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Options for Treating Gastrointestinal Diseases, Especially SIBO

doctor holding intestine diagram

Abdominal pain is one of the most common complaints seen in emergency rooms and doctor's offices, according to a 2012 report published in Gastroenterology. The reason for GI tract disturbances vary but more and more practitioners are testing for small intestine bacterial overgrowth (SIBO) as the possible cause.

The normal flora of the small intestine includes both good and bad bacteria. For people with SIBO, one form of microorganism has overgrown, disrupting this balance. The result is symptoms of bloating and stomach pain. What causes SIBO and what are the treatment options?

What is SIBO?

The human digestive sustem is supposed to be a balance of pathogenic (bad) and beneficial (good) bacteria. They keep each other in check to maintain this delicate ecosystem. In some people the system fails, though, and one type of bacteria takes over and disrupts the normal functioning of the digestive tract.

Some symptoms of SIBO include:

  • Abdominal bloating and distention
  • Gas
  • Diarrhea
  • Pain
  • Malnutrition
  • Unexplained weight loss

It's a condition that is often associated with irritable bowel syndrome (IBS), so the two have similar symptoms.

The Dietary Approach to Treating SIBO and Other Gastrointestinal Disorders

Proper diet is an essential first step in the management and treatment of disorders like SIBO. The Physician’s Elemental Diet, for example, offers a nutritional balance to ensure those with gastrointestinal problems get essential vitamins, electrolytes and minerals. The diet consists of a powdered formula that is gluten, soy and dairy free and hypoallergenic. This plan should be used under medical supervision and is effective both as the sole food source or in combination with a strategic half-diet plan.

The nutrients in the elemental diet come predigested, making them easier to process. For best results, the elemental diet should not include any additional food beyond the powdered formula for at least two to three weeks. It is a strategy that has proven to improve the symptoms of SIBO.

Once food is reintroduced into the diet, the timing of meals is essential. Fasting can trigger contractions in the small intestine that help clean it of excess bacteria. For this reason, treatment recommendations for gastrointestinal diseases often include four to five hour gaps between eating and, at least, 12 hours at night.

What About Medical Intervention for GI Diseases?

For SIBO, the most common treatment is antibiotics. The problem with this approach is that SIBO is typically chronic. As soon as you stop taking the antibiotics, the problem recurs.

Some people respond well to the long-term approach offered with herbal antimicrobials and other herbal supplements that support a healthy intestinal tract. Supplements that contain Oregon grape, for example, are used clinically to control bacteria growth in the small intestine. For other GI diseases like IBS, adding fiber supplements and pain medication help manage the symptoms.

SIBO is just one of a number of gastrointestinal conditions that can have an impact on your life. Finding the right balance of therapeutic treatment, diet and supplements may be the key to feeling better.



What is Small Intestine Bacterial Overgrowth (SIBO)?


Small intestine bacterial overgrowth (SIBO) is a disorder characterized by an excessive growth of bacteria in the small intestine. The large intestine normally has high levels of bacteria, but the small intestine should be virtually free of bacteria by comparison. SIBO causes various gastrointestinal symptoms that are also shared by many other disorders, making a positive diagnosis challenging. 


The symptoms of bacterial overgrowth include the following:

  • Abdominal distension
  • Abdominal pain
  • Bloating
  • Constipation
  • Diarrhea
  • Fatigue
  • Flatulence
  • Nausea
  • Weakness

Bacteria in the small intestines metabolize nutrients, which prevents those nutrients from being absorbed through the intestinal walls. The byproducts of this metabolism can inflame the small intestines, causing many of SIBO’s symptoms. The malabsorption of nutrients can also cause weight loss and malnutrition, which can have particularly severe consequences in developing children.

Long-term Effects

The long-term effects of SIBO include anemia, which can develop through a variety of mechanisms. The production of red blood cells is particularly sensitive to nutritional malabsorption since iron is primarily absorbed by the first parts of the small intestine, primarily the duodenum and jejunum. The malabsorption of iron can cause red blood cells to be smaller than normal, a condition known medically as microcytic anemia.

SIBO can also result in the malabsorption of vitamin B-12, which normally occurs in the last part of the small intestine, or ileum. This type of malnutrition can cause many conditions, including large red blood cells, or megaloblastic anemia. Older adults with chronic SIBO also have a lower body mass index, a higher rate of diarrhea and a lower level of serum albumin.


Bacterial metabolism of carbohydrates in the small intestine produces a number of byproducts, including hydrogen and methane. These gases can be detected by various methods, which are often used as presumptive tests for SIBO. Testing the level of hydrogen and methane in the breath generally requires the patient to fast for at least 12 hours before drinking a substrate containing a sugar such as glucose or lactulose. The level of these gases in the patient’s expired breath can then be measured over a period of several hours. This type of test compares favorably with the measurement of aspirates from the jejunum, which is the gold standard for diagnosing SIBO.

The small intestine normally has less than 104 bacteria per milliliter (ml) of aspirate, so a level above 105 bacteria/mm is typically considered to be SIBO. However, some experts set the threshold for SIBO at 103 bacteria/mm if the bacteria are primarily colonic types, which are more likely to cause pathological conditions in the small intestine.

SIBO has a significant overlap in findings with other gastrointestinal conditions such as post-infectious irritable bowel syndrome and tropical sprue. Furthermore, an acute gastrointestinal infection can occasionally trigger SIBO.


A course of antibiotics is the most common treatment for SIBO, although it isn't always a first-line treatment. Some experts recommend probiotics, prokinetics, specialty diets and/or herbal antimicrobials as the first-line treatment, while reserving antibiotics as the second-line treatment for severe cases of SIBO. Rifaximin provides the best evidence for use for diarrhea-predominant SIBO, although the following antibiotics have been referenced for use to treat SIBO:

  • amoxicillin-clavulanate
  • cephalexin
  • fluoroquinolones
  • metronidazole
  • neomycin
  • nitazoxanide
  • tetracycline
  • trimethoprim-sulfamethoxazole

A one-week course of antibiotics is usually sufficient to treat SIBO. However, a recurrence may require a cyclical course of treatment with to prevent the bacteria from developing a tolerance for the antibiotic. A cyclical course may consist of using the same antibiotic for one week, then discontinuing treatment for three weeks and repeating this cycle. Another type of cyclical therapy is to change the antibiotic at regular intervals. Prokinetic drugs are another treatment option for SIBO, although the current research on this application is still developing.

The underlying condition resulting in the patient’s predisposition to SIBO should also be treated. For example, if the SIBO was caused by chronic pancreatitis, the patient should receive pancreatic enzyme supplements.


QuinTron Instrument Company, Inc. is an industry leading manufacturer of non-invasive breath analyzers and breath test kits. We provide patented breath tests to help physicians narrow down the root cause of their patients’ gastrointestinal issues. We also have developed specialized testing products for other applications such as cancer research, veterinary sciences, naturopathic medicine and pharmaceutical research. Call us today to find out how we can help you.