Diseases and Disorders

What is SIBO? Small Intestinal Bacterial Growth

SIBO stands for Small Intestinal Bacterial Overgrowth. It’s an overgrowth of bacteria in the small intestine. Symptoms include bloating, gas, diarrhea, constipation, weight loss, fatigue, and more.

A diet high in fiber may help prevent SIBO. In order to treat SIBO, doctors recommend antibiotics.

SIBO (Small Intestinal Bacterial Growth)

It is referred to as the large accumulation of bacteria in the small intestine. The small intestine is the longest section of the digestive tract. This is where the food intermingles with digestive juices and the nutrients get absorbed into the bloodstream. When you have SIBO, as food passes through the small intestine, the bacterial overgrowth interferes with the healthy digestive and absorption process. The bacteria associated with SIBO consume some foods and nutrients, leading to unpleasant symptoms including gas, bloating and pain. The occurrence of this disease can also cause malabsorption of nutrients, particularly fat-soluble vitamins and iron.

SIBO Causes

Our gut depends on nerves, muscles, neurotransmitters and enzymes to efficiently digest food. Enzymes help in breaking down the food while the nerves, neurotransmitters and muscles physically move the food through the digestive tract from the stomach to the small intestine. When this happens in a healthy gut, the bacteria get passed through the digestive tract along with the food to its last destination in the colon. Problems arise when there is interference.

Damage to the nerves or muscles in the gut can cause leftover bacteria in the small intestine, increasing your risk for SIBO. For example, diabetes mellitus and scleroderma can both affect the muscles in the gut, increasing the chances of SIBO to develop.

Physical obstructions in the gut like scars from injuries or Crohn’s disease can also be the causes. Medications disrupt the normal gut function and antibiotics, acid breaking drugs and steroids. Diet high in sugar, refined carbohydrates and alcohol are various other causes.

SIBO Risk Factors

Some of the risk factors include low stomach acids, irritable bowel syndromes, celiac diseases, Crohn’s disease, multiple courses of antibiotics, prior bowel surgery, organ system dysfunction such as liver cirrhosis, chronic pancreatitis, or renal failure.

SIBO Symptoms

  1. Gas – When gas doesn’t pass through belching, it can build up in the stomach and intestines, which leads to bloating. With bloating, you may also experience abdominal pain can vary from mild and dull to intense. Passing gas or having a bowel movement may relieve the pain.
  2. Bloating – Bloating is any abnormal swelling or increase in the abdominal’s diameter area. The patient feels a tight and full abdomen, which might lead to abdominal pain.
  3. Diarrhoea – It is the condition of having at least three loose or liquid bowel movements each day. It can lead to dehydration because of liquid loss. There can also be decreased urination, loss of skin colour and a fast heart rate.
  4. Abdominal Pain – It is the pain that occurs between the chest and pelvic region. It can be cramps, achy, dull or sharp. It is more commonly referred to as stomach ache.
  5. Constipation – It is a condition when bowel movements are infrequent and hard to pass. Symptoms may include abdominal pain or bloating.
  6. B12 Deficiency – Vitamin B12 is very important for our body. It makes the DNA and red blood cells. Its deficiency could be because of immune system disorders, heavy drinking, pernicious anaemia, etc.

SIBO Test

Anyone who is experiencing chronic symptoms of bloating, abdominal pain, and diarrhoea should be tested for SIBO. SIBO should also be ruled out by anyone who is showing signs of nutritional deficiencies.

SIBO testing is also recommended for anyone who is experiencing a worsening of symptoms of the following health conditions despite adequate medical treatment: 

  • Chronic pancreatitis,
  • Crohn’s disease
  • Scleroderma

SIBO testing also is recommended for anyone who has celiac disease, but who continues to experience symptoms despite strict adherence to a gluten-free diet.

1. Breath Testing

Breath testing is a non-invasive test that is used fairly frequently to diagnose or rule out SIBO. The test works by testing for hydrogen or methane in the breath at specific intervals after a person drinks a liquid containing a sugar solution, such as glucose or lactulose.

The presence of hydrogen in the breath prior to the 90-minute mark is thought to show that bacteria are present in the small intestine as they are interacting with the consumed sugar and releasing hydrogen or methane, which is then excreted through the breath. This cut-off time period is because it typically takes two hours for an ingested sugar to reach the gut bacteria that are present within the large intestine, which is where such colonies are supposed to be.

2. Jejunal Aspiration

More invasive, but considered more accurate for diagnosing SIBO than the breath test, is a test called “jejunal aspiration.” This procedure takes place during an upper endoscopy procedure and requires that a sample of fluid be taken from the middle section of your small intestine. The sample is then cultured and evaluated for bacteria.

Jejunal aspiration is not used. Its downsides are that it is costly, time-consuming, and, while considered safe, still carries more risks than a breath test. This procedure also has its limitations in terms of accurately identifying SIBO.

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SIBO Treatment

In order to treat SIBO, doctors recommend antibiotics. However, some people experience side effects from these medications.

Medication Trial

A fairly common way for doctors to assess SIBO is through the use of a trial of SIBO medication. Quick symptom relief would therefore suggest that SIBO was present.

The most commonly used medication for SIBO is Xifaxan, which is an antibiotic. Xifaxan differs from most of the antibiotics that you are familiar with, as it is not absorbed into the body through your stomach. Instead, it acts locally on any bacteria that might be in your small intestine.

The Future of SIBO Testing

Researchers are working at a better understanding of SIBO itself, as well as how to improve the validity of diagnostic testing methods. It is hoped that in the future, doctors will be able to accurately identify SIBO’s presence, including specifying which types of bacteria are populating the small intestine of each individual and contributing to their symptoms.

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