Small intestinal bacterial overgrowth (SIBO)

Description

Small intestinal bacterial overgrowth (SIBO) occurs when there is an abnormal increase in the total bacterial population in the small intestine, particularly the types of bacteria that are not normally found in that part of the digestive tract. This condition is sometimes called blind loop syndrome.

small intestinal bacterial overgrowth (SIBO) commonly results when a situation such as surgery or illness — it slows the passage of food and waste products in the digestive tract, creating a breeding ground for bacteria. The excess of bacteria often cause diarrhea and can cause weight loss and malnutrition.

While the SIBO is often a complication of stomach (abdominal) surgery, this condition can also be the result of structural problems and some diseases. Sometimes surgery is needed to correct the problem, but antibiotics are the most common treatment.

Symptoms

The signs and symptoms of SIBO often include:

  • Loss of appetite
  • Abdominal pain
  • Nausea
  • Swelling
  • An uncomfortable feeling of fullness after eating
  • Diarrhea
  • Unintentional weight loss
  • Malnutrition

When to see a doctor

Abdominal distention, nausea, and diarrhea are the signs and symptoms of many intestinal problems. Consult your doctor for a full evaluationation — especially if you have had abdominal surgery — if you have:

  • Persistent diarrhea
  • Rapid, unintentional weight loss
  • Abdominal pain that lasts more than a couple of days

If you have severe abdominal pain, seek medical attention immediately.

Causes

Small intestinal bacterial overgrowth (SIBO) may be caused by:

  • Complications of abdominal surgery, including gastric bypass for obesity and gastrectomy for the treatment of peptic ulcers and stomach cancer
  • Structural problems in and around your small intestine, including the scar tissue (intestinal adhesions) which can be wrapped around the outer part of the small intestine, and the bulging pouches of tissue that protrudes through the wall of the small intestine (diverticulosis, intestinal)
  • Certain medical conditions, including Crohn's disease, radiation enteritis, scleroderma, celiac disease, diabetes or other conditions that may slow movement (motility) of food and waste products through the small intestine

Why small intestinal bacterial overgrowth (SIBO) is developed

The small intestine is the longest section of your digestive tract, which measured about 20 feet (6.1 meters). The small intestine is where food is mixed with digestive juices and nutrients are absorbed into the bloodstream.

Unlike your large intestine (colon), small intestine normally has relatively faithw bacteria due to the rapid flow of content and the presence of bile. But in SIBO , the stagnation of food in the margin small intestine becomes an ideal breeding ground for bacteria. The bacteria can produce toxins, as well as interfere with the absorption of the nutrients. The degradation products following bacterial digestion of food can also cause diarrhea.

Risk factors

Factors that increase the risk of SIBO include:

  • Gastric surgery for obesity or ulcers
  • A structural defect in the small intestine
  • An injury to the small intestine
  • An abnormal passage (fistula) between the two segments of intestine
  • Crohn's disease, intestinal lymphoma, or scleroderma involving the small intestine
  • History of radiation therapy to the abdomen
  • Diabetes
  • Diverticulosis of small intestine
  • Adhesions caused by previous abdominal surgery

Complications

Small intestinal bacterial overgrowth (SIBO) can lead to the escalation of problems, including:

  • The poor absorption of fats, carbohydrates and proteins.Bile salts, which are normally necessary for the digestion of fat, broken by excessive bacteria in the small intestine, which results in incomplete digestion of fats, and diarrhea. Bacterial products can also damage the lining (mucosa) of the small intestine, resulting in decreased absorption of carbohydrates and proteins. The bacteria may compete for the available food. And compounds produced by the bacteria of decomposition of stagnation of the food can also cause diarrhea. Together, these effects of bacterial overgrowth result in diarrhea, malnutrition, and weight loss.
  • Vitamin deficiency.As a result of the absorption of incomplete fat, the body cannot fully absorb the fat-soluble vitamins a, D, E, and K. the Bacteria in the small intestine synthesize as well as the use of the vitamin B-12, which is essential for the normal functioning of your nervous system and the production of blood cells and DNA. The excessive growth of bacteria can result in the B-12 deficiency can lead to weakness, fatigue, tingling, and numbness in the hands and feet and, in advanced cases, the mental confusion. The damage to your central nervous system resulting from B-12 deficiency may be irreversible.
  • Weakening of the bones (osteoporosis). With time, it can damage the intestine from the abnormal bacterial growth causes poor absorption of calcium, and can eventually lead to bone diseases, such as osteoporo- sis.
  • Stones in the kidney. Low absorption of calcium can also lead to kidney stones.

The poor absorption of fats, carbohydrates and proteins. Bile salts, which are normally necessary for the digestion of fats, are broken down by excessive bacteria in the small intestine, which results in incomplete digestion of fats, and diarrhea. Bacterial products can also damage the lining (mucosa) of the small intestine, which results in the decrease of the absorption of the carbohydrates, and proteins.

The bacteria may compete for the available food. And compounds produced by the bacteria of decomposition of stagnation of the food can also cause diarrhea. Together, these effects of bacterial overgrowth result in diarrhea, malnutrition, and weight loss.

The deficiency of the vitamin. As a result of the absorption of incomplete fat, the body cannot fully absorb the fat-soluble vitamins a, D, E, and K. the Bacteria in the small intestine synthesize as well as the use of the vitamin B-12, which is essential for the normal functioning of your nervous system and the production of blood cells and DNA.

The excessive growth of bacteria can result in the B-12 deficiency can lead to weakness, fatigue, tingling, and numbness in the hands and feet and, in advanced cases, the mental confusion. The damage to his central nervous system resulting from B-12 deficiency may be irreversible.

Small intestinal bacterial overgrowth (SIBO)

Diagnosis

In order to diagnose small intestinal bacterial overgrowth (SIBO), Ior you may have tests to check for bacterial overgrowth in the small intestine, malabsorption of fat, or other problems that may be causing or contributing to the symptoms. Common tests include:

  • The breath test. This type of non-invasive test that measures the amount of hydrogen or methane to breathe out after drinking a mixture of glucose and water. A rapid increase in exhaled hydrogen or methane may indicate an excessive growth of bacteria in your gut. Although it is widely available, the breath test is less specific thother types of tests for the diagnosis of bacterial overgrowth.
  • Small bowel aspirate and culture of fluid. Extraction and testing of fluid in the small intestine that used to be considered as a good way to diagnose SIBO. However, this technique can lead to a diagnosis of SIBO that is not correct due to the contamination of the bacteria in the mouth. Experts do not recommend this test.

In addition to these tests, your doctor may recommend blood tests to look for the deficiency of vitamin or a stool evaluation for the test of the fat of poorabsorption. In some cases, your doctor may recommend imaging tests, such as X-rays, computed tomography (CT) or magnetic resonance imaging (MRI) to look for structural abnormalities of the intestine.

Treatment

Whenever possible, doctors treat small intestinal bacterial overgrowth (SIBO) to deal with the underlying problem — for example, by surgical repair of a post-loop, stenosis or fistulas. But a loop that can't always be reversed. In that case, the treatment focuses on the correction of nutritional deficiencies and eliminating bacterial overgrowth.

Antibiotic therapy

For most people, the initial way to treat the bacterial overgrowth is with antibiotics. Doctors can start this treatment if the symptoms and the clinical history strongly suggest this is the cause, even when the results of the tests are not conclusive or without any proof at all. Testing may be performed if treatment with antibiotics is not effective.

A short course of antibiotics is often significantly reduces the number of abnormal bacteria. But bacteriacan return when the antibiotic is discontinued, so that the treatment will be long-term. Some people with a tie in your small intestine can go for long periods without the need for antibiotics, while others may need them regularly.

Doctors can also change among different antibiotics to help prevent bacterial resistance. Antibiotics wipe out the majority of the intestinal bacteria, both normal and abnormal. As a result, the antibiotics can cause some of the problems that they are trying to cure, including diarrhea. The switching between different drugs can help prevent this problem.

Nutritional support

The correction of nutritional deficiencies is a crucial part in the treatment of SIBO, particularly in people with severe weight loss. Malnutrition can be treated, but the damage they cause may not always be reversed.

These treatments may improve vitamin deficiencies, reduce intestinal distress and help with weight gain:

  • Nutritional supplements. People with SIBO may require intramuscular injections of vitamin B-12, as well as the oral vitamins, iron and calcium supplelements.
  • Lactose-free diet.Damage to the small intestine can cause a loss of the ability to digest the milk sugar (lactose). In that case, it is important to avoid most of the lactose-containing products, or the use of preparations of lactase, which helps digest the milk sugar. Some people are able to tolerate yogurt, because the bacteria used in the cultivation process, naturally, to break down lactose.

Lactose-free diet. Damage to the small intestine can cause a loss of the ability to digest the milk sugar (lactose). In that case, it is important to avoid most of the lactose-containing products, or the use of preparations of lactase, which helps digest the milk sugar.

Some affected people may be able to tolerate yogurt, because the bacteria used in the cultivation process, naturally, to break down lactose.

Preparing for your appointment

If you have signs and symptoms that are common to small intestinal bacterial overgrowth (SIBO), make an appointment with your doctor. After an initial assessment, you may be referred to a doctor who specializes in the treatment of disorders of the gastrointestinal (gienterologist).

Here's some information to help you prepare for your appointment, and what to expect from your doctor.

  • Write down your symptoms, including when they started and how they may have changed or worsened with time.
  • Bring your medical records, andespecially if you have had surgery on the stomach or intestines, have any known disorder of the intestine, or have received radiation to the abdomen or pelvis.
  • Make a list of all your medications, vitamins and supplements.
  • Write down your key medical information, ineven other conditions with which you have been diagnosed. Make sure you tell your doctor about any history of abdominal surgery that you had.
  • Write down key personal information, including any recent changes or stressors in your life. These factors can be connected to tor digestive signs and symptoms.
  • Have a family member or friend along, if possible. It can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write questions to ask their doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.

Do not hesitate to ask questions. Some basic questions to ask your doctor include:

  • What is the most likely cause of my pain?
  • What treatment approach do you recommend?
  • Are there side effects associated with the medicine you're prescribing?
  • I have other conditions. How can I deal with them?
  • I will have to stay in long-term medications?
  • How often do you look at me monitor my progress?
  • Should I take nutritional supplements?
  • Do I have any vitamin deficiency?
  • Are there any lifestyle or dietary changes I can do to help control or reduce the symptoms?

What to expect from your doctor

Your doctor may ask you a series of questions. Be ready to answer them may reserve time to go over points you want to spend more time. You may ask:

  • Have you ever had abdominal surgery?
  • What are your symptoms?
  • When did you first notice these symptoms?
  • Did your symptoms come and go or stay about the same?
  • Is your cramp-like pain?
  • The pain radiates to other parts of your abdomen or back?
  • You have lost weight without trying?
  • Have you noticed a change in your stools?
  • They have their signs and symptoms include vomiting?
  • Have your signs and symptoms include fever?
  • Has someone close to you has had similar signs or symptoms recently?
  • What is the typical daily diet?
  • Have you ever been diagnosed with a food allergy or lactose intolerance?
  • Have you been diagnosed with anyother medical conditions?
  • What medications are you taking, including prescription and over-the-counter medications, vitamins, herbs and supplements?
  • Do you have any family history of diseases of the intestine or colon cancer?
  • Have you ever had radiation therapy, andour abdomen or pelvis?
  • Have you ever had kidney stones?
  • Have you ever had problems with the pancreas?
  • Do you have Crohn's disease?
Symptoms and treatment of Small intestinal bacterial overgrowth (SIBO)