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Manipulative Medicine and GI Health

Patient having GI tract adjusted by physician

The National Institute of Diabetes and Digestive and Kidney Diseases reports that up to 70 million people in this country have a digestive disorder such a Crohn’s Disease or irritable bowel syndrome. Gastrointestinal disorders are notoriously hard to treat because there are so many variables attached to controlling them including lifestyle choices. Often people will look beyond drug therapies to lesser-known treatment options like manipulative medicine.

What is Manipulative Medicine?

Manipulative medicine is a term that is poorly understood. From a professional standpoint, it means osteopathic manipulative medicine, a specialized branch of medicine. Often healthcare consumers will lump alternative therapies into this category, too, such as chiropractic treatment and acupuncture. Manipulative medicine can also include allied health professions like physical therapy.

All of these fields have one thing in common; they use tissue manipulation to promote healing. By manually manipulating muscle and soft tissue, these treatments may improve the quality of life for those suffering from digestive disorders such as:

  • Irritable bowel syndrome (IBS)
  • Dyspepsia
  • Constipation
  • Diarrhea
  • Abdominal bloating
  • GERD
  • Inflammatory Bowel Disease (IBD) sometimes called Crohn's Disease

Since mainstream medical therapies don’t always work for gastrointestinal conditions, it may be beneficial to explore other treatment options like manipulative medicine.

Osteopathic Manipulative Therapy

Typically, osteopathic treatment is for problems of the joints and muscles like arthritis or back pain. There is evidence that manipulative treatment can help digestive disorders, too. A 2014 study published in The Journal of the American Osteopathic Association found manipulative therapy worked for those with irritable bowel syndrome, for example.

The goal of most osteopathic treatments is to make use of the body’s ability to heal itself. Osteopathic doctors (DOs) use stretching techniques to improve fluid movement and enhance digestive functioning.

Some common osteopathic treatments would include:

  • Stretch of the lesser omentum
  • Stretch of the vertical region of the duodenum
  • Stretch of the first part of the duodenum

It’s important to remember that osteopathic doctors are medical doctors with additional training so that they may use these techniques in combination with drug therapies and medical procedures.

Chiropractice Manipulation

Like osteopathic techniques, a chiropractor uses tissue manipulation to treat disorders of the musculoskeletal system. Some practitioners use their treatments to manage digestive disorders, as well. They theorize the nervous system is in control of digestive function and correcting spinal misalignments improves that connection.


Acupuncture uses needles to manipulate certain points on the body and improve the flow of energy. Acupuncture practitioners believe a disruption of energy is the ultimate cause of many gastrointestinal disorders. Treatments can work to:

  • Change the levels of acid secretion
  • Improve GI mobility
  • Reduce visceral pain

Applying needles to the lower limbs may cause contractions that improve digestive functioning. Application to the upper abdomen relaxes muscles that affect the GI tract.

Physical Therapy (PT)

Physical therapy specialists use mechanical force and movement to improve mobility and enhance healing. The combination of manipulative techniques and exercises treat the symptoms of some gastrointestinal disorders such as bloating or constipation. Decreased physical activity is often a source of intestinal problems, as well, so a physical therapist may improve internal mobility by stimulating and exercising those muscles.
Physical therapists can manipulate the visceral structures in the gut to:

  • Relieve symptoms
  • Release adhesions
  • Relax the parasympathetic nervous system
  • Improve the peristaltic movement

The may also recommend home exercise in conjunction with PT to strengthen muscles and support the GI tract better.

It's never wise to ignore chronic intestinal problems. See your doctor and find out why they occur then maybe consider how manipulative medicine might help.



The subtle differences in gastrointestinal diseases

Gastrointestinal (GI) diseases are extremely common and affect virtually everyone at some point. Approximately 60 to 70 million people are suffering from these diseases at any given time in the United States, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Many GI diseases cause symptoms that are merely nuisances, while others can be life-threatening if left untreated. However, these diseases often produce the same symptoms, making it difficult to distinguish between them without laboratory tests. Fortunately, careful observation of these symptoms can often help identify the subtle differences in GI diseases.

Crohn's Disease and Ulcerative Colitis

Crohn’s disease and ulcerative colitis (UC) are both inflammatory bowel diseases (IBDs) that cause GI problems. They have many of the same general symptoms, including diarrhea, loose stools, rectal bleeding, abdominal cramps and weight loss. Both diseases cause inflammation, typically manifest in young adults, and are indiscriminate as to gender. Doctors must therefore consider specific differences between these two G.I. diseases to make a diagnosis.

UC often causes blood in the stool and diarrhea, but these symptoms are significantly less likely in Crohn's disease. Both disorders can cause abdominal cramps, but they're typically more severe with Crohn's disease. Nausea, weight loss and vomiting are also more common in Crohn's disease than UC. Inflammation is common in both disorders, but its location can be a distinguishing feature. For example, Crohn's disease can affect the entire GI tract, from mouth to anus. In the case of UC, only the colon becomes inflamed.

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a collection of symptoms that generally includes abdominal pain and changes to bowel movement patterns in the absence of an underlying cause. Symptoms are typically chronic and may last for years. As a result, Chronic Fatigue Syndrome (CFS) is also common among people with IBS.

Healthcare professionals recognize four primary types of IBS based on the presence of constipation and diarrhea. Frequent diarrhea without constipation indicates IBS-D, while frequent constipation without diarrhea indicates IBS-C. Both symptoms are common in IBS-M, while neither symptom is common in IBS-U.

These symptoms usually occur as separate acute attacks that subside after 24 hours, although recurring attacks are also common. Abdominal bloating can occur in all form of IBS, along with an urgency for a bowel movement and a feeling of incomplete evacuation afterwards in the case of IBS-C and IBS-M. However, the symptoms of IBS-D and IBS-M are more likely to be relieved by a bowel movement.

IBS is more likely to cause gastroesophageal reflux and genitourinary symptoms than other GI diseases. It's also more closely associated with backaches, headaches and fibromyalgia. The chronic nature of IBS routinely affects the sufferer’s quality of life, resulting psychological symptoms such as anxiety and depression. These symptoms are relatively rare in other GI diseases, especially those that aren’t chronic. Another symptom that can help distinguish IBS from similar disorders is a loss of libido, which affects about one third of sufferers.

Celiac Disease and Gluten Sensitivity

Celiac disease is an auto-immune disorder in which an individual has an immune reaction to gluten, which is a protein found in grains such as wheat, barley and rye. Gluten sensitivity is a related disorder that occurs when someone has a low tolerance for gluten, although it isn’t an auto-immune disorder like Celiac disease. HealthGrades reports that up to five percent of the U.S. population has gluten sensitivity, while less than one percent suffer from Celiac disease.

Both Celiac disease and gluten sensitivity cause similar GI symptoms when gluten is ingested, including abdominal pain, bloating and diarrhea. However, the immune reaction in Celiac disease also damages the lining of the small intestine. In contrast, gluten sensitivity doesn’t actually cause damage, despite its symptoms.


The Connection between GI Problems and Autism

Seventy percent of children on the Autism Spectrum have some type of gastrointestinal problem. Compare that to 28 percent of kids who meet the standard developmental milestones such as talking and making eye contact by a certain age, and there seems to be a clear correlation. Although the data does show a link exists between GI problems and autism, medical science isn’t clear as to why.

What are common GI Problems Found in Autistic Children?

The most common complaints, according to a 2010 report published in Pediatrics, are:

  • Diarrhea
  • Constipation
  • Gastroesphageal reflux or heartburn

The incidents of constipation, especially, are potentially severe. A 2015 study published by the International Society for Autism Research found that children with autism have four times the risk of hospitalization due to severe constipation.

A second 2015 study listed in Microbial Ecology in Health and Disease suggests that diet might be a significant factor in controlling or triggering behaviors in those with autism. The report would seem to indicate that gut health may be a factor for kids on the Autism Spectrum.

Eating Habits and Autism

Food and eating problems are also common with autism. These children tend to have sensitive palates, so they refuse foods with a particular texture or taste. Those limitations can leave them with a restrictive diet and even unhealthy eating habits such as:

  • Overeating
  • Pica or eating non-food items like hair

Both can contribute to potential GI issues like small intestinal bowel overgrowth (SIBO).

Small Intestinal Bowel Overgrowth and Autism

The presence of small intestinal bowel overgrowth (SIBO) in autistic children is a theory gaining traction when it comes to the obvious GI issues. Small bowel overgrowth means there are more microbes in the small intestine than usual. Typically, bacteria live mostly in the large intestine where they help break down food to allow for the absorption of nutrients.

A healthy small bowel, on the other hand, rarely harbors many bacteria. In cases of SIBO, bacteria from the large intestine grow where they don't belong - in the small bowel. That bacteria overgrowth can wear down the lining of the intestine leading to a condition called leaky gut.

With leaky gut, undigested food, bacteria and byproducts pass through the intestine into the bloodstream causing inflammation in other areas of the body. SIBO can also lead to poor nutrition. The nutrients necessary for good health never make it to the large intestine for absorption.

What Can Parents Do?

Monitor things like behavior, gas, bloating and cramps when eating specific foods and before going to the bathroom. Take that information to the doctor to help assess ongoing gut problems. Keep a diary to write things down such as:

  • Foods the child likes
  • Foods the child refuses to eat
  • Any complaints about stomach pain
  • Behavior patterns before and after meals
  • Number of bowel movements
  • Consistency and color of stool

Consider testing for SIBO, as well. The simplest way to detect bacterial overgrowht is with the hydrogen breath test. Once identified, SIBO specific diets might help manage the GI symptoms and provide relief.



How Eating Disorders Can Affect Your Intestinal Tract

woman examining stomach in mirror

Eating disorders affects nearly every tissue and organ in your body, but they can have serious consequences on your digestive tract. Food restrictions and purging interferes with the normal function of nearly every organ in your digestive system, including your stomach and intestines. Very low calorie diets and other diets with severe food restrictions do not provide the nutrients your digestive tract needs for good health.

Purging is common in many types of eating disorders. Purging behaviors include self-induced vomiting, laxative abuse to speed bowel movements and the abuse of diuretics, which are drugs that remove excess fluid from the body by increasing urine. Research shows that vomiting causes the most medical complications, but other purging behaviors also cause health problems.

Digestive Problems Associated with Eating Disorders


Eating disorders can cause slowed digestion, also known as gastroparesis. Purging and food restrictions interfere with the way your stomach empties into your small intestine and affects the way your small intestine absorbs nutrients from food.

These can lead to a number of uncomfortable and potentially serious problems, such as:

  • Stomach bloating and pain
  • Nausea, vomiting
  • Fluctuations in your blood sugar
  • Solid masses of undigested food blocking your intestines
  • Bacterial infections
  • Feeling full after you eat only small amounts of food

Eating vegetables and high fiber foods can cause bloating and pain. Consuming sugar-free foods that contain sorbitol can also cause painful bloating.


Prolonged food restrictions can cause the muscles along your entire digestive tract to slow down, or atrophy. This means the muscles that push food and stool through your intestinal tract slow down, and this can lead to constipation. Long-term food restrictions can weaken the intestinal muscles so much that they are too weak to push stool out of your body, leading to severe constipation.

Many people with eating disorders use laxatives in hopes of pushing food through their digestive tract before their intestines have a chance to absorb the calories from food. Laxatives work by stimulating the nerves in the digestive tract walls in ways that speed up bowel movements. Abusing laxatives can damage the intestinal nerve endings, leaving your body dependent on laxatives to have a bowel movement.


Even binge eating can cause digestive problems. Eating large quantities of food in one sitting can actually cause your stomach to rupture, which is a life-threatening emergency. The risk of stomach rupture, while small, is higher after fasting for a long time.

Chronic and frequent vomiting can cause problems – including ruptures – in other parts of your digestive tract. Frequent vomiting for weeks or months can wear down your esophagus, which is the food pipe that connects your throat with your stomach. This erosion can eventually cause your esophagus to rupture, which can be life threatening. Frequent vomiting can also cause persistent sore throats and a hoarse voice. Chronic vomiting can even cause swelling in the salivary glands that sit under your jaw and in front of your ears.


Your pancreas produces insulin, which is a hormone that helps your body absorb sugar from your bloodstream. Purging and malnutrition can cause inflammation of your pancreas, a condition known as pancreatitis. Symptoms of pancreatitis include pain, nausea, and vomiting.

Excessive use of laxatives can damage your pancreas to cause pancreatitis and affect the way your pancreas produces insulin, which can lead to high blood sugar.

Bacterial overgrowth

Eating disorder behaviors can lead to small intestinal bacterial overgrowth (SIBO), a condition in which bacteria that normally grow in other parts of the body suddenly start growing in the small intestine instead. SIBO can cause pain and diarrhea.

Treatment for eating disorders can alleviate intestinal problems for many people, but eating disorders can cause long-term digestive problems for other people. For more information on how eating disorders can affect your intestinal tract, or to find out if an eating disorder has left behind a long-term intestinal problem, speak with your healthcare professional.



Opioids and GI Problems: What's the Connection?

Opioid addiction is on the rise in this country. The U.S. Department of Health and Human Services reports more than 42,000 overdose deaths in 2016 and that number continues to grow each year. The consequences of this epidemic go beyond the risk of overdose, though. the chronic use of drugs like heroin, Oxycontin or Roxicodone has a staggering effect on the human body, as well, including the gastrointestinal tract. Consider some ways using opioids can impact your GI tract.

Why is Opioid Use on the Rise?

The National Institute of Drug Abuse states the opioid crisis actually began in the 1990s. Pharmaceutical companies marketed opioid drugs to the medical community claiming they were not addictive. With that reassurance, physicians began prescribing these drugs to their patients to relieve pain. The increase of prescription opioid drugs circulating among the population eventually led to rampant misuse and addiction.

Anyone who takes an opioid drug has the potential to become addicted. Opioids stimulate the pleasure center of the brain in such a way that users feel they can’t live without that feeling. Their tolerance level builds up, so they need more of the drug to get high and fulfilling that craving takes over their lives.

The Gastrointestinal Side Effect of Opioid Use

There are a number of complications associated with the short and long-term use of opioids. For example, the drug may lower your blood pressure, especially when combined with over-the-counter medications or alcohol. It’s the gastrointestinal tract that is affected the most, though. Opioids work by acting on opioid receptors throughout the body and there are a great number of these in the GI tract.

It is estimated that around 25 percent of people get physically sick after taking an opioid but nausea and vomiting tend to pass quickly. It’s the long-term consequences of addiction that are the most alarming including opioid bowel dysfunction.

What is Opioid Bowel Dysfunction?

Opioid bowel dysfunction is something that can happen to anyone taking opioids whether it’s to feed an addiction or for therapeutic use. The primary symptom of Opioid Bowel Dysfunction is constipation, a problem that affects around 40 percent of opioid users. There are a number of factors associated with constipation but often it is the result of poor muscle control in the intestines. Ineffective muscle contractions lead to waste material becoming trapped, making bowel movements difficult.

With opioid bowel dysfunction you may also experience:

  • Abdominal cramping
  • Bloating
  • Gastroesophageal reflux

Chronic gastroesophageal reflux can cause burns to the esophagus and lead to permanent damage.

Managing GI Tract Problems Associated With Opioid Use

Opioid-induced constipation is a potentially debilitating side effect of these drugs. What can you do to reduce the risk if you do need narcotic pain relief? The first step is to talk to your doctor. It is possible that there is a way to treat the GI side effects and reduce the impact of the drug.

You should also take steps to prevent constipation such as:

  • Drinking hot water or herbal tea in the morning
  • Drinking more water throughout the day
  • Eating more fiber or taking a fiber supplement
  • Talk to your doctor about taking a laxative or stool softener

Before taking an opioid pain reliever, tell your doctor if there is a history of drug or alcohol abuse in your family, if you smoke or have a drinking problem and if you have any mental health issues like depression.

The National Institute on Drug Abuse estimates that around 80 percent of people who use heroin initially became addicted by taking prescription painkillers. Talk to your doctor about other ways to control chronic pain and avoid taking opioids when possible.



The Difference between Allergies and Intolerances


Food allergies and food intolerances may seem similar at first glance, but are really quite different. It is important to know the difference between the two, especially if you prepare food for others.

Physical reactions to certain foods are common. In most cases, though, these reactions are the result of food intolerance rather than food allergy.

Anyone who suffers a reaction after eating a certain food should see a medical professional, who can perform an evaluation and tests to determine whether the patient has a food allergy or a food intolerance. Getting tested is important because those with food allergies are at risk for anaphylaxis, which is a life threatening allergic reaction. Even people who have had mild allergic reactions to food in the past are at increased risk for anaphylaxis.

Food Allergy vs. Food Intolerance

Food intolerance often causes the same signs and symptoms as food allergy, so it is easy to confuse the two reactions.

A food allergy causes a reaction of the immune system; this reaction affects several organs and body systems to cause a wide range of symptoms. Reactions associated with food allergies can affect the person’s skin, gastrointestinal tract and respiratory tract. In the most serious cases, food allergy reactions can even affect the cardiovascular system. An allergic reaction to food can be severe or even life threatening.

Symptoms of a mild to moderate allergic reaction to food include hives, which are itchy, swollen and reddish areas on the skin. Eczema may occur as a persistent dry, itchy rash. Skin redness, especially around the eyes or mouth, may occur. Itchiness, nausea or vomiting, diarrhea, stomach pain, cough, and a runny nose may develop.

Symptoms of anaphylaxis include swelling of the throat, lips, or tongue that blocks breathing, trouble swallowing, wheezing or shortness of breath, turning blue, and feeling faint, weak, confused, or passing out.

Food intolerance, by contrast, usually causes mild to moderate symptoms that are usually limited to the digestive tract. Symptoms of food intolerance usually take longer to develop than symptoms of food allergy. These symptoms include nausea, vomiting, gas, bloating, stomach pain or cramps, heartburn or diarrhea.

Someone with intolerance to a particular food may be able to eat small amounts of that food without experiencing symptoms. The individual may also be able to prevent a gastrointestinal reaction. A person with lactose intolerance may be able to take a lactase enzyme pill to aid in the digestion of milk, for example. Someone with a food allergy can never consume that food.

Causes of Food Intolerance

A variety of factors can cause food intolerance. Causes of food intolerance include:

  • Lack of lactase, an intestinal enzyme normally that breaks down the lactose in milk and dairy products, which causes lactose intolerance
  • Irritable bowel syndrome, which causes cramping, constipation and diarrhea
  • Sensitivity to food additives, such as the sulfites used to preserve canned goods, dried fruit and wine, can trigger asthma attacks in people sensitive to sulfites
  • Recurring stress or other psychological factors can make a person feel nauseated at the mere thought of food

Celiac disease presents some features of a true food allergy because it involves the immune system. Because the symptoms are localized to the gastrointestinal tract, and because the condition does not cause anaphylaxis, celiac disease is usually categorized as food intolerance. Celiac is a chronic condition in which eating gluten, a protein found in wheat and other grains, triggers digestive symptoms.

People diagnosed with food allergies may need to carry injectable epinephrine to self-administer in case of anaphylaxis.

Medical professionals often recommend steps to aid digestion of certain foods or to treat any underlying conditions causing the localized reaction of food intolerance.

Recognizing anaphylaxis and knowing what to do if one occurs can save lives. So can preparing meals with food allergies and food intolerance in mind. Anyone cooking for people who may have food allergies or food intolerance should look into purchasing a cookbook that provides recipes for those with food allergy or food intolerance.


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.


Disclaimer: These articles are meant to be informative and are in no way an endorsement or suggestion by QuinTron. Individuals should always consult a medical professional regarding any treatment methods.