The IBS & Gut Disorder Centre

SIBO Test London

Is Small Intestinal Bacterial Overgrowth the REAL cause of IBS?



What is SIBO?

Small intestinal bacterial overgrowth (SIBO) is a painful condition of the gut caused by the presence of excessive numbers of bacteria in the small intestine. The small intestine is where most of the digestion and absorption of food and nutrients happens. Unlike the colon which is part of the large intestine and proliferates with bacteria, the small intestine is normally sparsely populated by bacteria. Bacterial overgrowth can happen when bacteria move from the large intestine to the small intestine or when naturally occurring bacteria in the small intestine grow out of control.
In a healthy individual, the body will try and remove large concentrations of bacteria from the small intestine using a migrating motor complex, MMC to sweep out the bacteria.

SIBO can develop when the normal control mechanisms that keep the growth of bacteria in check are disrupted.

What are the causes of SIBO?

•Low levels of stomach acid as seen with Helicobacter pylori infection or with ageing
This is know as Achlorhydria (lack of Hydrochloric acid)- this may be due to long-term use of proton pump inhibitors,

•Use of medications that reduce stomach acid production including proton pump inhibitors such as Omeprazole as the latter may cause bacterial overgrowth in the duodenum and stomach. Proton pump inhibitors also accelerate intestinal transit- diarrhea.

• Food poisoning- Acute Gastroenteritis

• Pancreatic exocrine insufficiency, (lack of pancreatic enzymes)

•Conditions resulting in reduced gastrointestinal motility such as gastroparesis (delayed stomach emptying), irritable bowel syndrome, Crohn’s disease, coeliac disease and small bowel dysmotility

•People with a suppressed immune system


What are the symptoms of SIBO?

The signs and symptoms of SIBO are non-specific and are similar to other digestive disorders such as irritable bowel syndrome (IBS), lactose intolerance and fructose malabsorption. Common complaints include:

•Abdominal pain and discomfort
•Bloating
•Indigestion
•Diarrhoea
•Constipation
•Excessive gas and flatulence
•Unintentional weight loss
•Belching,
•Burping,
•Malabsorption,
•Inability to tolerate high fibre foods including vegetables,broccoli, beans, lentils, onions and garlic.



How can you be tested for SIBO? Hydrogen Breath Test
Because of the large amount of symptom overlap of SIBO with other gastrointestinal conditions like IBS, it is important that proper testing is done to ensure a correct diagnosis and treatment. If symptoms point to SIBO, then a breath test is usually requested. A breath test measures the concentration of hydrogen and methane in the breath. These gases are produced by bacteria from the fermentation of carbohydrates in the gut. You need to follow a special diet 24 hours before doing the test which involves drinking a sugar glucose or lactulose drink and then breathing into collection tubes. If you would like to test for SIBO, please contact our clinic- [email protected]

Is there a cure for SIBO?

In many cases, SIBO can be successfully treated by directly addressing the bacterial overgrowth. The most common first-line antibiotic prescribed is Rifaximin. The problem with antibiotics is that they are not always initially effective with one study finding that in people with SIBO-related IBS, two-thirds had to be retreated with Rifaximin, with some needing retreatment up to 5 times. This raises the very serious concern of developing bacterial antibiotic resistance.

We have successfully used herbal treatments such as oil of oregano, lemon balm, and red thyme oil, we have found these to be an effective alternative treatment for SIBO. A 2014 study found that herbal treatments were just as effective as the antibiotic rifaximin in treating SIBO. And from the same study, herbal treatments were just as effective as triple antibiotic therapy in people that did not respond to rifaximin.



The Importance of Diet and SIBO
Dietary changes are also an important part of managing SIBO. Because bacteria feed on carbohydrates, then a diet that aims to reduce these can help. A low FODMAP diet is sometimes recommended to treat SIBO and which also has proven effective in treating IBS. FODMAPs are short-chain carbohydrates such as lactose, fructose, fructans (long chains of fructose molecules) and sugar alcohols that are commonly present in dairy products, grains, legumes and certain fruits and vegetables. The reduction in fermentable carbohydrates in the diet helps to starve excess bacteria of their important food source.

The elemental diet is another option for people with SIBO. The diet supplies nutrients in an easy-to-digest form. The easier and quicker digestion and absorption of nutrients mean there is less available for bacteria to feed off. In a 2-week study of people with SIBO-related IBS trialling an elemental diet, 80 percent returned a normal lactulose breath test after 1 month.

With SIBO, different dietary changes work for different people. That is where working with an experienced nutritionist to assist in tailoring changes to your diet to manage symptoms of SIBO can be of help. Please contact us at [email protected]



The SIBO breath test (Small Intestinal Bacterial Overgrowth) is also an excellent test that is now available and is also of tremendous benefit to IBS sufferers.

How can I order a SIBO test-
If you would like to do book in SIBO test, at our clinic please contact us by [email protected]

or by phone - 0345 1297996 and we can arrange a consultation.

We recommend using a lactulose breath test or a hydrogen breath test, however we do offer glucose testing as well.


In my experience, at least 40% of patients who have IBS and have taken the SIBO test do test positive for SIBO.

There has also been a study conducted by Dr. Mark Pimentel and published in The American Journal of Gastroenterology that claims 84% of IBS patients have abnormal lactulose breath tests and were diagnosed with SIBO.


The NHS still does not routinely test for SIBO, but it is certainly worth investigating if you have been diagnosed with IBS.


How common is SIBO?

The prevalence of SIBO ranges from 30-85%.

The prevalence of SIBO in patients with coeliac disease non-responding to a gluten-free diet was as high as 50%.
In liver cirrhosis, SIBO was diagnosed in more than 50% of cases.
In a small study on elderly people (70 to 94 years old) who had lactose malabsorption, SIBO was documented in 90%.


References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/Small Intestinal Bacterial Overgrowth
A Comprehensive Review
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3155069/- How to Interpret Hydrogen Breath Tests
https://link.springer.com/article/10.1007%2Fs10620-011-1728-5
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4030608/Herbal Therapy Is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918736/Efficacy of the low FODMAP diet for treating irritable bowel syndrome: the evidence to date
https://link.springer.com/article/10.1023/B:DDAS.0000011605.43979.e1A 14-Day Elemental Diet Is Highly Effective in Normalizing the Lactulose Breath Test

© Victoria Tyler
The IBS & Gut Disorder Centre

0345 1297996
www.ibs-solutions.co.uk

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