Small Intestinal Bacterial Overgrowth

What is Small Intestinal Bacterial Overgrowth?

Small intestinal bacterial overgrowth (SIBO) is a gastrointestinal disorder that occurs when there is a disruption in the small intestinal flora that results in excess bacteria. SIBO can also occur as a result of underlying medical conditions of the gut such as Inflammatory Bowel Disorders, Celiac Disease and Intestinal Motility Disorders. Excessive use of medications, in particular antibiotics- which can destroy both ‘good’ and ‘bad’ bacteria, is a recognised trigger for the condition too. Similarly, poor dietary habits and stress can predispose individuals to develop gut floral imbalance and SIBO.

Diagnosis for Small Intestinal Bacterial Overgrowth:

Symptoms include:

• Bloating
• Excessive flatulence
• Abdominal distention,
• Constipation
• Indigestion
• Diarrhea
• Weight loss

These symptoms are nonspecific and are found in numerous other gastrointestinal disorders, indeed those with SIBO can be mistaken for having Irritable Bowel Syndrome (IBS). A physician may perform the following tests to establish a diagnosis:

• Breath Test: Measuring quantities of metabolised gases from the gut (hydrogen and methane)
• Small Intestine Aspirate and Fluid Culture: This is when a small intestinal aspirate is obtained and sent for culture and analysis. This test provides a detailed insight into the pathology of the bacteria in the small intestine. However, the procedure involves performing an endoscopy to directly access the gut, and due to its invasive nature, the breath test is often preferred.
• Blood tests: These can be used to assist in identifying other possible pathologies such as coeliacs disease, and also to determine the presence of deficiencies in vitamins and iron which often coexist with SIBO.
• Stool Evaluation: Comprehensive stool evaluation can look at the functionality of the gut microbiome from several different perspectives, including gut microbiome balance, metabolic processes and digestive processes.
• Imaging: Specialists can consider the use of imaging to establish anatomical abnormalities, though this would be after other investigations and treatment trials have been exhausted.

Treatments for Small Intestinal Bacterial Overgrowth

Treatments for small intestinal bacterial typically include:

• Antibiotics: Usually prescribed for 1-2 weeks. In some patients, antibiotics may be required for a prolonged period of time. Gut analysis can help generate a microbiome profile and guide which antibiotics are best to use.
• Nutrition: Nutrition plays a key role in the management of SIBO, as with any other gut disorder.
• Supplements: The co-existence of iron, calcium, and vitamin B-12 deficiencies are common. Subsequently, it is recommended to take supplements to replenish these.
• Probiotics and Prebiotics: These are agents that help fortify the gut microbiome. Natural sources include yogurt, kefir, sauerkraut, and many others. A physician may recommend specific products are taken to ensure these are adequately consumed.
• Surgery: It is extremely uncommon for this to be considered, though if there is an anatomical aetiology driving the issue then this can be considered by the specialists.

If you are experiencing any gastrointestinal symptoms, please see your doctor for a review, and consider speaking to them about SIBO. At ROC we have access to the necessary tools to assist in the diagnosis of SIBO, as well as a myriad of other gastrointestinal disorders in the form of detailed gut analysis with stool evaluation and breath testing. We also have the expertise to help evaluate and manage your issues as appropriate. Should you wish to see us we would be delighted to help you, please get in touch.