SIBO - Many ways to Treat but very Difficult to Cure.

 Small Intestinal Bacterial Overgrowth (SIBO) is a condition where there is an abnormal increase in the number of bacteria in the small intestine. This overgrowth can cause various digestive symptoms, including bloating, abdominal pain, diarrhea, and malabsorption of nutrients. In this blog post, we will discuss the diagnosis and treatment of SIBO.

Diagnosis of SIBO:

The diagnosis of SIBO is made through a breath test. This test measures the amount of hydrogen and methane gas in the breath after consuming a substrate such as lactulose or glucose. These gases are produced by the bacteria in the small intestine. An increase in the levels of these gases indicates the presence of SIBO. There is a new test called TRIO which measures all three gases. 

Another way to diagnose SIBO is through an endoscopy with a biopsy of the small intestine. However, this method is invasive and is not commonly used. It  is important to identify and address the underlying cause of SIBO. In some cases, SIBO can be caused by structural abnormalities in the small intestine, such as strictures or adhesions; other  conditions to exclude are hypothyroidism or diabetes.  One of the main problems is the movement of the ileo-cecal valve which may malfunction and be unable to sweep bacteria out from the small intestine. Addressing the underlying cause may help prevent the recurrence of disease. 

There are three main types of Small Intestinal Bacterial Overgrowth (SIBO): hydrogen-dominant, methane-dominant, and hydrogen sulfide-dominant. 

1. Hydrogen-dominant SIBO:

Hydrogen-dominant SIBO is the most common type of SIBO, and it occurs when there is an overgrowth of hydrogen-producing bacteria in the small intestine. Treatment for hydrogen-dominant SIBO typically involves the use of antibiotics, such as rifaximin, to reduce the number of bacteria in the gut. A low FODMAP diet may also be helpful in managing symptoms.

1. Methane-dominant SIBO:

Methane-dominant SIBO occurs when there is an overgrowth of methane-producing bacteria in the small intestine. This type of SIBO can be more challenging to treat than hydrogen-dominant SIBO. Antibiotics, such as rifaximin and neomycin, may be used to reduce the number of bacteria in the gut. Prokinetics, such as erythromycin and prucalopride, can also be helpful in improving gut motility.

1. Hydrogen sulfide-dominant SIBO:

Hydrogen sulfide-dominant SIBO occurs when there is an overgrowth of bacteria that produce hydrogen sulfide gas in the small intestine. This type of SIBO is less common than the other two types, and it can be challenging to diagnose. Treatment for hydrogen sulfide-dominant SIBO may involve antibiotics, such as metronidazole and tinidazole, and dietary changes.

Alternative therapies include herbal preparations of berberine , garlic , Neem , or oregano . Another option is the elemental diet which is an Amino Acid powder that you purchase or you can make your own . The idea is to use a medical food that gets absorbed before it gets to the large intestine where the fermenting bacteria reside. Probiotic treatment may be beneficial but it depends on the stage of treatment and the degree of inflammation in the gut. Prebiotics like guar gum have been shown to be helpful  in some cases. If there is an underlying problem with fungi or parasites, this  also may be complicating the healing and elimination of SIBO. The length of treatment may vary and there may be recurrences  after a course of therapy which make it very frustrating for many  patients.