make sure you do, in fact, have SIBO, rather than spend years barking up the wrong tree, potentially.

As far as treatment goes for stubborn SIBO goes, well, unfortunately they don't necessarily have any magic bullets. Perhaps I missed it, but were you ever on motility agents in addition to the antibiotics? Conventional doctors are less likely to Rx these because they can have bad side-effects, but a gut mobility specialist could help find one that's right for you.

Besides that, if I was suffering from your version of SIBO (and as a reminder, I have a different version of SIBO), I would put on a pot of coffee, go to https://old.reddit.com/r/SIBO/, sort by "best all time", and start reading to find people with my exact symptoms and read how they solved their situations and make myself a list of ideas to try.