What is Small Intestinal Bacterial Overgrowth (SIBO). How does it affect digestion and overall health. What are the common symptoms, risk factors, and treatment options for SIBO. How can dietary changes help manage SIBO symptoms.

Understanding Small Intestinal Bacterial Overgrowth (SIBO)

Small Intestinal Bacterial Overgrowth (SIBO) is a condition characterized by an abnormal increase in the bacterial population within the small intestine. While bacteria are essential for our digestive system, particularly in the large intestine, the small intestine typically contains fewer microorganisms. When this balance is disrupted, it can lead to various digestive issues and health complications.

Under normal circumstances, gastric secretions and the forward movement of food through the digestive system prevent excessive bacterial growth in the small intestine. However, when these functions are compromised, bacteria can multiply rapidly, leading to SIBO. The small intestine is not equipped to handle large numbers of bacteria, and when a person with SIBO eats, these bacteria begin to ferment the food, often resulting in uncomfortable symptoms.

Common Symptoms of SIBO

The symptoms of SIBO can vary from person to person, depending on the severity of the bacterial overgrowth and any coexisting conditions. Some of the most common symptoms include:

• Bloating
• Diarrhea
• Constipation
• Unexplained vitamin deficiencies, especially vitamin B12

Interestingly, the type of microbe that is overgrowing may influence the specific symptoms experienced. Research suggests that hydrogen-producing bacteria are more associated with diarrhea, while methane-producing species are more likely to cause constipation.

Risk Factors and Causes of SIBO

The exact causes of SIBO are not always clear, but researchers have identified several factors that may contribute to its development:

Low Motility

Normally, the intestines push food and bacteria through the digestive tract, preventing bacterial accumulation in the small intestine. When motility is reduced, this mechanism slows down, allowing food to ferment in the small intestine and potentially leading to SIBO.

Dysbiosis

Dysbiosis refers to an imbalance in the gut microbiome, where there may be too many harmful species of microbes or not enough beneficial ones. Studies suggest that people with Irritable Bowel Syndrome (IBS) often have less diversity in their microbiome, fewer beneficial species, and higher amounts of methane-producing species, which can slow motility and contribute to SIBO.

Hypochlorhydria

This condition is characterized by low levels of stomach acid. Insufficient stomach acid may allow bacteria to migrate further up the digestive tract than usual, as the environment is not acidic enough to kill them. People who take proton pump inhibitors (PPIs), have autoimmune gastritis, or have undergone a gastrectomy may be at increased risk of hypochlorhydria and, consequently, SIBO.

Structural Differences

Sometimes, SIBO occurs due to structural differences in the digestive tract. Examples include small bowel diverticulosis, fistulas, and a shortened colon. A 2018 study found that individuals who have undergone a colectomy are at higher risk of developing SIBO.

Alcohol Abuse

Excessive alcohol consumption can damage the microbiome, leading to dysbiosis, intestinal wall damage, and inflammation, all of which may contribute to the development of SIBO.

Underlying Conditions Associated with SIBO

Certain underlying conditions increase the likelihood of developing SIBO. These include:

• Hypothyroidism
• Diabetes
• Parkinson’s disease
• Short bowel syndrome
• Amyloidosis
• Systemic sclerosis
• Chronic kidney failure

SIBO is also more common in older adults, possibly due to slower digestive motility. There is a higher prevalence among females, though the reasons for this are not fully understood.

The Link Between SIBO and Obesity

A small 2017 study found that people with obesity were 11 times more likely to have SIBO than those without obesity. The reasons for this association are not entirely clear, as the risk was higher in participants who had healthy digestive motility and pH levels. Further research is needed to understand the connection between SIBO and obesity.

Diagnosing SIBO: Methods and Challenges

Diagnosing SIBO involves a combination of symptom assessment, medical history evaluation, and specific tests. A doctor will typically begin by asking about a person’s symptoms and medical history, and may perform a physical examination to check for signs of excess gas or bloating.

Breath Testing

One of the primary diagnostic tools for SIBO is the lactulose breath test. This test measures the concentration of hydrogen and methane in a person’s breath. The results can confirm a SIBO diagnosis, reveal the extent of the overgrowth, and indicate whether the overgrowth consists mainly of hydrogen- or methane-producing microbes.

To prepare for the breath test, a person must fast for 24 hours before the procedure. They then drink a sugary solution containing lactulose, and their breath is analyzed at regular intervals over several hours. The presence of certain gases in the breath can indicate bacterial overgrowth in the small intestine.

Treatment Options for SIBO

Once SIBO is diagnosed, there are several treatment options available. The choice of treatment may depend on the severity of the condition, the type of bacteria involved, and any underlying health issues.

Antibiotics

Antibiotics are often the first-line treatment for SIBO. The most commonly prescribed antibiotic is rifaximin, which is minimally absorbed by the body and primarily targets the small intestine. Other antibiotics may be used depending on the specific bacteria involved.

Fecal Microbiota Transplant (FMT)

In some cases, particularly when antibiotics are ineffective, a fecal microbiota transplant may be considered. This procedure involves transferring fecal matter from a healthy donor to the patient’s intestine, with the goal of restoring a healthy balance of gut bacteria.

Dietary Changes

Dietary modifications play a crucial role in managing SIBO symptoms and preventing recurrence. Several diets have shown promise in alleviating SIBO symptoms:

• Low FODMAP diet: This diet restricts certain types of carbohydrates that are easily fermented by gut bacteria.
• Specific Carbohydrate Diet (SCD): This diet eliminates most complex carbohydrates and all grains.
• Elemental Diet: This liquid diet provides nutrients in their simplest form, allowing for easy absorption and minimal bacterial fermentation.

It’s important to work with a healthcare provider or registered dietitian when making significant dietary changes to ensure nutritional needs are met.

Managing SIBO: Long-term Strategies and Considerations

Managing SIBO often requires a multi-faceted approach that goes beyond initial treatment. Long-term strategies may include:

Addressing Underlying Conditions

If SIBO is secondary to another health condition, such as hypothyroidism or diabetes, effectively managing that condition is crucial for preventing SIBO recurrence.

Prokinetics

For individuals with low motility, prokinetic agents may be prescribed to improve gut motility and prevent bacterial overgrowth.

Nutritional Support

SIBO can lead to malabsorption of nutrients, particularly vitamin B12. Supplementation may be necessary to address deficiencies.

Lifestyle Modifications

Certain lifestyle changes can support gut health and reduce the risk of SIBO recurrence. These may include:

• Stress management techniques
• Regular exercise
• Adequate hydration
• Avoiding excessive alcohol consumption

The Relationship Between SIBO and IBS

SIBO appears to be closely related to Irritable Bowel Syndrome (IBS). People with IBS are more likely to have SIBO than the general population. However, it’s important to note that not everyone with an IBS diagnosis tests positive for SIBO.

The connection between SIBO and IBS is complex and not fully understood. Some researchers suggest that SIBO may be a contributing factor to IBS symptoms in some patients, while others propose that the altered gut motility and microbiome associated with IBS may create conditions favorable for SIBO development.

Overlapping Symptoms

Many symptoms of SIBO overlap with those of IBS, including bloating, abdominal pain, diarrhea, and constipation. This similarity in symptoms can sometimes lead to misdiagnosis or delayed diagnosis of SIBO in IBS patients.

Treatment Implications

The relationship between SIBO and IBS has important implications for treatment. In some cases, treating SIBO with antibiotics or dietary interventions may lead to improvement in IBS symptoms. However, more research is needed to fully understand the interplay between these two conditions and to develop optimal treatment strategies for patients with both SIBO and IBS.

Emerging Research and Future Directions in SIBO Management

As our understanding of SIBO and its impact on overall health continues to evolve, researchers are exploring new avenues for diagnosis, treatment, and prevention. Some areas of ongoing research include:

Improved Diagnostic Methods

While breath testing is currently the most common diagnostic tool for SIBO, it has limitations in terms of accuracy and specificity. Researchers are working on developing more precise and reliable diagnostic methods, including advanced imaging techniques and molecular testing of small intestine samples.

Targeted Probiotics

The role of probiotics in SIBO management is a subject of ongoing research. While some studies suggest that certain probiotic strains may be beneficial in preventing or treating SIBO, others indicate that probiotics could potentially exacerbate the condition. Future research aims to identify specific probiotic strains that may be most effective for SIBO patients.

Personalized Treatment Approaches

Given the complex nature of SIBO and its varying presentations, there is growing interest in developing personalized treatment plans based on an individual’s specific bacterial overgrowth profile, underlying conditions, and genetic factors.

Gut-Brain Axis Research

The connection between gut health and mental health, known as the gut-brain axis, is an area of increasing focus in SIBO research. Understanding how SIBO impacts this axis could lead to new treatment strategies that address both gastrointestinal and neurological symptoms.

As research in these areas progresses, it is likely that our approach to diagnosing, treating, and managing SIBO will continue to evolve, offering hope for more effective and targeted interventions in the future.

Living with SIBO: Coping Strategies and Quality of Life Considerations

Living with SIBO can be challenging, as the symptoms can significantly impact daily life and overall well-being. However, there are several strategies that can help individuals cope with the condition and improve their quality of life:

Support Networks

Connecting with others who have SIBO through support groups or online communities can provide emotional support, practical advice, and a sense of community. Sharing experiences and coping strategies can be invaluable in managing the challenges of living with SIBO.

Stress Management

Stress can exacerbate SIBO symptoms, so implementing effective stress management techniques is crucial. This may include practices such as meditation, yoga, deep breathing exercises, or engaging in hobbies and activities that promote relaxation.

Meal Planning and Preparation

Following a SIBO-friendly diet can be easier with careful meal planning and preparation. Batch cooking, meal prepping, and always having suitable snacks on hand can help individuals stick to their dietary plan and avoid triggering foods.

Working with Healthcare Providers

Maintaining open communication with healthcare providers is essential for effective SIBO management. Regular check-ins, discussing new symptoms or concerns, and staying informed about treatment options can help individuals feel more in control of their condition.

Addressing Mental Health

The chronic nature of SIBO and its impact on daily life can take a toll on mental health. It’s important to address any feelings of anxiety, depression, or frustration that may arise. Working with a mental health professional who has experience with chronic health conditions can be beneficial.

By implementing these coping strategies and working closely with healthcare providers, individuals with SIBO can improve their quality of life and better manage their symptoms. As research continues to advance our understanding of SIBO, there is hope for even more effective management strategies in the future.

Symptoms, causes, treatment, and diet

Small intestinal bacterial overgrowth (SIBO) occurs when large numbers of bacteria colonize the small intestine. It can cause bloating, diarrhea, or constipation. Treatment options include antibiotics, fecal transplant, and dietary changes.

Bacteria are essential to the digestive system, in the form of the gut microbiome. This is mostly present in the large intestine, but the small intestine does not contain many bacteria.

Gastric secretions and the forward movement of food through the digestive system prevent too many bacteria from growing in the small intestine. However, if these functions do not work effectively, bacteria can multiply.

The small intestine is not able to handle high numbers of bacteria. When a person eats, these bacteria begin to ferment the food. In some people, this causes symptoms.

SIBO appears to be related to irritable bowel syndrome (IBS). People with IBS are more likely to have SIBO than the rest of the population. However, not everyone with an IBS diagnosis tests positive for SIBO.

In this article, we discuss the symptoms, risk factors, and complications of SIBO. We also look at the best diets to relieve the symptoms.

The symptoms of SIBO can vary from person to person, depending on how mild or severe the overgrowth of bacteria is and whether someone has any coexisting conditions.

However, the symptoms may include:

• bloating
• diarrhea
• constipation
• unexplained vitamin deficiencies, especially a vitamin B12 deficiency

The type of microbe that is overgrowing may also determine the symptoms. Research suggests that hydrogen-producing bacteria are more associated with diarrhea, while methane-producing species are more associated with constipation.

Doctors are not always sure what causes SIBO. So far, researchers have identified the following factors that may contribute to SIBO:

• Low motility: Usually, the intestines push food and bacteria through the digestive tract, which prevents too much bacteria from accumulating in the small intestine. However, if someone has low motility, this mechanism slows down, allowing food to ferment in the small intestine.
• Dysbiosis: Dysbiosis is when a person’s microbiome becomes imbalanced, containing too many harmful species of microbes or not enough beneficial species. Research into how different species of microorganisms influence digestion is still ongoing, but previous studies suggest that people with IBS often have less diversity, fewer beneficial species, and higher amounts of methane-producing species in their microbiome, which can slow motility.
• Hypochlorhydria: This term describes low levels of stomach acid. When someone does not have sufficient stomach acid, it may be possible for bacteria to migrate further up the digestive tract than usual, as the environment is not acidic enough to kill them. Researchers believe that people who take proton pump inhibitors (PPIs), have autoimmune gastritis, or have undergone a gastrectomy have an increased risk of hypochlorhydria and SIBO. However, there is a lack of conclusive evidence on this, and low motility may be a more important risk factor.
• Structural differences: Sometimes, SIBO occurs because a person has structural differences in the digestive tract. Examples include small bowel diverticulosis, fistulas, and a shortened colon. According to a 2018 study, people who have undergone a colectomy are more at risk of developing SIBO.
• Alcohol abuse: Excessive alcohol consumption can damage the microbiome, leading to dysbiosis, damage to the intestinal walls, and inflammation.

People with certain underlying conditions are more likely than other people to get SIBO. These people include those with:

• hypothyroidism
• diabetes
• Parkinson’s disease
• short bowel syndrome
• amyloidosis
• systemic sclerosis
• chronic kidney failure

SIBO is also more common in older adults, possibly due to slower digestive motility. There is a higher prevalence among females, too, but the reasons for this are unclear.

A small 2017 study found that people with obesity were 11 times more likely to have SIBO than those without obesity. It is unclear why this was the case, as the risk was higher in participants who had healthy digestive motility and pH levels. More research is necessary to understand the link.

A doctor will diagnose SIBO by asking about a person’s symptoms and medical history. They may feel the abdomen for signs of excess gas or bloating. If they suspect SIBO, they will recommend testing.

Breath testing

A lactulose breath test measures the concentration of hydrogen and methane in a person’s breath. The results of this test can confirm a SIBO diagnosis and reveal the extent of the overgrowth. They also show whether the overgrowth consists mainly of hydrogen- or methane-producing microbes.

A person has to fast for 24 hours before the test. They then drink a sugary solution containing lactulose, which is a sugar that only gut bacteria can break down.

When bacteria break the sugar down, they produce gases, which enter the bloodstream and travel to the lungs. A breath test measures these gases as a person exhales.

Glucose vs. lactulose breath testing

Some doctors perform glucose breath testing instead of lactulose breath testing. Some scientists have criticized this method, as the body can absorb glucose quickly, which means that it might not reach the area of overgrowth.

However, others argue that this rapid absorption can be an advantage, as it makes it less likely that the sugar will reach the colon, where it would generate a false positive result by feeding a large number of bacteria there.

Small bowel aspirate and culture

This is the gold standard for SIBO testing, but it is a more invasive test. Small bowel aspirate tests involve a doctor performing an endoscopy, which means inserting a small, thin camera through the mouth and down into the stomach.

When the device reaches the duodenum, which is where the stomach joins up with the small intestine, doctors use the endoscope to take a tissue sample. They then send the sample to a laboratory, which analyzes the bacteria present.

It is worth noting that with small bowel aspirate testing, as well as breath testing, there is no universally accepted threshold for what constitutes a positive SIBO result. This makes diagnosis more difficult for those who have less conclusive test results.

Other tests

The existing tests for SIBO are not always precise, so a doctor may recommend other tests to get a better picture of someone’s digestive health. These could include:

• blood tests to detect markers of autoimmunity or inflammation
• a mobility test to determine whether someone has any structural problems in the small intestine
• an intestinal permeability test, which assesses whether the intestinal lining is “leaky“
• stool tests to analyze the gut microbiome

As SIBO can occur for complex reasons, it can be difficult to treat. Various treatment options are available, including antibiotics, fecal microbiota transplants, and dietary changes.

Antibiotics

This is the main treatment for SIBO. Doctors may use one type of antibiotic or a combination to remove the overgrowth.

A popular option is rifaximin (Xifaxan). Previous studies suggest that this antibiotic works best for people with hydrogen-dominant overgrowths. Neomycin, or a combination of rifaximin and neomycin, may be better for those with methane-dominant SIBO. However, research into the best ways of treating SIBO is still ongoing.

Recurrence rates after SIBO treatment are relatively high. For this reason, alongside taking antibiotics, it is essential to address the underlying cause of the SIBO to reduce the risk of the overgrowth coming back.

Depending on the root cause, this may mean taking medications to speed up motility, stopping PPI treatment, or treating other conditions that might be contributing.

Probiotics and fecal microbiota transplants

The role of probiotics in SIBO treatment is controversial. While some studies have shown that specific species can improve motility and reduce hydrogen in the breath, others have shown that probiotics may cause SIBO.

If a person has low motility and takes probiotics, it is possible that they may make an overgrowth more likely or worsen an existing one. The results can vary from person to person.

A fecal microbiota transplant (FMT) is a fairly new treatment that involves a doctor transplanting a donor’s gut flora into a patient via the rectum. Again, research has produced mixed results on using this procedure as a treatment for SIBO. Some case studies have noted that FMT seems to cause SIBO. Currently, the Food and Drug Administration (FDA) has not approved this treatment.

Diets cannot cure SIBO, but they can lessen the symptoms. What works can vary from person to person, but a popular option is the low FODMAP diet.

The low FODMAP diet limits the intake of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are substances that the human body does not break down, which means that bacteria can feed on them. Limiting high FODMAP foods may reduce gas, bloating, constipation, and diarrhea.

Both the type and amount of foods a person eats are important in the low FODMAP diet. As it is fairly complex and can involve major dietary changes, it is best to work with a dietitian to implement it. A professional can ensure that a person gets all the nutrients they need.

Learn more about the low FODMAP diet.

In cases where SIBO is severe or not well-controlled, a person may have significant diarrhea or constipation. These symptoms can lead to complications, such as:

• nutritional deficiencies
• unintentional weight loss
• dehydration

These complications can affect many aspects of health, including a person’s energy levels, hormones, and mental health. Additionally, living with SIBO can be challenging, which may cause stress, anxiety, and low mood.

Learn more about chronic illness and depression.

It is not always possible to prevent SIBO, but people can take steps to look after their gut health. These include:

• Eating a nutritious and varied diet: Eating a wide variety of foods can help increase gut flora diversity, which may reduce the chances of dysbiosis. Fruits, vegetables, and whole grains are especially beneficial.
• Stopping smoking: Cigarettes and other products that contain nicotine can change the composition of a person’s gut flora. This may play a role in dysbiosis.
• Taking prokinetics: Prokinetics are a type of drug that speeds up digestive motility. They may reduce the risk of SIBO in people with an increased risk of developing it, such as those who have underlying conditions or take PPIs. A 2018 study found that people who took prokinetics and PPIs together were less likely to receive a SIBO diagnosis that those who took PPIs alone.
• Treating hypochlorhydria: If a person has low stomach acid, addressing this issue may reduce the risk of SIBO, although there is a need for more studies to confirm this link. How a doctor treats hypochlorhydria will depend on the cause.
• Managing other conditions: If a person has conditions that are associated with SIBO, such as hypothyroidism or diabetes, then effectively managing these conditions may reduce the impact they have on the digestive system.

Here are some answers to questions people often ask about SIBO.

What is SIBO poop like?

Stools may be watery, fatty, and foul-smelling. Fatty stools tend to float on water.

How do you fix SIBO?

Treatment is usually with antibiotics. Around 45% of people find SIBO returns after a full course of treatment. If this happens within 3 months, the doctor will prescribe a second course of antibiotics. If it returns at a later date, they may give antibiotics or they may look for other possible causes.

What are the symptoms of SIBO?

Symptoms typically include abdominal discomfort, bloating and flatulence, watery diarrhea, and fatty stools. Over time, weight loss and vitamin deficiencies can result.

What happens if you do not treat SIBO?

Complications of SIBO include weight loss and nutritional deficiencies. Eventually, it can lead to intestinal failure, where the gut no longer functions effectively.

Where is SIBO pain located?

SIBO causes pain in the abdomen.

SIBO occurs when bacteria from the large intestine migrate into the small intestine. It can cause symptoms such as bloating, diarrhea, and constipation. Doctors can diagnose SIBO by carrying out a lactulose breath test or a small bowel aspirate and culture test.

The treatment for SIBO usually involves taking one or more antibiotics to remove the overgrowth of bacteria. The effectiveness of other treatments, such as probiotics, is less clear. Newer options, such as FMT, are not fully understood and may carry risks.

People should speak with a gastroenterologist who knows about SIBO and related digestive disorders if they are experiencing persistent symptoms.

Symptoms, causes, treatment, and diet

Small intestinal bacterial overgrowth (SIBO) occurs when large numbers of bacteria colonize the small intestine. It can cause bloating, diarrhea, or constipation. Treatment options include antibiotics, fecal transplant, and dietary changes.

Bacteria are essential to the digestive system, in the form of the gut microbiome. This is mostly present in the large intestine, but the small intestine does not contain many bacteria.

Gastric secretions and the forward movement of food through the digestive system prevent too many bacteria from growing in the small intestine. However, if these functions do not work effectively, bacteria can multiply.

The small intestine is not able to handle high numbers of bacteria. When a person eats, these bacteria begin to ferment the food. In some people, this causes symptoms.

SIBO appears to be related to irritable bowel syndrome (IBS). People with IBS are more likely to have SIBO than the rest of the population. However, not everyone with an IBS diagnosis tests positive for SIBO.

In this article, we discuss the symptoms, risk factors, and complications of SIBO. We also look at the best diets to relieve the symptoms.

The symptoms of SIBO can vary from person to person, depending on how mild or severe the overgrowth of bacteria is and whether someone has any coexisting conditions.

However, the symptoms may include:

• bloating
• diarrhea
• constipation
• unexplained vitamin deficiencies, especially a vitamin B12 deficiency

The type of microbe that is overgrowing may also determine the symptoms. Research suggests that hydrogen-producing bacteria are more associated with diarrhea, while methane-producing species are more associated with constipation.

Doctors are not always sure what causes SIBO. So far, researchers have identified the following factors that may contribute to SIBO:

• Low motility: Usually, the intestines push food and bacteria through the digestive tract, which prevents too much bacteria from accumulating in the small intestine. However, if someone has low motility, this mechanism slows down, allowing food to ferment in the small intestine.
• Dysbiosis: Dysbiosis is when a person’s microbiome becomes imbalanced, containing too many harmful species of microbes or not enough beneficial species. Research into how different species of microorganisms influence digestion is still ongoing, but previous studies suggest that people with IBS often have less diversity, fewer beneficial species, and higher amounts of methane-producing species in their microbiome, which can slow motility.
• Hypochlorhydria: This term describes low levels of stomach acid. When someone does not have sufficient stomach acid, it may be possible for bacteria to migrate further up the digestive tract than usual, as the environment is not acidic enough to kill them. Researchers believe that people who take proton pump inhibitors (PPIs), have autoimmune gastritis, or have undergone a gastrectomy have an increased risk of hypochlorhydria and SIBO. However, there is a lack of conclusive evidence on this, and low motility may be a more important risk factor.
• Structural differences: Sometimes, SIBO occurs because a person has structural differences in the digestive tract. Examples include small bowel diverticulosis, fistulas, and a shortened colon. According to a 2018 study, people who have undergone a colectomy are more at risk of developing SIBO.
• Alcohol abuse: Excessive alcohol consumption can damage the microbiome, leading to dysbiosis, damage to the intestinal walls, and inflammation.

People with certain underlying conditions are more likely than other people to get SIBO. These people include those with:

• hypothyroidism
• diabetes
• Parkinson’s disease
• short bowel syndrome
• amyloidosis
• systemic sclerosis
• chronic kidney failure

SIBO is also more common in older adults, possibly due to slower digestive motility. There is a higher prevalence among females, too, but the reasons for this are unclear.

A small 2017 study found that people with obesity were 11 times more likely to have SIBO than those without obesity. It is unclear why this was the case, as the risk was higher in participants who had healthy digestive motility and pH levels. More research is necessary to understand the link.

A doctor will diagnose SIBO by asking about a person’s symptoms and medical history. They may feel the abdomen for signs of excess gas or bloating. If they suspect SIBO, they will recommend testing.

Breath testing

A lactulose breath test measures the concentration of hydrogen and methane in a person’s breath. The results of this test can confirm a SIBO diagnosis and reveal the extent of the overgrowth. They also show whether the overgrowth consists mainly of hydrogen- or methane-producing microbes.

A person has to fast for 24 hours before the test. They then drink a sugary solution containing lactulose, which is a sugar that only gut bacteria can break down.

When bacteria break the sugar down, they produce gases, which enter the bloodstream and travel to the lungs. A breath test measures these gases as a person exhales.

Glucose vs. lactulose breath testing

Some doctors perform glucose breath testing instead of lactulose breath testing. Some scientists have criticized this method, as the body can absorb glucose quickly, which means that it might not reach the area of overgrowth.

However, others argue that this rapid absorption can be an advantage, as it makes it less likely that the sugar will reach the colon, where it would generate a false positive result by feeding a large number of bacteria there.

Small bowel aspirate and culture

This is the gold standard for SIBO testing, but it is a more invasive test. Small bowel aspirate tests involve a doctor performing an endoscopy, which means inserting a small, thin camera through the mouth and down into the stomach.

When the device reaches the duodenum, which is where the stomach joins up with the small intestine, doctors use the endoscope to take a tissue sample. They then send the sample to a laboratory, which analyzes the bacteria present.

It is worth noting that with small bowel aspirate testing, as well as breath testing, there is no universally accepted threshold for what constitutes a positive SIBO result. This makes diagnosis more difficult for those who have less conclusive test results.

Other tests

The existing tests for SIBO are not always precise, so a doctor may recommend other tests to get a better picture of someone’s digestive health. These could include:

• blood tests to detect markers of autoimmunity or inflammation
• a mobility test to determine whether someone has any structural problems in the small intestine
• an intestinal permeability test, which assesses whether the intestinal lining is “leaky“
• stool tests to analyze the gut microbiome

As SIBO can occur for complex reasons, it can be difficult to treat. Various treatment options are available, including antibiotics, fecal microbiota transplants, and dietary changes.

Antibiotics

This is the main treatment for SIBO. Doctors may use one type of antibiotic or a combination to remove the overgrowth.

A popular option is rifaximin (Xifaxan). Previous studies suggest that this antibiotic works best for people with hydrogen-dominant overgrowths. Neomycin, or a combination of rifaximin and neomycin, may be better for those with methane-dominant SIBO. However, research into the best ways of treating SIBO is still ongoing.

Recurrence rates after SIBO treatment are relatively high. For this reason, alongside taking antibiotics, it is essential to address the underlying cause of the SIBO to reduce the risk of the overgrowth coming back.

Depending on the root cause, this may mean taking medications to speed up motility, stopping PPI treatment, or treating other conditions that might be contributing.

Probiotics and fecal microbiota transplants

The role of probiotics in SIBO treatment is controversial. While some studies have shown that specific species can improve motility and reduce hydrogen in the breath, others have shown that probiotics may cause SIBO.

If a person has low motility and takes probiotics, it is possible that they may make an overgrowth more likely or worsen an existing one. The results can vary from person to person.

A fecal microbiota transplant (FMT) is a fairly new treatment that involves a doctor transplanting a donor’s gut flora into a patient via the rectum. Again, research has produced mixed results on using this procedure as a treatment for SIBO. Some case studies have noted that FMT seems to cause SIBO. Currently, the Food and Drug Administration (FDA) has not approved this treatment.

Diets cannot cure SIBO, but they can lessen the symptoms. What works can vary from person to person, but a popular option is the low FODMAP diet.

The low FODMAP diet limits the intake of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are substances that the human body does not break down, which means that bacteria can feed on them. Limiting high FODMAP foods may reduce gas, bloating, constipation, and diarrhea.

Both the type and amount of foods a person eats are important in the low FODMAP diet. As it is fairly complex and can involve major dietary changes, it is best to work with a dietitian to implement it. A professional can ensure that a person gets all the nutrients they need.

Learn more about the low FODMAP diet.

In cases where SIBO is severe or not well-controlled, a person may have significant diarrhea or constipation. These symptoms can lead to complications, such as:

• nutritional deficiencies
• unintentional weight loss
• dehydration

These complications can affect many aspects of health, including a person’s energy levels, hormones, and mental health. Additionally, living with SIBO can be challenging, which may cause stress, anxiety, and low mood.

Learn more about chronic illness and depression.

It is not always possible to prevent SIBO, but people can take steps to look after their gut health. These include:

• Eating a nutritious and varied diet: Eating a wide variety of foods can help increase gut flora diversity, which may reduce the chances of dysbiosis. Fruits, vegetables, and whole grains are especially beneficial.
• Stopping smoking: Cigarettes and other products that contain nicotine can change the composition of a person’s gut flora. This may play a role in dysbiosis.
• Taking prokinetics: Prokinetics are a type of drug that speeds up digestive motility. They may reduce the risk of SIBO in people with an increased risk of developing it, such as those who have underlying conditions or take PPIs. A 2018 study found that people who took prokinetics and PPIs together were less likely to receive a SIBO diagnosis that those who took PPIs alone.
• Treating hypochlorhydria: If a person has low stomach acid, addressing this issue may reduce the risk of SIBO, although there is a need for more studies to confirm this link. How a doctor treats hypochlorhydria will depend on the cause.
• Managing other conditions: If a person has conditions that are associated with SIBO, such as hypothyroidism or diabetes, then effectively managing these conditions may reduce the impact they have on the digestive system.

Here are some answers to questions people often ask about SIBO.

What is SIBO poop like?

Stools may be watery, fatty, and foul-smelling. Fatty stools tend to float on water.

How do you fix SIBO?

Treatment is usually with antibiotics. Around 45% of people find SIBO returns after a full course of treatment. If this happens within 3 months, the doctor will prescribe a second course of antibiotics. If it returns at a later date, they may give antibiotics or they may look for other possible causes.

What are the symptoms of SIBO?

Symptoms typically include abdominal discomfort, bloating and flatulence, watery diarrhea, and fatty stools. Over time, weight loss and vitamin deficiencies can result.

What happens if you do not treat SIBO?

Complications of SIBO include weight loss and nutritional deficiencies. Eventually, it can lead to intestinal failure, where the gut no longer functions effectively.

Where is SIBO pain located?

SIBO causes pain in the abdomen.

SIBO occurs when bacteria from the large intestine migrate into the small intestine. It can cause symptoms such as bloating, diarrhea, and constipation. Doctors can diagnose SIBO by carrying out a lactulose breath test or a small bowel aspirate and culture test.

The treatment for SIBO usually involves taking one or more antibiotics to remove the overgrowth of bacteria. The effectiveness of other treatments, such as probiotics, is less clear. Newer options, such as FMT, are not fully understood and may carry risks.

People should speak with a gastroenterologist who knows about SIBO and related digestive disorders if they are experiencing persistent symptoms.

Causes of flatulence: facts and myths

September 10, 2020
12:34

Flatulence is one of the most common symptoms of indigestion. On the air of the Russia 1 channel, the hosts of the About the Most Important program, Mikhail Politseymako and Sergey Agapkin, together with gastroenterologist Sergey Vyalov, analyzed several popular facts about flatulence and decided which of them are really trustworthy and which are not.

Flatulence is one of the most common symptoms of indigestion. On the air of the Russia 1 channel, the hosts of the About the Most Important program, Mikhail Politseymako and Sergey Agapkin, together with gastroenterologist Sergey Vyalov, analyzed several popular facts about flatulence and decided which of them are really trustworthy and which are not.

Normally, a person releases gases about 14 times a day. “If flatulence, for example, every hour, then this, of course, is too much. If flatulence inflates the stomach so much that it increases in size, this is also an alarm. Even if flatulence is accompanied not only by a feeling of puffiness, but also by bursting from the inside out, as if the stomach wants to explode, this is also an alarming symptom,” explained gastroenterologist, hepatologist Sergei Sergeevich Vyalov.

Causes of flatulence

Wrong diet. Most gaseous substances are found in the intestines. The lack of vegetables, fruits and fiber-rich plant foods in the diet leads to a violation of the stool. Try to eat at least 500 g of fruit per day!

Entry of excess air into the gastrointestinal tract when eating. Stress and anxiety speed up intestinal motility! Chew food thoroughly, drink slowly, try not to talk while eating! If you are prone to increased gas formation, drink water at least half an hour before meals!

Inflammatory bowel disease. Ulcerative colitis or Crohn’s disease is a serious bowel disease. If, when eating more fiber, gas formation increases, then we can talk about the presence of mild inflammation or irritation in the intestines.

Helicobacter pylori. The waste products of this bacterium cause inflammation and damage to the gastric mucosa. The mucous barrier and the production of hydrochloric acid are disrupted, which leads to disruption of the acid-producing cells. Bacteria in the small intestine begin to multiply actively, gas formation occurs, which leads to constant bloating. Get tested for Helicobacter pylori!

Facts and myths

Raw vegetables and bran lead to flatulence. Raw vegetables are slightly more gassy and bloated than cooked vegetables.

Taking antibiotics or other drugs. Some antibiotics also kill germs in the intestines, leading to bloating and gas. However, for example, the drug amoxicillin in combination with clavulanic acid causes asthmatic diarrhea, but does not affect the microflora.

Flatulence and dysbacteriosis are synonyms. Dysbacteriosis in the vast majority of cases is accompanied by flatulence. An imbalance in the composition of the intestinal microflora can cause ulcerative colitis.

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Dysbacteriosis is a civil war of the internal intestinal microflora / Health / Nezavisimaya Gazeta

A characteristic symptom of dysbacteriosis – bloating. Photo by Depositphotos/PhotoXPress. ru

The term “dysbacteriosis” is on hearing today. There is a misconception that this is an independent disease. However, in the new international classification of diseases, intestinal dysbacteriosis does not appear. It is not used as a medical diagnosis in our country either. That is, intestinal dysbacteriosis is not an independent disease. It refers to a syndrome (a set of symptoms) caused, for example, by poor nutrition or various ailments associated with a disorder in the normal functioning of the intestine. In this case, a quantitative and qualitative violation of the microflora living in it often occurs. By the way, the mass of all microorganisms living in the intestines of one person (and there are about 500 species of them) can be more than 2 kg.

Among the microorganisms included in the normal microflora, there are both beneficial and harmful bacteria. The first include, for example, bifidobacteria and lactobacilli, the second – staphylococci and streptococci. Beneficial microorganisms are always part of the normal microflora, they are also called mandatory. They participate in the digestion process, promote the absorption of vitamins, regulate water-salt metabolism, stimulate the immune system, have anti-allergic effects, and help to remove various toxins from the body. In a word, their value is difficult to overestimate.

As for harmful (pathogenic) bacteria, they are considered optional and non-permanent representatives of the normal microflora. Harmful bacteria enter the intestines, for example, with insufficiently thermally processed food. It is noteworthy that for the time being these microorganisms peacefully coexist with beneficial bacteria without causing problems in a healthy person.

However, this equilibrium is unstable. As soon as it is disturbed under the influence of any negative factor, pathogenic microorganisms begin to actively multiply, causing a breakdown in the normal intestinal microflora and contributing to the occurrence of dysbacteriosis.

A common reason for its appearance is poor nutrition, for example, the predominance of proteins and fats of animal origin in the diet and the lack of fresh vegetables, fruits, and dairy products. Another reason is the prolonged and uncontrolled use of antibacterial and some other drugs and, as a result, weakening of the immune system. And this, in turn, leads to the development of dysbacteriosis. Reproduction of pathogenic flora also occurs in various gastrointestinal diseases, infections and a number of other ailments.

One of the signs of a violation of the microflora is a violation of the stool, due to the increased formation of bile acids and increased intestinal motility. In other cases (more often in older people), dysbacteriosis, on the contrary, is manifested by constipation. Another characteristic symptom is bloating, caused by increased formation of gases in the colon. In addition, with dysbacteriosis, appetite decreases, there are nausea, belching. The patient also has a metabolic disorder, sleep disturbance, fatigue, dry skin.

Now about the treatment. Drug therapy is aimed at eliminating the cause that caused the disease, and restoring the normal intestinal microflora. For this purpose, drugs are used that stimulate the reproduction of beneficial bacteria, as well as containing living microorganisms (lactobacilli and bifidobacteria). To destroy pathogenic microorganisms, antibacterial drugs are prescribed, and with a pronounced violation of the digestive process, enzymes. Phytotherapeutic recommendations are also actively used.

Diet plays an important role in restoring normal microflora. Spicy and fatty foods, smoked meats, foods that enhance fermentation processes in the intestines – sweets, sauerkraut, carbonated drinks should be excluded from the diet. You should also not eat legumes (beans, peas), fresh bread, alcohol. The menu may include dishes from lean meat (boiled or stewed), cereals (rice, buckwheat, oatmeal), herbs (parsley, dill) and lactic acid products (kefir, yogurt).