Small Intestinal Bacterial Overgrowth. What is it? How do you diagnose it? and how do you treat it?

On Saturday the 8^th of November I attended the SIBO summit in Melbourne. The event was showcased by key experts in the field including: Dr Alison Siebecker, Dr Nirala Jacobi, Dr Jason Hawrelack and many more.

It was an extremely informative day in which I learnt a great deal about the causes, diagnosis and treatment of SIBO.

For those of you who don’t know SIBO stands for Small Intestinal Bacterial Overgrowth which as the name suggests is when there is an overgrowth of bacteria occurring in the small intestine. This bacterial accumulation is not pathogenic bacteria but normal flora which has moved up from the large intestine for whatever reason. Typically, the small intestine has a small colonisation of flora as this flora can compete for the host’s food and cause issues of indigestion and malabsorption which is the case in SIBO.

The main symptoms associated with SIBO can be very similar to that of Irritable Bowel Syndrome (IBS) including: bloating, flatulence, pain, diarrhoea, constipation, fatigue and reflux. Some other key signs can be low body weight, the presence of steattorhea (oily, smelly, floating stool) as well as deficiencies in Iron, B12 and Ferritin.

SIBO has also found to be the underlying cause of the majority of suffers of IBS. When treated for SIBO many IBS patients have experienced alleviation of symptoms.

The main underlying causes of SIBO are due to issues with the Migrating Motor Complex (MMC) or structural issues but risk factors such as food poisoning can also play a large role in its development. The MMC helps to facilitate transport of matter through the digestive system. This movement known as peristaltic movement also help to transport bacteria from the small intestine to the large intestine, and to inhibit the migration of colonic bacteria back up into the small intestine. The MMC occurs ever 90-120 minutes between meals and is ‘turned off’ when we start to eat again. Therefore, any issues with the MMC can lead to bacteria not being flushed out properly or bacteria migrating back up into the small intestine.

Diagnosis
The primary method of diagnosing SIBO is via a lactulose and glucose breath test.  If a large amount of gas (Hydrogen and Methane) is produced in the first two hours or so this will indicate that SIBO is present as fermentation should not be occurring this early on in the gastrointestinal tract.  For more information on breath testing visit a previous blog post of mine.

Treatment

Treatment will depend on which type of gas you predominantly produce i.e. Hydrogen or Methane. The typical treatment will usually include a course of antibiotics or herbal antibiotics, a probiotic, dietary intervention (low FODMAP Diet or Bi-Phasic Diet) and a prokinetic (helps the MMC). Treatment of any present deficiencies i.e. Iron deficiency or B12 will also be required.

If you are feeling 90% better post treatment you will continue with prevention tactics i.e. lower carbohydrate diet, meal spacing and a prokinetic (to allow efficiency of MMC).

If there is not much change in your symptoms then you will need to do another breath test to assess whether the SIBO is still present in which case you may need to go through another bout of treatment.

SIBO can often be a chronic condition due to the main underlying cause being structural. Two-thirds of patients will relapse and require treatment again.

Who do I see?

Go see your GP and discuss whether you expect that you may have SIBO and always eliminate any other causes first i.e. coeliac disease.

You may want to get a Lactulose and Glucose breath test which you can self-refer for or have your health practitioner refer you www.breathtest.com.au

Confirmed diagnosis of SIBO?

Go back to your referring practitioner and discuss treatment options.

Don’t have a referring practitioner?

You may require a team of health practitioners to treat SIBO i.e doctor, dietitian, and naturopath but ensure the practitioner you are going to is a specialist in the area.

I practice as a dietitian out of Ringwood, Victoria but also do skype consultations for those who live further out, interstate or overseas.

For more information about my practice visit the home page of the website.

I hope you find this helpful,

Until next time,

I am Atlanta Miall (APD, SDA),

Good Eating!