The SIBO is the acronym for the syndrome bacterial overgrowth of the small intestine, which is a disease that is in vogue in recent years and is characterized by a series of symptoms and signs that are shared with many other gastrointestinal diseases.

In SIBO, there is an excessive proliferation of bacteria in the small intestine. It is estimated that under normal conditions the amount of bacteria in the small intestine is low, being very high in the large intestine or colon.

SIBO prevalence

The prevalence of this disease in the population is not known exactly. Several studies have estimated that between 2.5% and 22% of the population has bacterial overgrowth .

What conditions predispose to the appearance of SIBO?

There are conditions that predispose to the appearance of bacterial overgrowth .

Anatomical conditions

Among the anatomical conditions we have any change in the structure of the digestive system, for example, of surgical origin (surgeries to lose weight or bariatric, previous surgeries in the intestine and colon, in addition to strictures or narrowing of the intestine, diverticula and fistulas).

Functional conditions

Those conditions that alter the functioning of the digestive system, such as advanced age, decreased secretion of gastric juice, including that caused by gastric protectors such as omeprazole and similar medications; alterations in the immunity or defense of the intestine and alterations of the gastrointestinal movement.

Causes of SIBO

The predisposing conditions lead to a series of diseases that, due to their characteristics, are closely linked to the appearance of bacterial overgrowth of the small intestine.

We mention several common conditions:

  • Exocrine pancreatic insufficiency, or decreased secretion of pancreatic juice, which is due to chronic pancreatitis or diseases of the pancreas.
  • Immunodeficiency, decreased defenses and antibodies located in the small intestine.
  • Irritable bowel syndrome.
  • Celiac disease or gluten intolerance.
  • Crohn’s disease, chronic inflammatory disease of the digestive system.
  • Short bowel syndrome (post-surgical conditions, after resecting and removing part of the intestine for a specific cause).
  • Nonalcoholic Hepatic Steatosis (Fatty Liver).
  • Hepatic cirrhosis.
  • Parkinson’s disease.
  • Hypothyroidism
  • Mellitus diabetes.
  • Fibromyalgia
  • Morbid obesity.

Symptoms of small intestine bacterial overgrowth:

The symptoms of SIBO are not exclusive to this disease, worse still, they are very similar to other intestinal problems, so sometimes it is not easy to reach the correct diagnosis.

  • Sickness.
  • Abdominal bloating (gas).
  • Vomiting
  • Diarrhea.
  • Malnutrition
  • Weightloss.
  • Fatigue.
  • Skin manifestations: rash, reddish discoloration of the face (rosacea) or acne.

How is the diagnosis of SIBO made?

There are no specialized and easy tests for the detection of SIBO . So the diagnosis is mainly clinical, evaluating medical history, antecedents, predisposing conditions and symptoms.

Some tests have been carried out:

  • Breath test to determine the level of expired hydrogen, as well as methane, glucose and xylose.
  • Count and culture of bacteria from intestinal fluid, obtained through endoscopic aspiration of the small intestine.

What is the treatment of SIBO?

  1. Discover the cause and treat the underlying disease according to each particular protocol.
  2. Lifestyle changes:
  3. Reduce stress.
  4. Avoid large or large meals.
  5. Eat in smaller portions up to 6 times a day.
  6. Alternative or natural treatments:
  7. Acupuncture has been proposed as an alternative with some success stories.
  8. Some natural oils or extracts have been proposed such as: oregano oil, berberine, wormwood, peppermint oil, tarragon oil.
  9. Diet:
  10. Avoid : foods rich in fructose and sugars, juices, honey, processed sugars, lactose, garlic, onion, cabbages, soy, and sweeteners.
  11. Recommended : Tuna and salmon, meat and lamb, poultry and free-range eggs, raw cheeses, almond or coconut milk, green leafy vegetables, carrots, cucumbers, tomatoes, plantains and bananas, blueberries, grapes, pineapple, strawberries , quinoa and melon.
  12. Nutritional supplements, the following minerals and vitamins must be restored:
  13. Vitamin B12
  14. Iron
  15. Vitamin D
  16. Vitamina K
  17. Zinc
  18. Vitamin A
  19. Football
  • Probiotics: Their use has been shown to improve SIBO cases. It is advisable to consume foods enriched with probiotics such as Lactobacillus or Bifidobacteria .
  • Prokinetics : these are drugs that improve bowel movement, in case of presenting any alteration of intestinal motility or gastroparesis. Among them we find domperidone, cisapride, among others.
  • Antibiotics : they are used for 7-day cycles, repeating treatment or alternating antibiotics, according to the frequency with which symptoms appear annually. The most used are:
  • A. Rifaximina.
  • B. Quinolones: comociprofloxacin or norfloxacin.
  • C. Tetraciclinas.
  • D. Amoxicillin / clavulanic acid.
  • E. Metronidazole.

The syndrome bacterial overgrowth of the small intestine, is a common and already widely studied entity that deserves special attention because it affects the quality noticeably visa patients who have it .

By Dr. Eric Jackson

Dr. Eric Jackson provides primary Internal Medicine care for men and women and treats patients with bone and mineral diseases, diabetes, heart conditions, and other chronic illnesses.He is a Washington University Bone Health Program physician and is a certified Bone Densitometrist. Dr. Avery is consistently recognized in "The Best Doctors in America" list.

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