SIBO is the New IBS – Small Intestinal Bacterial Overgrowth

SIBO stands for Small Intestinal Bacterial Overgrowth. It is a topic of tremendous interest in the gastrointestinal health sphere, and could be a factor or a cause of many of the conditions that were previously labeled as IBS.

We have trillions of bacteria living throughout our intestinal tract, most of which are concentrated in the large intestine (aka colon). However, risk factors such as low stomach acid, stress, grazing throughout the day, infections, and motility disorders allow these bacteria to migrate up into the small intestine, which is not designed to house these bacteria. Within the small intestine, foods are in the process of being broken down and absorbed. Because bacteria eat the same food we do, they thrive in this environment. As they consume food, they produce gas — producing symptoms of gas, bloating, and belching within an hour after eating. Furthermore, this buildup of gas can lead to either constipation or diarrhea. In serious cases, it can lead to nutritional deficiencies, sleep disturbance, and other symptoms.

What do we now know about SIBO?

SIBO is confirmed with breath testing by seeing increased hydrogen or methane gas after the patient is given a sugar solution. IBS-D (diarrhea) tends to correlate with hydrogen producers, while IBS-C (constipation) tends to correlate with methane producers. New research is suggesting the following:

  1. It is believed that a large portion of hydrogen-producing SIBO may be triggered by a foodborne illness, with subsequent autoimmune attack on the neurons within the intestines. This attack leads to motility disturbance of the intestinal tract, allowing bacteria to start accumulating in the small intestine.
  2. Hydrogen producers tend to respond well to Xifaxin (the typical antibiotic given for SIBO), but will relapse if the underlying motility issue is not corrected. In some cases, Xifaxin is not enough to “kill” the bacteria and additional antibiotics or herbals need to be used concurrently.
  3. Prokinetics (aka motility agents) should be considered with every SIBO protocol.
  4. Methane producing SIBO tends to need a comprehensive approach, utilizing more than one antimicrobial to kill the methane producing bacteria.
  5. Lovastatin (a cholesterol medication) has been found to inhibit the production of methane, thus acting as a very helpful therapeutic in methane based SIBO, commonly characterized as IBS-C. There is a new drug that is currently being studied that removes the cholesterol lowering effects, and simply works on inhibiting methane production.

If you have gastrointestinal symptoms that are confusing you or interfering with your quality of life, contact us for an evaluation.


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