Do I have Small Intestinal Bacteria Overgrowth (SIBO)?
Small Intestinal Bacterial Overgrowth (SIBO) is an increasingly recognized condition that can significantly impact your digestive health. It can lead to a range of uncomfortable and debilitating symptoms and may be more common in some groups than others. In this post, we will explore what SIBO is, symptoms, causes, triggers, risk factors, diagnosis, complications, and treatment options.
What is Small Intestinal Bacteria Overgrowth (SIBO)?
Small Intestinal Bacteria Overgrowth, or SIBO, is caused by excessive bacteria accumulated in the small intestine. SIBO occurs when the normal mechanisms that regulate the population of bacteria in the intestines are disrupted. The two main factors that often lead to bacterial overgrowth are reduced stomach acid production and problems with the movement of the small intestine. Issues with the immune function of the gut and structural abnormalities in the gastrointestinal tract can also raise the risk of developing SIBO.
At first, this disease was thought to only occur in a small number of people. This usually included people with an anatomic abnormality of the upper gastrointestinal (GI) tract or those with a motility disorder. However, it has now been discovered to be more common than initially thought. As more improved readily available diagnostic tests have surfaced, these diagnoses have increased.
Signs and Symptoms of SIBO
Those suffering from SIBO may show many signs, or just a few. Some of the symptoms include:
Diarrhea
Weight loss
Malabsorption
Abdominal distension
Fatigue
Weakness
Nutritional deficiencies
Appetite loss
Naseua
Uncomfortable feeling of fullness after eating
What Causes of SIBO?
The true extent of small intestinal bacterial overgrowth is largely unknown. Irritable bowel syndrome, intestinal motility disorders, and chronic pancreatitis are the primary reasons for SIBO and make up 80-90% of cases. SIBO is more common among women and older individuals. The occurrence of SIBO rises with age due to reduced stomach acid and intestinal movement.
SIBO Triggers
SIBO can be triggered by a number of causes.
Post-Abdominal Surgery Complications
One of the most common triggers for this bacteria growth is abdominal surgery complications. This can include gastric bypass for obesity or gastrectomy to treat peptic ulcers and stomach cancer.
Structural Issues in the Small Intestine
Another common cause for this bacteria growth is structural problems in and around the small intestine. Structural problems include scar tissue or intestinal adhesions that may wrap their way around the outside of the small bowel. It may also include bulging tissue pouches that protrude through the small intestine wall, otherwise known as intestinal diverticulosis.
Underlying Medical Conditions
One other common cause for SIBO bacteria growth is certain medical conditions. These medical conditions include Crohn's disease, radiation enteritis, scleroderma, celiac disease, diabetes, or other conditions that can slow the movement of food and waste products through the small intestine.
Overuse of Medication
Antibiotics and narcotics can disrupt the natural balance of bacteria in your stomach and may cause a slowdown in digestion. These include drugs like codeine, fentanyl, and oxycodone.
Slow Digestive Flow
When your small intestine doesn't push food through fast enough, bacteria can overgrow and linger, leading to SIBO. This may be due to nerve and muscle issues, often following a sickness, trauma, or operation. It can also occur with low thyroid hormone levels.
Low Stomach Acid
Insufficient stomach acid can result in poor control of bacterial growth in the body. This can also cause SIBO. Taking medications like antacids and proton pump inhibitors, which are commonly used for heartburn, can contribute to low stomach acid. Infections like H. pylori — a leading cause of stomach ulcers — can also decrease acid levels. Additionally, gastric bypass surgery for weight loss can lead to reduced stomach acid.
Increased Risk Factors for SIBO
Some conditions and events increase the risk of developing SIBO. Conditions that increase this risk are:
Structural defect or injury small intestine
Abnormal passageway between two segments of the bowel
Crohn's disease
Intestinal lymphoma involving the small intestine
Diabetes
HIV
Systematic Sclerosis
Parkinson’s disease
Hypothyroidism
Diverticulosis of the small intestine
Gastric surgery for obesity or ulcers, a history of radiation therapy to the abdomen, or adhesions caused by previous abdominal surgery, can also increase the risk of developing SIBO.
How Does SIBO Get Diagnosed?
If a patient feels like they may be showing signs of SIBO, there is a variety of tests a doctor may have them take to diagnose them. After accessing the patient's symptoms and medical history, some exams they may follow up with include:
The first way doctors test for SIBO is usually through physical examination. This can include palpating or gently feeling the abdomen, as well as ordering blood, fecal, or other testing.
A second common test for SIBO is a breath test. This is because the excess bacteria in the small intestine can cause hydrogen and methane gas release, which can be picked up in a breath test. These tests can be performed at the doctor's office or at home. However, they do require an overnight fast ahead of time. For the test, patients simply breathe into a tube and drink a sweet liquid provided by the doctor before breathing into a series of additional tubes at 2 to 3-hour intervals after consuming the drink.
Doctors may perform one other test for inconclusive breath tests and SIBO treatment. This test involves taking a fluid sample from the small bowel to identify the bacteria growing there.
What Complications Can Come From SIBO?
In addition to the side effects of SIBO itself, leaving the condition untreated can lead to other complications. Some of these complications include:
Poor Absorption
SIBO can cause reduced absorption of fats, carbohydrates, and proteins. This is because the bile salts needed to digest fats are getting broken down by the excess bacteria in your small intestine. This causes incomplete digestion of fats and diarrhea. The bacteria can also harm the mucous lining, or “mucosa,” of the small intestine. This decreases the ability to absorb carbohydrates and proteins.
The bacteria caused by SIBO can also compete for available food. The bacterial breakdown causes compounds to be produced from the stagnant food. This may also trigger diarrhea. When all of these effects of SIBO-related bacterial growth are put together, they lead to diarrhea, malnutrition, and weight loss.
Kidney Stones
SIBO leads to inefficient calcium absorption. When the body does not absorb enough calcium, it can lead to the formation of kidney stones.
Osteoporosis
The lack of calcium absorption also has an impact on the bones in the body. This can lead to weakened bones over time from the usual bacteria growth. Eventually these weakened bones can turn to bone disease, such as osteoporosis.
Vitamin Deficiency
Due to the incomplete absorption of fats, your body is unable to fully absorb vitamins A, D, E, and K, which are soluble in fat. Vitamin B-12 is synthesized and utilized by bacteria in the small intestine, and it is crucial for the proper functioning of your nervous system, as well as the production of blood cells and DNA.
If there is an overgrowth of bacteria, it can cause a deficiency in B-12, leading to symptoms such as weakness, fatigue, tingling, and numbness in the hands and feet. In severe cases, it can even result in mental confusion. Sometimes that damage to the central nervous system caused by B-12 deficiency can be permanent.
How is SIBO Treated?
SIBO can be treated in a number of ways. One of the most common ways is by antibiotics. These antibiotics help get the bacteria in the small intestine under control. Some commonly prescribed antibiotics for this include ciprofloxacin (Cipro), metronidazole (Flagyl), and rifaximin (Xifaxan).
Patients may also experience dehydration or malabsorption and require fluids, vitamins, or mineral replacements. While these antibiotics do help eliminate the bacteria caused by SIBO, they do not address the initial trigger for it. If the SIBO is caused by an underlying condition, specific treatment for that condition may also be needed.
SIBO and Diet
Diet is also important for treating SIBO. While no link has been found between certain diets causing SIBO, a link has been found between certain diets and offering relief from SIBO. Some beneficial diet changes for SIBO include maintaining a balanced and nutritious diet, eating more frequent and smaller meals as opposed to larger and less frequent meals, and avoiding gluten products for those with celiac disease.
Some patients may talk with their doctor about starting an “elemental diet,” which involves replacing food and drinks with liquid formulas for a set amount of time.
Alternative SIBO Treatment
One other way some patients deal with SIBO is with probiotics. Some studies have found that taking probiotics can help the gut return to normal, and it may be a more effective treatment method than antibiotics for some patients.
Conclusion
More data on SIBO and how to effectively treat it continues to surface. Understanding SIBO for effectively managing its symptoms and preventing complications. By identifying the signs, receiving a diagnosis early on, and considering all of the available treatment options, patients can significantly enhance their quality of life.
Whether it involves taking antibiotics, modifying your diet, or exploring alternative options like probiotics, addressing SIBOthere are many options for managing SIBO. If you suspect you may have SIBO, it is best to seek guidance from a healthcare professional as soon as possible to find a successful management strategy and improve your digestive well-being.
