#SIBO
SIBO (Small Intestinal Bacterial Overgrowth) is a digestive condition characterized by an imbalance of the bacterial flora in the small intestine. Although less known to the general public, SIBO is increasingly recognized in medical practice as a possible cause of persistent digestive symptoms, such as bloating, abdominal discomfort, excessive gas or transit disorders.
The symptoms of SIBO are often non-specific and can overlap with other gastrointestinal diseases, which is why the diagnosis is sometimes delayed. Understanding this condition is important not only for identifying the cause of the symptoms, but also for choosing a correct management approach.
What is SIBO – physiopathological mechanism
Normally, the small intestine contains a relatively small number of bacteria, compared to the large intestine, where the bacterial flora is much richer. The role of the small intestine is mainly the digestion and absorption of nutrients, and the excessive presence of bacteria disrupts this process.
SIBO occurs when bacteria that should be predominant in the large intestine end up multiplying excessively in the small intestine. These bacteria ferment the carbohydrates consumed before they are properly absorbed, producing gases (hydrogen, methane or hydrogen sulphide) and substances that irritate the intestinal mucosa.
The consequence is a combination of local inflammation, intestinal motility disorders and poor absorption of nutrients.
The main causes of SIBO
Most of the time, SIBO is the result of a pre-existing problem that affects the natural protective mechanisms of the small intestine.
Among the most common causes are:
• intestinal motility disorders (slowed transit)
• irritable bowel syndrome, especially the form with severe bloating
• abdominal surgeries that modify the digestive anatomy
• prolonged use of proton pump inhibitors (medicines that decrease gastric acidity)
• diabetes, by affecting the nerves that control intestinal movements
• inflammatory bowel diseases or autoimmune diseases
Gastric acid, digestive enzymes and the rhythmic movements of the intestine are essential mechanisms that limit bacterial proliferation. When these are compromised, the risk of SIBO increases significantly.
Frequent symptoms and clinical manifestations
SIBO symptoms are often non-specific and can mimic other digestive disorders, which explains why diagnosis is often delayed.
The most common manifestations include:
• pronounced abdominal bloating, especially after meals
• excessive flatulence
• abdominal pain or cramps
• diarrhea, constipation or alternation between them
• the feeling of rapid fullness
• nausea
In chronic forms, general symptoms such as fatigue, mental fog, weight loss or progressive food intolerances may appear.
The impact of SIBO on nutrient absorption
One of the most important effects of SIBO is malabsorption. Excess bacteria “consume” part of the nutrients before the body can absorb them.
The most common deficiencies associated with SIBO are:
• vitamin b12 (consumed by bacteria)
• fat-soluble vitamins (A, D, E, K), due to poor fat digestion
• iron and calcium
• proteins and carbohydrates, partially fermented
In the long term, these deficits can contribute to anemia, osteopenia, muscle weakness and decreased immunity.
SIBO diagnosis – methods used
The standard most used in practice for diagnosing SIBO is the breathing test. It measures the gases eliminated in the exhaled air after the ingestion of a fermentable substrate, usually lactulose or glucose.
The rapid increase in hydrogen or methane indicates premature bacterial fermentation in the small intestine.
It is important to mention that the interpretation of the tests must be done by a specialist, in a clinical context, to avoid erroneous diagnoses.
Treatment principles in SIBO
SIBO treatment is complex and must be adapted to each patient. The modern approach is one in several stages.
The basic principles include:
• reducing bacterial overpopulation, usually through specific antibiotics or non-antibiotic alternatives
• correcting the factors that led to SIBO (motility, gastric acidity)
• restoring the intestinal flora and the intestinal mucosa
• correction of nutritional deficits
Diet plays an important role, diets with a low content of fermentable carbohydrates are often recommended for limited periods.
The treatment does not stop when the symptoms disappear. Prevention of recurrence is essential, because SIBO has a relatively high rate of recurrence if the underlying mechanisms are not corrected.
The role of probiotics in SIBO
In SIBO, probiotics are not the central element of treatment. However, when used correctly, in well-chosen contexts, probiotics can have a complementary role, as part of a wider therapeutic approach. They can contribute to maintaining the balance of the intestinal microbiome and digestive health in the long term, without replacing the measures necessary to correct the bacterial overpopulation.
PureBiom+from Calivitais a formula designed to support the balance of the intestinal microbiome, by combining several probiotic strains with prebiotic components and nutrients that support the intestinal environment. Such formulas can be relevant in the phases of intestinal recovery, after the reduction of bacterial overpopulation, when the main objective becomes the restoration of microbial diversity and the normal function of the intestinal mucosa.
In SIBO, the imbalance is not limited to the number of bacteria, but also to their distribution and functionality. By supporting a more diverse and stable microbiome, formulas such as PureBiom+ they can contribute to the creation of a more balanced intestinal environment, which supports digestion, the intestinal barrier and the local immune response.
However, the integration of such products should be seen as part of a complementary, individually tailored strategy, and not as a substitute for the interventions needed to correct the underlying mechanisms of SIBO.
Bibliography
1. Pimentel M, Saad RJ, Long MD, Rao SSC. Small intestinal bacterial overgrowth: pathophysiology, diagnosis, and treatment. Am J Gastroenterol. 2020;115(2):165–178. doi:10.14309/ajg.00000000000000501
2. Rezaie A, Buresi M, Lembo A, et al. Hydrogen and methane-based breath testing in gastrointestinal disorders: the North American consensus. Am J Gastroenterol. 2017;112(5):775–784. doi:10.1038/ajg.2017.46
3. Ghoshal UC, Ghoshal U. Small intestinal bacterial overgrowth and other intestinal disorders. Gut liver. 2017;11(2):196–208. doi:10.5009/gnl16103
4. Quigley EMM. The gut microbiota and the role of probiotics in small intestinal bacterial overgrowth. Gastroenterol Clin North Am. 2017;46(1):131–143. doi:10.1016/j.gtc.2016.09.012
5. Hill C, Guarner F, Reid G, et al. Expert consensus document: The International Scientific Association for Probiotics and prebiotics (ISAPP) consensus statement on the scope and appropriate use of probiotics. Nat Rev Gastroenterol Hepatol. 2014;11(8):506–514. doi:10.1038/nrgastro.2014.66
This article was written by…
Dr. Ovidiu Calapod
Medical Specialist Gastroenterologist, Doctor of Medical Sciences
A graduate of the “Carol Davila” University of Medicine and Pharmacy in Bucharest, I accumulated knowledge and experience in the management of gastroenterological diseases over the years of training at the Bucharest University Emergency Hospital, the Floreasca Emergency Hospital and the Colentina Clinical Hospital, where I also obtained the skills of upper and lower digestive endoscopy, general ultrasound and liver elastography. My medical experience is completed by belonging to the Romanian Society of Digestive Endoscopy (SRED) and the Romanian Society of Gastroenterology and Hepatology (SRGH). In addition, I started dedicating my time to the development of an online community, trying to offer correct medical information and constant support in the management of digestive health.
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