Small Intestinal Bacterial Overgrowth (SIBO)

SIBO can cause a wide variety of symptoms. Importantly, these symptoms also overlap with other gastrointestinal disorders such as 'Irritable Bowel Syndrome'. 

Symptoms of SIBO can include:

• Bloating

• Diarrhoea

• Abdominal pain

• Fatty stools (steatorrhea)

• Abnormal blood tests - High folate levels may be present, less commonly Vitamin B12 deficiency

Key risk factors which can lead to development of SIBO include:

• Motility Issues:  Conditions which affect the normal movement of small bowel,  such as diabetic autonomic neuropathy, scleroderma, or chronic opiate use.

• Anatomic Changes: Small intestinal diverticulosis, prior intestinal surgery, or resection of the ileocecal valve.

• Associated Disorders: SIBO can develop in association with Crohn's disease, Coeliac disease, chronic pancreatitis, IBS etc.

There are two main tests which can be used for diagnosis of SIBO.

1. Hydrogen & Methane Breath Test: Human cells do not produce hydrogen or methane gas. As part of the test, patients ingest carbohydrate substrate - lactulose or glucose. As this passes through small bowel, in patients with high bacterial count, these get fermented and hydrogen or methane gas is produced, which is detected in breath. By checking amount of gas, and how quickly it is produced, this can indicate presence of bacterial overgrowth in small intestine.

2. Duodenal / Jejunal Aspiration: This involves directly sampling fluid from the small bowel during an endoscopy, and quantifying bacterial colonies in laboratory. 

   Please note, these tests are far from perfect, and several factors affect accuracy and validity of these test results. Please discuss further with your specialist.

1) Antibiotic therapy - This is the mainstay of treatment, and involves intermittent courses of antibiotics based on symptom response. 

2) Nutritional correction - This involves identification and treatment of any nutritional deficiencies in vitamins or minerals