SIBO (small intestinal overgrowth of bacterial) is a relapsing, permanent condition that could be affecting up to 10 percent of the population. The most characteristic feature that characterizes SIBO is when the small intestine is colonized by normal gut flora. The small intestine usually completely free of any colonisation by bacterial species but any changes to the environment inside the small bowel may cause an overgrowth of bacteria that can manifest in a variety of symptoms that are a hallmark of SIBO.
Signs and symptoms
When a patient is diagnosed with SIBO they might be afflicted with a variety of symptoms that include bloating, gas, abdominal discomfort, diarrhoea and fatigue among many other. Since the beginning, patients with SIBO signs have been identified and labeled with IBS. This is mainly due to the fact that there isn’t any international consensus and understanding of the nature of the disease and the best method of diagnosing it, but also an absence of solid evidence on the best treatment for these patients.
The small intestine does not usually colonised by bacteria. In SIBO the bacteria that are normally found in the large bowel begin to develop within the bowel of the small. They feed on small molecule sugars and fermentable carbohydrates that we consume. The resulting gas production in SIBO may cause problems with digestion, absorption and absorption of food, and can damage the membranes that line the intestinal lining which can cause symptoms.
Risk Factors
A variety of risks have been listed as a risk factor for SIBO. In addition, it may occur in normal people, however certain individuals may be suffering from anatomical issues, such as prior small bowel surgery and gastric bypass. A number of medications reduce the ability of the gut to move like narcotic painkillers and anti-diarrhoeal medications. These may cause the growth of bacteria. Some patients who use acid-suppressing medications like proton pump inhibitors that decrease amounts of acids that goes through the small bowel may be affected by bacterial overgrowth however this is not confirmed. People with connective tissue diseases such as Ehlers Danlos syndrome, fibromyalgia or rheumatoid arthritis could be more susceptible to suffering from chronic symptoms of small intestine overgrowth of bacterial.
Diagnosis
The identification of bacterial overgrowth is a matter of contention, with various methods being suggested. There is no universally-acceptable gold standard test for SIBO and the use of the lactulose breath test has become extremely common over the past few years. The goal of the test is to try to replicate the environment inside the small bowel which would take place on a regular basis in patients suffering from small intestinal bacterial overgrowth. The test will monitor the amount of gas that result from the bowel’s small intestine to determine whether there’s SIBO. The measurement of methane and hydrogen carbon dioxide in samples of breath is among the least expensive test, non-invasive and likely the most commonly used test to diagnose an overgrowth of bacterial cells in the United Kingdom. The gasses in the human breath are a reflection of the metabolic process of fermentable carbohydrates found in the bowel’s small. It’s not completely evident how important it is to take tests on breath after treatment.
SIBO Treatment
Treatment for SIBO is a combination of three strategies. First, it is to trigger an end-of-life of SIBO and secondly, ensure that remission is maintained and stop SIBO becoming recurrent, and thirdly and possibly more important is to alter or treat the root cause or factors that lead to the growth of SIBO.
The treatment for bacterial overgrowth Although it’s controversial, the treatment is still mostly focused on reducing the number and growth of bacteria within the bowel. In this regard, antibiotics remain the most effective treatment currently. The selection, dosage and duration of the treatment is not yet completely understood since there aren’t many studies of a high standard that provide guidance to clinicians in the selection of an antibiotic. In the near future we will see more attention paid to more specific treatments targeted at specific components of a person’s microbiome. They aren’t yet available. We typically provide Rifaximin which is among the most researched antibiotics used in patients suffering from any type of functional bowel diseases. Studies have shown that it is reliable and safe for treating SIBO. It is especially effective in those suffering from hydrogen over production and diarrhoea, bloating and indigestion symptoms. The issue with it in the United Kingdom is that it is approved only for use in patients suffering from diarrhoea in travelers, but it is also used for those suffering from liver diseases so its usage in small intestinal bacterial overgrowths is usually difficult, since many clinics or hospitals do not prescribe it, and patients are often required to pay for a two-week duration of antibiotics. ALternatives include doxycycline that is a lot less expensive but is not as scientifically backed for its usage.
M-SIBO – Production of Methane
It should also be noted that when we perform breath tests to detect SIBO we also test at methane production. There is evidence presented in Digestive Disease Weekly in Chicago 2017 that shows methane overproduction can result in the slowness of transit and motility in the gut. These patients typically do not respond to Rifaximin on its own and require an additional antibiotic. Neomycin is a non-toxic antibiotic that is used in a variety of other diseases and has been demonstrated to reduce methane production in patients. Pro-kinetics are a method of enhancing the efficacy of this group of patients, like a lower dose of a medication known as prucalopride may enhance the effectiveness of the antibiotics, which can increase the gut’s motility and increase the effectiveness in the therapy.
Herbal Antibiotics
In certain patients, there is the option of using herbal antibiotics.
Maintenance
Remission maintenance is extremely crucial since SIBO is a chronic illness that can recur for a number of patients. In some studies, as much as 1/3 of patients may experience an incidence of small-intestinal overgrowth of bacteria. Observation is required for patients following the induction of remission SIBO to check that if symptoms are persistent, that treatment is commenced early. A lot of practices employ the following strategies to stop SIBO from returning. One important aspect that patients must consider is eating habits. The restriction of fermentable carbohydrates and the use of an eating plan such as one that is low FODMAP diet will make sure that the ambiance is exposed to less fermentable foods, and will create an environment that is less favorable for any remaining bacteria to grow. Research has shown that in a few patients, an eat low FODMAP diet can lead to an improvement in patients suffering from overgrowth of bacterial. Additionally, the mobility and movement in the small bowel has to be improved by using prokinetics. Prokinetics can help to boost your MMC (migrating motor complex) of the small intestine in order to stop the recurrence of infections and recolonization. I always suggest to patients that when they’ve completed their first course of antibiotic therapy, we may look into prokinetics. They fall into natural options like iberogast drops, which can be taken in the evening or pharmacological treatments like an infrequent dosage of Resolor (prucalopride) in the evening. I also suggest patients investigate the possibility of using digestive and pancreatic enzymes while seeking to optimize the bowel’s environment following treatment to avoid SIBO from recurring.
Diabetic Control for SIBO
In a few patients where the above strategies haven’t resulted in success, it is possible to consider more thorough dietetic exclusion, like eating the essential diet. It is important to note that this option is only available for those suffering from resistant symptoms, despite at least three to four treatments of antibiotics or failing to make a test of an extremely diet that is low in FODMAP diet. In simplest terms, the term “elemental” diet refers to a type of diet consisting of a liquid that is made up of digested carbohydrates, proteins, and fats. It’s been used for a long time for treating diseases like Crohn’s disease. The reason for the elemental diet is that the above ingredients are taken in very fast through the digestive system. This helps patients suffering from bacteria overgrowth because it is not a good idea to have food items to remain in the intestines of the small intestine, in order to generate gas for the unwelcome growth of bacteria. A diet that is elemental provides the ability to provide nutrition to the patient while reducing the bacterial. Implementing the diet for elemental health is usually performed under the supervision by one of our experienced dieticians. Patients take a drink instead of their usual meals for 2 to 3 weeks based on the nature of their symptoms as well as their medical history. It should be noted that there aren’t any high-quality research regarding the effectiveness of the elemental diet, but there are a few studies that have proven that in certain patients following fourteen days on the diet, there’s an 80 percent response to a positive breath tests following treatment. There are obviously some drawbacks to this. The most significant one is the issue of the degree of compliance. It can be extremely difficult to limit consumption of fluids for two weeks.
Probiotics
There has been an increase in concern about the importance of prebiotics and probiotics in the past 10 years and I frequently get inquired by patients if they play a part in treating bacteria overgrowth. The exact function of probiotics in the treatment of SIBO is not clear and requires to be established. It is evident that replacing harmful bacteria with beneficial bacteria, in a sense, will have positive effects on patients. However, I would suggest caution with the use of probiotics following treatment for an overgrowth of bacterial, as it may for some patients cause things to become little bit worse in the short-term.
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