Just a query

Would anyone on this forum let me know , what SIBO is, and how is its diagnosed, Also how's it treated.?

[lesleyshep]

SIBO stands for Small Intestinal Bacterial Overgrowth. It is normal for the large intestine (colon) to be loaded with beneficial bacteria, but the small intestine should be virtually sterile. SIBO is when the bacteria that normally reside in the colon start to proliferate in the small intestine. These bacteria digest the food we eat and create gas (hydrogen and methane) in the process, so when the bacteria reside in the small intestine, the production of this gas can build up and create the pain and bloating symptoms (sometimes nausea and acid reflux) that are often experienced in someone with SIBO, especially after eating.

The muscles of the small intestine can contract against the gas which can lead to pain. Visceral hypersensitivity – enhanced sensitivity to pain in your internal organs – is also common in those with IBS, and this can further exacerbate the pain.

Possible Causes of SIBO

One of the most common causes of SIBO is altered gut motility. Normal gut motility ensures that there is a regular wave motion (called ‘peristalsis’) that gently mixes and churns and slowly moves our food along the gastrointestinal tract (GIT) while allowing it to be absorbed. This also ensures that the large majority of bacteria remain in the colon where they can perform their normal functions. When this motility is disrupted, this upsets the natural movement of both food and bacteria towards the colon, and bacteria can get lodged in the small intestine. Since the bacteria survive by eating the food we eat, they will happily reside in the small intestine, producing hydrogen and methane gases in the process.

In addition to peristalsis, there is another mechanism in the GIT called the Migrating Motor Complex (MMC). After we have finished eating, the MMC sweeps away any debris i.e. food particles and bacteria, out of the small intestine down into the colon in a kind of propulsive movement. Disruption to the MMC can therefore lead to debris, including bacteria, not being effectively cleared from the small intestine.

So what causes disruption to gut motility? One cause is damage to the interstitial cells of cajal (ICC) which are cells within the GIT which help to regulate gut motility. This can occur following gastrointestinal infections, or surgery on the gastrointestinal tract. The pathogenic bacteria that typically cause gastrointestinal infections (e.g. E. coli, Shigella, etc.) all produce the same toxin which stimulates the immune system to respond to the infection. In molecular terms, this toxin looks very similar to ICCs, and therefore during the process of eliminating the pathogenic bacterial infection, the immune system may inadvertently destroy ICCs. ICCs are responsible for the appropriate functioning of the MMC, the Migrating Motor Complex which clears all the food and bacterial debris after we have finished a meal. So when ICCs are damaged, not only can this affect gut motility but it can also affect the clearing up system function of the MMC.

Testing for SIBO

The best available test for SIBO (in terms of the research behind it) is a breath test which measures the amount of hydrogen and methane in your breath after you swallow a solution containing lactulose or glucose. The lactulose /glucose are sugars which are eaten by the bacteria thus stimulating the production of these gases. A positive hydrogen result is more likely to be associated with diarrhoea and loose stool symptoms, while a positive methane result is likely to be more associated with constipation symptoms. Positive results for both hydrogen and methane are more likely to be associated with alternating constipation and diarrhoea symptoms.

You may be able to obtain this test from your GP, but it is a specialist test, so you may be more likely to obtain it from a gastroenterologist. Complementary health practitioners, such as nutritional therapists and other health practitioners who have been trained in the functional medicine / systems biology approach are also likely to have access to this test and will have been trained in how to interpret the results and the appropriate follow-up procedures and interventions. If you do decide to go down the complementary health route, make sure that the practitioner you choose is registered with the Complementary & Natural Healthcare Council (CNHC) which is the UK’s national voluntary register for complementary therapists, including nutritional therapists. You can also search for a Nutritional Therapist in your area on the website of the professional body BANT (British Association for Applied Nutrition & Nutritional Therapy). It is a requirement of BANT membership to be registered with the CNHC. This also ensures that the training your nutritional therapist has received is a training course that has been accredited by the Nutritional Therapy Education Commission (NTEC).

Treatments and Interventions for SIBO

As mentioned above, one cause of disrupted gut motility is damage to the interstitial cells of cajal (ICCs) which regulate gut motility and are responsible for the functioning of the Migrating Motor Complex. ICCs have the capacity to regenerate over a matter of months. When functioning optimally and in the right environment for optimal function, our bodies have natural mechanisms in place for repairing ICCs following possible damage in the wake of a gastrointestinal infection.

Two important factors in helping the repair process of ICCs are to ensure that your blood sugar levels are balanced and to reduce inflammation in the gastrointestinal tract. In fact, blood sugar imbalances and inflammation in the body are inextricably linked. Balancing blood sugar levels can be assisted by eating regular meals and not skipping meals and including good quality protein and good quality fats along with vegetables at each meal, while avoiding highly refined carbohydrates and sugary products.

With regard to inflammation, certain foods are known to be ‘pro-inflammatory’ and can therefore exacerbate any attempts to reduce inflammation while other foods are known to have ‘anti-inflammatory’ properties. Obviously any changes in diet should be discussed with your dietician and/or health practitioner to ensure it takes into account your individual case history and specific requirements.

Another contributory factor to gut motility is stress, and therefore chronic stress (whether physical, physiological or psychological) may be a contributing factor in SIBO. Chronic stress can also impact on blood sugar balance and can disrupt the immune system which controls inflammation. I mentioned above that the body has mechanisms in place to repair ICCs "when functioning optimally and in the right environment for optimal function". Much of what consists of 'the right environment for optimal function' involves the ability to manage stress appropriately and effectively. Stress reduction techniques, such as yoga, meditation, creative pursuits or going for regular walks in nature are habits that are worth cultivating in this regard.

Treatment for SIBO is normally via antibiotics, and studies have shown that a particular antibiotic called Rifaximin is effective in eradicating SIBO without having the undesirable systemic side effects often experienced with antibiotics e.g. urinary tract infections. This is due to the fact that rifaximin is virtually non-absorbable so it stays in the gut where it’s needed. The low FODMAP diet has also been shown in the research to alleviate the symptoms associated with SIBO, as this diet removes the foods that the bacteria particularly like to feed on. The low FODMAP diet is therefore not a long-term solution to treating SIBO, but it may help to alleviate the symptoms while the causes of your SIBO are being addressed. Rifaxamin may be obtained via your GP, but it is an expensive antibiotic and your GP (if in the UK) may not be willing or able to prescribe it. It may help to provide your GP or gastroenterologist with the research behind this antibiotic, which can be found on this website: siboinfo.com/antibiotics.html. This website also gives details of some herbal remedies that have been researched in the treatment of SIBO. This site is owned by Dr Allison Siebecker who is an expert in SIBO. Her work is based on the work of Dr Mark Pimentel, one of the leading researchers in SIBO: cedars-sinai.edu/Bios---Phy....

Every case of SIBO is likely to be different based on your individual case history and biochemical uniqueness. The above post is therefore for information only and should not be construed as individual advice or recommendations. If you suspect you may have SIBO, you should consult the appropriate medical and health professionals within your country of residence so that you can obtain a treatment strategy that is personalised to your specific needs and requirements.