Small Intestinal Bacterial Overgrowth (SIBO)

So I've been doing some research, because unfortunately to this date I'm still getting daily gastrointestinal problems, and I came across this article from medicinenet.com. It's about Small Intestinal Bacterial Overgrowth (SIBO) and how it can be closely related to Irritable Bowl Syndrome (IBS). 


The article was written by Dr Jay W Marks, a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicineand trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles. For twenty years he was the Associate Director of the Division of Gastroenterology at Cedars-Sinai Medical Centerand an Associate Professor of Medicine, In Residence, at UCLA. At Cedars-Sinai he co-directed the Gastrointestinal Endoscopy Unit, taught physicians during their graduate and postgraduate training, and performed specialized, non-endoscopic, gastrointestinal testing. He carried out Public Health Service-sponsored (National Institutes of Health) clinical and basic research into mechanisms of the formation of gallstones and methods for the non-surgical treatment of gallstones. He is the author of 36 original research manuscripts and 24 book chapters. He is Co- Editor of the Webster's New World™ Medical Dictionary, Year 2000 First Edition. Dr. Marks presently directs an independent Gastrointestinal Diagnostic Unit where he continues to perform specialized tests for the diagnosis of gastrointestinal diseases.


I'll give a summary here of the article, but for the full version refer to http://www.medicinenet.com/small_intestinal_bacterial_overgrowth/article.htm. 


What is SIBO?


The entire gastrointestinal tract, including the small intestine, normally contains bacteria. The number of bacteria is greatest in the colon (at least 1,000,000,000 bacteria per milliliter (ml) of fluid) and much lower in the small intestine (less than 10,000 bacteria per ml of fluid). Moreover, the types of bacteria within the small intestine are different than the types of bacteria within the colon. Small intestinal bacterial overgrowth (SIBO) refers to a condition in which abnormally large numbers of bacteria (at least 100,000 bacteria per ml of fluid) are present in the small intestine and the types of bacteria in the small intestine resemble more the bacteria of the colon than the small intestine. 


What Causes SIBO?

The gastrointestinal tract is a continuous muscular tube through which digesting food is transported on its way to the colon. The coordinated activity of the muscles of the stomach and small intestine propels the food from the stomach, through the small intestine, and into the colon. Even when there is no food in the small intestine, muscular activity sweeps through the small intestine from the stomach to the colon.

The muscular activity that sweeps through the small intestine is important for the digestion of food, but it also is important because it sweeps bacteria out of the small intestine and thereby limits the numbers of bacteria in the small intestine. Anything that interferes with the progression of normal muscular activity through the small intestine can result in SIBO. Simply stated, any condition that interferes with muscular activity in the small intestine allows the bacteria to stay longer and multiply in the small intestine. The lack of muscular activity also may allow bacteria to spread backwards from the colon and into the small intestine.

SIBO Symptoms


- excess gas
- abdominal bloating and distension
- diarrhoea
- abdominal pain



A small number of patients with SIBO have chronic constipation rather than diarrhoea. When the overgrowth is severe and prolonged, the bacteria may interfere with the digestion and/or absorption of food, and deficiencies of vitamins and minerals may develop. Weight loss also may occur. Patients with SIBO sometimes also report symptoms that are unrelated to the gastrointestinal tract, such as body aches or fatigue. The reason for these symptoms is unclear. The symptoms of SIBO tend to be chronic. A typical patient with SIBO can experience symptoms that fluctuate in intensity over months, years, or even decades before the diagnosis is made.


In patients with SIBO, large numbers of gas-producing bacteria (normally present in the colon) are present in the small intestine. The abundant bacteria in the small intestine compete with the small intestine the digestion of sugars and carbohydrates, but unlike the small intestine, the bacteria and produce large amounts of gas.


How does SIBO cause symptoms?


When bacteria digest food in the intestine, they produce gas. The gas can accumulate in the abdomen giving rise to abdominal bloating or distension. Distension can cause abdominal pain. The increased amounts of gas are passed as flatus (flatulence or farts). The bacteria also probably convert food including sugar and carbohydrate into substances that are irritating or toxic to the cells of the inner lining of the small intestine and colon. These irritating substances produce diarrhea (by causing secretion of water into the intestine). There is some evidence that the production of one type of gas by the bacteria-methane-causes constipation.


Relationship between SIBO and irritable bowel syndrome (IBS)


Irritable bowel syndrome (IBS) is a common gastrointestinal condition. Patients with IBS typically complain of abdominal pain associated with bloating, gaseousness, and alterations in their bowel habit (diarrhea, constipation, alternating diarrhea and constipation, or a sense of incomplete evacuation of stool). IBS is a chronic condition. Symptoms can be continuous or vary over months, years, or even decades. While irritable bowel syndrome is not life-threatening, symptoms of irritable bowel syndrome can have a major impact on a person's quality of life and can even be debilitating. For example, a patient with diarrhea after meals may avoid eating out. Patients who experience bloating and abdominal pain after meals may develop a fear of eating. In its extreme, they may even lose weight. Even flatulence can be socially limiting.


There is a striking similarity between the symptoms of IBS and SIBO. It has been theorized that SIBO may be responsible for the symptoms of at least some patients with irritable bowel syndrome. The estimates run as high as 50% of patients with irritable bowel syndrome. Support for the SIBO theory of IBS comes from the observation that many patients with IBS are found to have an abnormal hydrogen breath test, and some patients with irritable bowel syndrome have improvement of their symptoms after treatment with antibiotics, the primary treatment for SIBO. Furthermore, it has been reported that successful treatment of symptoms with antibiotics causes the hydrogen breath test to revert to normal, suggesting that bacteria indeed are causing the symptoms.


Treatment


The two most common treatments for SIBO in patients with IBS are oral antibiotics and probiotics. Probiotics are live bacteria that, when ingested by an individual, result in a health benefit. The most common probiotic bacteria are lactobacilli (also used in the production of yogurt) and bifidobacteria. Both of these bacteria are found in the intestine of normal individuals.

The following are some treatment options:

• Neomycin orally for 10 days. Neomycin is not absorbed from the intestine and acts only within the intestines.

• Levofloxacin (Levaquin) or ciprofloxacin (Cipro) for 7 days.

• Metronidazole (Flagyl) for 7 days.

• Levofloxacin (Levaquin) combined with metronidazole (Flagyl) for 7 days.

• Rifaximin (Xifaxan) for 7 days. Rifaximin like neomycin is not absorbed from the intestine, and, therefore, acts only within the intestine. Because very little rifaximin is absorbed into the body, it has few important side effects. Higher than normal doses of rifaximin (1200 mg/day for 7 days) were superior to the standard lower doses (800 or 400 mg/day) in normalizing the hydrogen breath test in patients with SIBO and IBS. However, it is not yet known whether the larger dose is any better at suppressing symptoms.

• Commercially available probiotics such as VSL#3 or Flora-Q, which are mixtures of several different bacterial species, have been used for treating SIBO and IBS, but their effectiveness is not known. Bifidobacterium infantis 35624 is the only probiotic that has been demonstrated to be effective in treating patients with IBS.

One option is to initially treat the patient with a short course of antibiotics and then long-term with probiotics. Long-term studies comparing antibiotics, probiotics, and combinations of antibiotics and probiotics are badly needed.


I hope this article helps some people out there. I am currently on VSL#3 myself, and it has reduced the flatulence a bit in my opinion, but I still have problems. I'm going to suggest taking a course of antibiotics to my specialist and see what he thinks. Personally, I don't see the harm in taking one course of antibiotics and then after take a course of probiotics. Reminds me of a computer. Cleaning out all of the bugs and then reintroducing the software.


Shikz