Small Intestine Bacterial Overgrowth

Abdominal bloating.  Cramping.  Diarrhea, constipation or both.

If you have these symptoms, you may have been told you have irritable bowel syndrome.  This is probably correct.  But you may also have small intestine bacterial overgrowth (SIBO) as well.

Small intestine bacterial overgrowth is a condition where bacteria present in the colon spread into the small intestine.  The small intestine isn’t normally sterile but large amounts of bacteria are not present.

There are several reasons why bacteria might get into the small intestine where they don’t belong.  As we discussed last week, hypochlorhydria is a condition where the stomach doesn’t make enough acid.  Acid helps to kill bacteria in the food we eat, so that they don’t get into the small intestine.  If there’s not enough acid, bacteria can survive and sneak through.  Long-term use of acid-blocking medications can increase the risk of SIBO.

Another problem that can predispose to SIBO is pancreatic insufficiency.  Digestive enzymes produced by the pancreas also kill bacteria.  Chronic pancreatitis, cystic fibrosis and pancreatic cancer are often complicated by small intestine bacterial overgrowth.

Immune deficiency is another risk for SIBO.  The immune system makes antibodies that help to keep the small intestine’s bacterial population under control.  If the immune system isn’t working right, the bacteria can get out of hand.

If your intestine doesn’t work normally or has had its anatomy changed, these also can increase the risk of SIBO.  Bariatric surgery and other types of small-bowel surgery are examples.  Also, there is a valve that keeps bacteria from moving from the cecum (the first part of the large intestine) into the ileum (the last part of the small intestine) and if part of the cecum has been removed for any reason, that barrier may have been removed too.  Appendicitis and Crohn’s disease are examples of reasons why surgery may have been done on that part of the intestine.

I already mentioned irritable bowel syndrome.  Other problems associated with an increased risk of SIBO are celiac disease, liver disease like nonalcoholic fatty liver disease and liver cirrhosis, diabetes, scleroderma, radiation treatment to the abdomen and pelvis, and fibromyalgia.

OK, so suppose you have one or more of the above problems.  How do you know if you have SIBO?  This is the tough part.  Since it isn’t well understood there are very few tests that can be ordered to diagnose it.  One test is the hydrogen breath test which you can read more about here.  Stool testing can also be done, although it’s difficult to tell when using stool tests whether the bacteria are present in the small bowel or the large bowel.

What can be done about small intestine bacterial overgrowth?  First and foremost the underlying predisposing factors must be corrected if possible.  If you have hypochlorhydria or achlorhydria, taking betaine HCL with meals will correct it.  If you have chronic pancreatitis, taking pancreatic enzymes is key.  If you have celiac disease or other food allergies or intolerances, you must identify and avoid your trigger or allergenic foods.

Probiotics are an important therapy for SIBO.  They help suppress the growth of more dangerous bacteria in the large intestine and support the immune system.  As I have mentioned before, my family and I take Shaklee’s OptiFlora daily to promote digestive and immune health.

Many people with SIBO benefit from treatment with antibiotics to eradicate the bacteria in the small intestine.  This may need to be done periodically since, if the underlying cause(s) can’t be fixed, small intestine bacterial overgrowth tends to recur.

Small intestine bacterial overgrowth is a complication found with many common illnesses like irritable bowel syndrome, fibromyalgia, nonalcoholic fatty liver disease and diabetes.  Its symptoms are nonspecific and the problem isn’t easy to diagnose.  Treating it requires patience and persistence, as it tends to recur.  However, success results in better intestinal health, better immune function and overall better health for the person.

QUESTION:  Do you have any symptoms of small intestine bacterial overgrowth?