Therefore, it would follow that probiotics would be counterproductive to treating and managing SIBO.Īnother school of thought is that SIBO is caused or worsened by the presence of a "bad" bacteria, or a bad mix of bacteria. One school of thought is that SIBO is not due to a "bad" bacteria, but rather a simple overgrowth of ordinary / healthy bacteria. The role of probiotics in treatment is controversial. Pro-kinetic Agents Įxperts also recommend the use of prokinetic drugs or herbs for those for whom dysmotility is an issue. ĭiets have been used and/or shown to be helpful in treating or controlling SIBO include: However, one study comparing two herbal formulations to standard treatment found herbs to be as or more effect as antibiotics for eradicating SIBO. Neomycin is sometimes given in addition to Rifaximin when methane-producing bacteria are present.Only a small percentage of the drug is absorbed by the body, and its activity is mostly limited to the small intestine. It is effective on hydrogen producing bacteria, but not methane producing bacteria. Rifxaimin is the most commonly used antibiotic used for SIBO treatment.These antibiotics may be synthetic or herbal, though synthetic antibiotics appears to be used most often. However, certain antibiotics are used preferentially when treatment is explicitly targeting SIBO. Īny antibiotic that is active in the small intestine may potentially affect the bacterial flora and therefore SIBO. Treatment via antibiotics is most common. Treatment generally involves some combination of antibiotics, dietary changes, pro-kinetic agents, and probiotics. SIBO can also cause carbohydrate and protein malabsorption. In severe cases, malabsorption of fat-soluble vitamins ( A, D, E and K) due to the deconjugation of bile salts can cause neuropathies and immune dysfunction. It can also cause excess folic acid due to synthesis by bacteria in the small bowel.
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Vitamin B12 malabsorption may be caused by competitive uptake of B12 by bacteria in the small intestine. It can cause malabsorption of nutrients including iron and Vitamin B12, resulting in microcytic anemia or megaloblastic anemia. It causes increased permeability of the small intestine. Symptoms include bloating, abdominal distension, abdominal pain or discomfort, diarrhea, fatigue, weakness, and brain fog. The symptoms of SIBO can vary greatly depending on the severity and the species of bacteria populating the small intestine. Higher levels of Enterococcus and Stretptococcus have been found in ME/CFS patients. It is believed that this enables lipopolysaccharides from bacteria, food particles, and other undesirable substances to enter the blood stream, ultimately leading to an inflammatory response.īacteria commonly implicated in SIBO include Escherichia coli, Streptococcus, Lactobacillus, Bacteroides and Enterococcus. SIBO appears to cause increased intestinal permeability, also known as Leaky Gut. SIBO cannot be diagnosed via stool testing. But this is rare due to the difficulty and cost of retrieving a sample from the small intestine.
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Sometimes it is diagnosed using a bacterial culture. SIBO is usually diagnosed via a Lactulose breath test. One study found that a 100% of fibromyalgia patients tested positive to a lactulose breath test, indicating SIBO, and that the degree of abnormality on the breath test correlated with the amount of pain reported. Several studies have shown that up to 84% of patients with irritable bowel syndrome have SIBO and that symptoms improve after treatment, while others fail to replicate these results. Patients with CFS have alterations in microbiota, including lower levels of bifidobacteria and SIBO. One study found 77% of CFS patients had SIBO and eradication lead to decrease in chronic fatigue syndrome symptoms. Comorbidities Īnecdotal reports suggest a high prevalence of SIBO among CFS patients. The rate of a positive lactulose test is low in healthy adults (0 to 20%).