SIBO and H. pylori: What’s the Connection?

When trying to get your gut health in check, it’s necessary to recognize the connection between SIBO (small intestinal bacterial overgrowth) and H. pylori (Helicobacter pylori).

Besides the unconventional names, both conditions indicate a gut microbiome disruption. They impact different areas of the digestive tract, but they overlap in many other ways—symptoms, causes, consequences, and yes, even treatment.

What is H. pylori? And How Does It Relate to SIBO?

H. pylori is the name of a spiral-shaped bacterium that infects the lining of the stomach and the upper portion of the small intestine. Even though we might not hear much about it, H. pylori is extremely common and impacts almost half the global population.

H. pylori is often acquired during childhood. The incidence of H. pylori is lower in the United States, with only about 5% of the general population under 10 carrying the bacteria. Why is it so ubiquitous? Because it can be completely asymptomatic. Many people never realize they have, or have had, it. Still, for a particular segment of people, active Helicobacter pylori can cause long-term damage to the stomach lining and a higher risk for issues like gastritis and gastric ulcers.

If you are experiencing symptoms like chronic bloating, abdominal pain, nausea, or unexpected weight changes, a bacterial imbalance could be at the root of your situation. Because of the possibility of overlap and connection between the two, tackling H. pylori might be critical for successfully treating SIBO.

Like H. pylori, SIBO also indicates an overproliferation of bacteria in the small intestines. SIBO occurs when the bacteria in the small intestine suddenly increase in growth. The overgrowth of bacteria wreaks havoc on your system, resulting in digestion disruption, inflammation, and similar symptoms of gas, bloating, abdominal pain, diarrhea, and constipation.

The two conditions refer to different but adjacent parts of the gastrointestinal tract and can be connected in surprising ways. Both can also mimic other disorders like irritable bowel syndrome (IBS). Many treatments can also positively affect both conditions, but the first step is always testing with medical experts to ensure you’re on the right path. 

How Are SIBO and H. pylori Connected?

Both conditions cause symptom overlap. You may experience bloating, abdominal pain, nausea, and changes in bowel movements with either diagnosis. Because of this, the two conditions are easily mistaken for one another, and patients can go undiagnosed or mistreated if only one of the conditions is identified.

Both SIBO and H. pylori flourish when stomach acid levels are low. Stomach acid is a natural protective barrier that destroys unwanted bacteria in our digestive systems. When acid production drops, bacteria can migrate to places they shouldn’t and give off higher levels of gases as they digest sugars and other foods in the digestive tract.

Stomach acid is influenced by medication use, infection, and aging. Acid-suppressing medications, called proton pump inhibitors (PPIs), are often suggested for the treatment of H. pylori-related acid reflux. However, these treatments can increase the risk and development of SIBO by lowering stomach acid levels. In fact, long-term PPI use has been theorized as one of the most common drug-related contributors to bacterial overgrowth.

If you’re already dealing with H. pylori, the damage it can cause to your stomach lining and the changes in your gut biome pH create a welcoming environment for excess bacteria. This sets the stage for secondary SIBO. Similarly, people with chronic SIBO may have compromised gut health to the point that H. pylori becomes virulent and reactivated.

While scientists are still exploring this connection between H. pylori and SIBO, there is support for the link between H. pylori infection and altered gut ecology. Acidic pH levels can influence H. pylori growth and alter the gastric microbiome. This may contribute to downstream SIBO.

The bidirectional influence between H. pylori and intestinal flora has also been explored, supporting the idea that treating one condition can positively impact the other and significantly improve both. But which should you treat first?

Should You Treat H. Pylori Before SIBO?

This question comes up often, and it’s complicated and individualized. In some cases, treating H. pylori infection first makes sense (particularly if it’s actively causing painful ulcerations or stomach inflammation). Addressing the H. pylori first may help restore stomach acid production, which in turn could reduce the risk of persistent SIBO.

However, treatment protocols are very tricky. Standard H. pylori treatment includes antibiotics along with acid-suppressing drugs (PPIs), increasing SIBO risk. Some clinicians prefer to treat SIBO and H. pylori sequentially, while others work to manage both conditions concurrently using a careful selection of antimicrobial protocols.

The most important advice when addressing SIBO and H. pylori is NEVER to DIY your gut protocol. Working with an experienced and trusted healthcare professional familiar with your medical history is crucial. Don’t experiment with treatment for gastrointestinal conditions without guidance.

Effective treatment for both SIBO and H. pylori involves strong medications, sensitive timing, and a targeted course of antibiotics. Self-treating by following someone else’s protocol (especially from the internet) or jumping between herbal remedies can worsen your symptoms and ultimately prolong your recovery.

Even natural remedies, such as supplements, may impact the gut’s pH and microbial balance. A study in Integrative Medicine underscores the importance of following an individualized treatment plan instead of a generic, “one-size-fits-all” approach.

Treatment Starts with Testing for Both Conditions

If you suspect that you might have one or both conditions, it’s essential to be tested by a healthcare professional.

Often, the steps will involve a simple breath test to determine which conditions are causing your discomfort. H. pylori breath tests are non-invasive and widely used. Breath tests for SIBO evaluation can be ordered through QuinTron and performed in the privacy of your home or office.

Clinicians may order further tests after exploring the initial test results. These tests can include stool antigen tests or blood antibody tests to rule out other conditions. From the point of a proper diagnosis, professionals can help you navigate the appropriate treatment plan and get your digestive balance and bacterial growth back on track.