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What Is Small Intestinal Bacterial Overgrowth and Why Is Everyone Talking About It?

A Sarasota gastroenterologist explains what Small Intestinal Bacterial Overgrowth, or SIBO, is, and how it's treated.

By Allison Forsyth October 6, 2021

Image: Kari Perrin

Many gastrointestinal illnesses can have very similar symptoms, making them difficult to diagnose. There is one illness, however, that has received more attention online than others, and the experience of treating it has been shared widely on social media. It is called Small Intestine Bacterial Overgrowth, or SIBO, and can develop for several reasons.

Why is SIBO being talked about more now, and what are the ways it can be treated? Dr. Ronald Andari from Florida Digestive Health Specialists in Lakewood Ranch answers our questions.

What Is SIBO?

"SIBO occurs when there is an overgrowth of bacteria in the small bowel, where it is not likely to occur," says Andari. "The acidity of the stomach, the motility of the bowel, the digestive enzymes and our immune system protect the bowel from such overgrowth of microbes." Andari says bacteria is more likely to occur in the colon, not the small intestine.

Why is SIBO being diagnosed more often and discussed online?

An increased interest in the gut's microbiome and microbiology could be why more people are discovering they have SIBO when visiting the doctor.

"We are learning more about the delicate balance of gut bacteria and gut health is a trending topic," says Andari. "It is a good thing people are more aware of the existence of this condition so it can be discussed with their doctors and considered as a possible diagnosis, especially since SIBO is a treatable illness."

How does SIBO develop?

Andari says a combination of predisposing factors is what leads to SIBO. A few examples of risk factors include the overuse of acid-reducing medications (or proton pump inhibitors), metabolic problems such as diabetes, a history of abdominal surgeries and insufficiency of digestive enzymes, among others. All can cause an imbalance and rise in the presence of microbes in the small bowel.

"SIBO typically has an underlying cause, so we take a look at the medical history of the patient to help determine the cause for the illness," says Andari.

What are the symptoms of SIBO?

Symptoms look like other gastric illnesses, with complaints of excess flatulence, abdomen distention (bloating) with discomfort and irregular bowel movements. Symptoms can also flare after eating particular foods, such as sugars and carbohydrates, which bacteria feed on.

"A breath test is completed in our office to determine whether a patient has SIBO," says Andari. These hydrogen breath tests will detect the amount of hydrogen and methane that patients breathe out after drinking a mixture of glucose and water. "If there is an increase when exhaling after a short period of time, we can assume bacteria overgrowth is present in the small bowel," says Andari.

What does treatment look like?

Andari says the first line of treatment is a course of antibiotics, which significantly reduce the number of abnormal bacteria.

"Treatment lasts about 14 days, but there is a chance SIBO can come back after the treatment," says Andari. "This is when another course of antibiotics, or a different kind of antibiotic may be necessary."

Looking at the underlying cause of SIBO and helping treat those illnesses can also help reduce the symptoms of SIBO.

In addition to medication, dietary changes may be needed. Andari recommends a lean diet filled with protein and fats, while reducing the number of carbohydrates, including fruit, that you eat. He also recommends eating several small meals throughout the day.

Are there any supplements or lifestyle changes patients can make?

"SIBO can cause malabsorption of nutrients, so taking vitamins like zinc, niacin, B-12, calcium and iron is beneficial," says Andari.

Andari also recommends light exercise to help with bowel motility and mobility. This can help reduce symptoms of SIBO and other gastrointestinal issues. Stay hydrated throughout the day.

Is SIBO treatment covered by insurance?

The breath test is not typically covered by insurance. The out-of-pocket cost for the test is anywhere from $100 to $125. Antibiotic treatment, however, is covered by most private insurance and Medicare.

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