Small intestinal bacterial overgrowth (SIBO) is also known as small bowel bacterial overgrowth (SIBO) refers to a condition in which abnormally large numbers of bacteria (at least 100,000 bacteria per ml of fluid) are present in the small intestine and the types of bacteria in the small intestine resemble more the bacteria of the colon than the small intestine.
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Bacterial overgrowth of the small intestine is a frequently overlooked contributing factor in several common disorders. For example, irritable bowel syndrome (IBS), responsible for up to 40% of referrals to gastroenterologists, is frequently associated with SIBO. One study of more than 200 patients with IBS found that 78% tested positive for SIBO. Of those successfully treated for SIBO, 48% no longer met the Rome criteria for IBS
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Patients with fibromyalgia and chronic fatigue syndrome also have been observed to have a high rate of SIBO (78% and 77% of subjects, respectively). About half of such patients who tested positive for SIBO in one study experienced marked subjective improvement after antibiotic administration. Interestingly both of these disorders have been observed to overlap with IBS.
Other groups of patients particularly prone to bacterial overgrowth of the small intestine include those with intestinal dysmotility syndromes associated with systemic disease (e.g., diabetes, scleroderma, and intestinal pseudoobstruction), prior intestinal surgery, and strictures of the small bowel. Both jejunal diverticulosis and Crohn’s disease have been associated with SIBO, particularly in patients with Crohn’s disease who have undergone previous intestinal surgery. Interestingly most patients with celiac disease whose gastrointestinal symptoms persist with a gluten-free diet have been shown to have SIBO, with amelioration of symptoms after bacterial eradication.
The incidence of bacterial overgrowth increases with age, particularly in people 80 years and older. It has been found that 64% of individuals older than 75 years with chronic diarrhea have colonic-type flora in their small bowels and that SIBO is the most common cause of clinically significant malabsorption in elderly persons
Two major factors control the numbers and kinds of bacteria found within the small bowel: intestinal peristalsis and gastric acid secretion. Consequently SIBO has been associated with both intestinal stasis and hypochlorhydria.
Signs and Symptoms of Bacterial Overgrowth
Gas, bloating, and flatulence
Diarrhoea
Constipation
Abdominal cramping
Steatorrhea – fatty stool
Lactose intolerance
B12 deficient anaemia
Further possible signs include
Bloating / burping after meals
Alternating constipation with diarrhoea
Heartburn
GERD
Reflux
Nausea
Leaky gut / Intestinal permeability
IBS
IBD
Food sensitivities
Lactose intolerance
Fructose malabsorption
FODMAP sensitivity
A gas bubble may cause the pancreas to not bee seen on a CT scan
Fibromyalgia
Chronic fatigue syndrome
Joint Pain
Restless leg syndromeBreathing difficulties
Difficulty swallowing
Rosacea or eczema
Cystitis
headaches
Brai fog/memory problems
Iron deficient anaemia
Improvement of symptoms after antibiotics
Probiotics are not tolerated and can worsen symptoms
Probiotics such as FOS can worsen symptoms
Possible causes of SIBO
Low stomach acid
Drug induced low stomach acid
Chronic constipation
Stasis resulting from structural changes
(e.g., diverticulosis, blind loops, radiation damage, stricture, fistulas, intestinal pseudoobstruction,
adhesions resulting from prior surgery)
Chronic pancreatic insufficiency
Disaccharidase deficiencies (lactase)
Damaged ileocecal valve
Immunodeficiency (especially of secretory immunoglobulin A)
Diabetes mellitus
Scleroderma
Crohn’s disease
SIBO breath test
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“I found Emma by chance whilst googling. And I’m so genuinely glad that I did. I’d suffered for a year with symptoms that my NHS consultant couldn’t understand, he was keen to perform tests, taking months to plan appointments… However when I found Emma I was able to have convenient appointments in the comfort of my own home via Skype. With Emma’s expertise on SIBO, it was a quick diagnosis confirmed with hydrogen breath testing – something that you may find rare within the NHS. This was affordable and easily completed and I received my results within 10 days. I am currently working with Emma to improve my quality of life – I’m positive for the first time in months. So I want to take this opportunity to say thank you Emma, thank you for sharing your expertise and working hard to help me beat SIBO.”
KP 22.5.15
