Ever felt that everything you eat makes you bloat?

Have your symptoms been dismissed as irritable bowel syndrome? You could have SIBO.

SIBO – that is, small intestinal bacterial overgrowth. Research is slowly growing on this common cause of abdominal bloating and pain. However, as with all early research, it won’t necessarily have found its way into the mindset of your local GP or gastroenterologist yet.

Research shows that SIBO is common to develop in people who have been put on proton pump inhibitors (for example, Nexium, Losec and Pariet). SIBO may also be present after bowel surgery, which may lead to changes in motility (i.e. the movement through the gut). (On the former topic, there are a number of unwanted side effects of reflux medications, or proton pump inhibitors).

Some research shows SIBO is present in around 40% of people with IBS, but it may be even higher. Common symptoms are diarrhoea (more common than constipation), abdominal pain and bloating. Longer term symptoms can be nutrient deficiencies, leading to low iron (for example) or even iron-deficiency anaemia,

So what is SIBO – how can you find out if you have it – and what can you do about it?

To understand SIBO, you need to know a little about the normal gut. It is normal to have large numbers of normal bacteria in the colon, or the large intestine. However, numbers of normal bacteria in the upper gut, or small intestine, should be much lower. In SIBO, there is an increase in the numbers of normal bacteria in the small intestine. These bacteria are not the “bad guys” – so it’s not the same as having an infection – rather, there are simply too many of them in the wrong place. In this situation, using probiotics (“good bacteria”) is a bad idea. It won’t help, and can possibly make the problem worse.

This increased number of bacteria in the upper gut causing increased fermentation when you eat, leading to the common symptoms of irritable bowel syndrome, especially bloating and pain.

Interestingly, though, SIBO may contribute to symptoms in a whole range of other conditions as well, from fibromyalgia to interstitial cystitis.

Here’s what you need to know about diagnosing SIBO.

SIBO cannot be diagnosed via a blood test or stool test. It can’t be diagnosed via an endoscopy. This also means it cannot be ruled out by an endoscopy. So if you have had a normal endoscopy, and your gastroenterologist says “you’re fine, it’s just a little bit of irritable bowel syndrome”, SIBO is a possibility.

It’s always important to get the main medical things ruled out first. Other conditions with overlapping symptoms include inflammatory bowel disease, coeliac disease, non-coeliac gluten sensitivity and FODMAPS malabsorption. As I have said in another blog post, it’s ideal to aim for an accurate diagnosis before excluding gluten from the diet. Symptoms of coeliac disease vary, and there are essentials you should know if suspecting coeliac disease in your child. It may also help to understand the effects of stress on irritable bowel syndrome in more detail.

But if you have had these things ruled out, you may wish to investigate SIBO.

If SIBO is confirmed, there is a very effective herbal antimicrobial and specific dietary regime available for treatment. We are trained in the this at Equilibria.

If you would like more information on whether you could have SIBO, contact us.

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