SIBO (Small Intestinal Bacterial Overgrowth), also known as small bowel bacterial overgrowth, is one of the most common, yet often undiagnosed, causes of chronic bloating and digestive complaints. This condition develops when bacteria normally present in the large intestine proliferate abnormally in the small intestine. This not only causes unpleasant symptoms but also impairs the absorption of nutrients. The Endomedix Gastroenterology Centre In this article, experts explain the causes of SIBO, how it can be recognised, and what modern diagnostic tools can be used to identify it.
What happens in cases of SIBO?
Normally, there are relatively few bacteria in the small intestine; the vast majority of the bacterial flora live in the large intestine. Our body prevents bacteria from travelling upwards through a number of defence mechanisms (e.g. stomach acid, bile, the peristaltic movements of the small intestine and the valve between the small and large intestines).
In the case of SIBO, these defences are weakened. Bacteria entering the small intestine deplete the body of nutrients (particularly vitamin B12 and iron) and begin to ferment carbohydrates whilst still in the small intestine. This process involves the production of large amounts of gas (hydrogen or methane), which causes distension and irritation of the small intestine’s wall.
The most common symptoms of SIBO
The symptoms of SIBO often overlap with those of irritable bowel syndrome (IBS); in fact, in a significant proportion of patients with IBS, SIBO is the actual cause of their symptoms.
- Pronounced bloating: It often occurs immediately after a meal, with patients reporting a „bloated feeling”.
- Abdominal pain and bloating: Due to the distending effect of intestinal gas.
- Changes in bowel movements: Diarrhoea (in the case of a hydrogen excess) or constipation (in the case of a methane excess).
- Increased gas production and rumbling in the gut.
- Malabsorption disorders: In the longer term, iron deficiency, vitamin B12 deficiency or unexplained weight loss may occur.
- Symptoms resembling food intolerance: The patient feels that almost every type of food makes them feel bloated.
Why does SIBO develop? (Underlying causes)
SIBO rarely occurs on its own; it is usually the result of an underlying disease or condition:
- Slowed bowel movements: Due to diabetes, an underactive thyroid or certain medicines.
- Anatomical differences: Post-operative scars, diverticula (pockets) in the small intestine.
- Low stomach acid levels: Due to the use of long-acting proton pump inhibitors (PPIs), bacteria are able to survive passage through the stomach more easily.
- Digestive enzyme deficiency: E.g. pancreatic insufficiency.
How is SIBO diagnosed at Endomedix?
The key to diagnosis is a specific exhalation test, which Endomedix Gastroenterology Centre available at all its clinics:
- H₂ breath test (with lactulose load): This is the most reliable non-invasive method. The patient drinks a lactulose solution (which the human body cannot break down, only bacteria can). If there is an overgrowth of bacteria in the small intestine, they begin to produce gas, which is absorbed into the bloodstream and then exhaled via the lungs. An early rise in hydrogen levels measured by the machine is a clear indication of the presence of SIBO.
Treatment options
The treatment of SIBO is a complex process:
- Course of antibiotics: We use a specialised antibiotic that acts only in the gut (e.g. rifaximin) to reduce the pathogenic bacterial flora.
- Diet: A low-FODMAP diet or a low-carbohydrate diet to „starve” the bacteria.
- Prokinetics: Stimulating bowel movements to prevent a relapse.
- Treatment of the underlying condition: Treating the underlying cause of SIBO (e.g. a thyroid problem).
When to consult a specialist: Maintaining liver health is a complex task, in which prevention plays a key role. However, if you experience any symptoms or are in a high-risk group, do not hesitate to consult a specialist. The Endomedix Gastroenterology Centre is equipped with modern diagnostic tools and staffed by highly qualified specialists to provide an accurate diagnosis and develop a personalised treatment plan. Early detection and appropriate treatment can prevent serious, irreversible liver damage and significantly improve your quality of life. Don’t let misconceptions influence your healthcare decisions! Get your information from reliable sources and take the first step towards a healthy liver today!
