Small Intestinal Bacterial Overgrowth (SIBO), pronounced See-bow, is a condition characterized by an abnormal increase in the number of bacteria in the small intestine. Normally, the small intestine contains relatively low levels of bacteria compared to the colon. However, in SIBO, these bacteria proliferate excessively, leading to various digestive and full-body symptoms, and nutritional deficiencies.
Causes of SIBO
SIBO may occur due to several underlying factors:
1. Motility Disorders: Conditions that slow down the movement of food and bacteria through the small intestine can lead to bacterial overgrowth. This can be caused by diseases such as diabetes, gastroparesis, scleroderma, or conditions like irritable bowel syndrome (IBS) (1).
2. Structural Abnormalities including strictures (narrowing of the intestine), diverticula (small pouches in the intestine), or surgical changes can create an environment conducive to bacterial overgrowth.
3. Immune System Impairment can contribute to SIBO by allowing bacteria to proliferate unchecked (2).
4. Use of Certain Medications: Long-term use of medications that affect gut motility, such as opioids, benzodiazepines, or proton pump inhibitors (PPIs), and microbiome altering antibiotics, can increase the risk of SIBO (3).
5. Recent gastrointestinal infections including food poisoning may lead to a disturbed microbiome and an increased risk of SIBO.
Symptoms of SIBO
The symptoms of SIBO can vary widely and it can worsen existing conditions. Most common symptoms you may experience include:
– Bloating and Gas: Excessive bacteria produce gas as they ferment undigested food, leading to bloating and discomfort.
– Diarrhea or Constipation: SIBO can cause changes in bowel habits, including chronic diarrhea, constipation, or alternating between the two.
– Abdominal Pain: Pain and cramping in the abdomen are common due to increased gas and bacterial activity.
– Nutrient Deficiencies: SIBO can interfere with nutrient absorption, leading to deficiencies in vitamins such as B12, iron, and fat-soluble vitamins.
– Unintended Weight Loss: Malabsorption of nutrients can result in weight loss, despite adequate food intake.
– Other symptoms may include heartburn or nausea but many fall outside the GI tract entirely. Such as headache, joint pain, fatigue, mood, skin concerns, and plus there are numerous other conditions associated with SIBO. (4)
Diagnosis of SIBO
Diagnosing SIBO typically involves the following methods:
1. Breath Tests: The most common diagnostic test for SIBO is a breath test, where a patient drinks a solution containing a sugar like glucose or lactulose. The test measures hydrogen, methane, and hydrogen sulfide levels in the breath, which are produced by bacteria fermenting these sugars in the small intestine (5).
2. Small Intestinal Aspirate and Culture: A more direct method involves taking a sample of fluid from the small intestine and culturing it to detect bacterial overgrowth. This method is less commonly used outside of research facilities due to its cost and invasiveness.
Treatment of SIBO
Treatment for SIBO may include:
1. Antibiotics: The first line of treatment often involves antibiotics to reduce bacterial overgrowth. Rifaximin is a commonly prescribed antibiotic due to its effectiveness and minimal absorption into the bloodstream. Herbal antibiotics are often considered as well.
2. Dietary Changes: There are several diets that limit fermentable carbohydrates, that may help manage symptoms by reducing the substrate available for bacterial fermentation (8), but these may not eliminate the bacteria.
3. Prokinetics: Medications or nutrients that enhance gut motility can help prevent the recurrence of SIBO by promoting the regular movement of contents through the small intestine.
4. Probiotics and Nutritional Support: Probiotics may help restore a healthy balance of gut bacteria, while nutritional support may be necessary to address deficiencies caused by malabsorption. (6)
In Conclusion
SIBO is a condition that have significantly impacted your quality of life due to its uncomfortable symptoms and potential nutritional complications. Early diagnosis and appropriate treatment are essential for managing SIBO. To explore an integrative approach to SIBO check out siboinfo.com a website compiled by Dr. Allison Siebecker, who is a leader in SIBO treatment and training. If you experience persistent digestive symptoms, you may benefit from individualized care with a knowledgeable licensed healthcare provider for evaluation and management.
References:
1. Takakura, W. and Pimentel, M. (2020). Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome – An Update. Front Psychiatry.
2. Quigley, E. M. M., & Quera, R. (2006). Small intestinal bacterial overgrowth: Roles of antibiotics, prebiotics, and probiotics. Gastroenterology.
3. Lo, W. K., & Chan, W. W. (2013). Proton pump inhibitor use and the risk of small intestinal bacterial overgrowth: A meta-analysis. Clinical Gastroenterology and Hepatology.
4. Ghoshal, U. C., & Shukla, R. (2017). Small intestinal bacterial overgrowth and other intestinal disorders. Gastroenterol Clin North Am.
5. Rezaie, A., et al. (2017). Hydrogen and methane-based breath testing in gastrointestinal disorders: the North American Consensus. Am J Gastroenterol.
6. Achufusi, T.G.O., et al. (2020). Small Intestinal Bacterial Overgrowth: Comprehensive Review of Diagnosis, Prevention, and Treatment Methods. Cureus.
