Small Intestinal Bacterial Overgrowth (SIBO), also known as Bacterial Overgrowth Syndrome, is a disorder marked by an abnormal increase in the population of bacteria in the small intestine. Typically, the colon and other portions of the digestive tract have more bacteria than the small intestine. Excessive bacteria can interfere with nutrition absorption and digestion when this equilibrium is upset, resulting in a variety of gastrointestinal symptoms and possible consequences.
Causes and Risk Factors
SIBO is frequently brought on by illnesses that change the environment of the gut or interfere with the small intestine’s natural motility. SIBO risk is increased by a number of variables, such as:
- Impaired Gut Motility: Diseases such as diabetes, irritable bowel syndrome (IBS), and gastroparesis can cause the small intestine to move less quickly when it comes to moving food and germs.
- Structural Abnormalities: Bacteria can proliferate in areas created by diverticula, adhesions from prior surgeries, or obstructions in the small intestine.
- Immune system disorders: HIV and immunosuppressive medications can impair the body’s ability to fight off germs.
- Chronic Illnesses: Conditions such as Crohn’s disease, coeliac disease, and persistent pancreatitis can change the environment in the digestive tract, which promotes the growth of bacteria.
- Medication: The small intestine’s barrier to bacterial colonisation can be lowered by proton pump inhibitors (PPIs) or other drugs that lower stomach acid.
Physiopathology
When it comes to nutrient absorption and food digestion, the small intestine is essential. The movement of the muscles in the digestive tract, known as peristalsis, and the stomach’s acidic environment typically aid in controlling the amount of bacteria in the small intestine. Bacteria may grow when this mechanism malfunctions.
These overabundance of bacteria can
- Gases like hydrogen and methane are produced during the fermentation of undigested carbohydrates, which results in gas, diarrhoea, and bloating.
- Bile acids must be deconjugated in order for fat to be digested. Steatorrhea (fatty stools) and fat malabsorption may follow from this.
- Toxin production or direct invasion can harm the intestinal lining, impairing the body’s ability to absorb vital nutrients.
SIBO symptoms
It can be challenging to detect bacterial overgrowth because of its wide range of symptoms, many of which are similar to those of other gastrointestinal conditions including IBS. Typical signs and symptoms include of:
Symptoms related to the digestive system:
- Gas and bloating
- cramps and discomfort in the abdomen
- constipation or, less frequently, diarrhoea
- Steatorrhea, or fatty, pungent stools
Inadequate Dietary Resources:
- Inadvertent reduction of body mass
- Weary
- Vitamin B12 deficiency-related anaemia (small intestine bacteria can eat this vitamin)
Other signs of the system:
- Cognitive problems or fog in the brain
- Joint discomfort
- Skin rashes (in some circumstances
Diagnosis
Due to the symptoms of SIBO sometimes overlapping with those of other digestive illnesses, diagnosis can be difficult. The following tests are performed to determine the condition:
- Breath Tests: The lactulose or glucose breath test is the most often used diagnostic technique. Breath samples are taken over a few hours after patients consume a sugar solution in order to quantify the creation of hydrogen and methane, which is an indicator of bacterial fermentation in the small intestine.
- Little Intestinal Aspiration and Culture: This test, which is less popular because it is invasive, entails taking a sample of fluid from the small intestine and cultivating it to look for bacterial overgrowth.
- Blood Tests and Stool Analysis: Stool analysis and blood tests can be performed to detect SIBO-related indicators, malabsorption, and nutritional deficits.
- Imaging: X-rays, CT scans, and MRIs are examples of imaging procedures that can occasionally be used to find structural problems.
Treatment of Bacterial Overgrowth Syndrome
The goals of SIBO treatment are to lessen bacterial overgrowth, address the underlying cause, and manage symptoms. Typical methods include of:
- Antibiotics: In order to lower the bacterial burden and treat SIBO, antibiotics are the mainstay of treatment. Non-systemic antibiotics like rifaximin are frequently used because they target gut bacteria without entering the bloodstream. Depending on the kind of bacteria, other antibiotics like ciprofloxacin or metronidazole may also be appropriate.
- Dietary Modifications: To lessen bacterial fermentation, it is often advised to follow a specific carbohydrate diet (SCD) or a low-FODMAPS diet (low in fermentable carbs). A brief elemental diet, which starves the bacteria by providing nutrients in an easily digested form, may also be beneficial for certain people.
- Prokinetics: By enhancing gut motility, these drugs guarantee that food and microorganisms pass through the digestive system normally. Low-dose erythromycin and prucalopride are two examples.
- Nutritional Support: In order to treat nutrient deficits, especially those involving vitamin B12, fat-soluble vitamins, and minerals, patients with SIBO frequently need to take supplements.
- Probiotics: Although their application in SIBO is still up for debate, some data points to the possibility that some probiotics may help balance the bacteria in the gut and alleviate symptoms.
SIBO Complications When Untreated
Serious consequences from SIBO can arise if treatment is not received, such as:
- Poor nutritional absorption is the cause of severe malnutrition.
- Osteoporosis: Caused by malabsorption of calcium and vitamin D.
- Neurological symptoms: Such as vitamin B12 deficiency-induced peripheral neuropathy.
- Bacterial fermentation and malabsorption are the causes of chronic diarrhoea and dehydration.
Recurrence and Prognosis
The prognosis for people with SIBO depends on the underlying aetiology and the efficacy of treatment. Recurrence is typical even though many people respond well to medications and dietary adjustments, especially if the underlying cause is not treated. To avoid relapse, some patients might need intermittent antibiotics, long-term maintenance therapy with prokinetics, or ongoing dietary control.
Prevention
The underlying risk factors must be addressed in order to prevent SIBO. This comprises:
Managing chronic conditions including IBS, diabetes, or scleroderma that can contribute to impaired gut motility.
minimising the needless use of drugs that lower stomach acid, such as proton pump inhibitors.
Eating a balanced diet and steering clear of foods high in fructooligosaccharides (FODMAPS) that encourage excessive bacterial fermentation.
Conclusion
SIBO, also known as Bacterial Overgrowth Syndrome, is a complicated illness that needs to be carefully diagnosed and treated. Although many people find relief with adequate treatment, the symptoms can have a major negative impact on quality of life. Long-term success depends on continuous treatment of underlying risk factors because of their propensity to recur.
