Small Intestinal Bacterial Overgrowth (SIBO): Understanding symptoms and treatment approaches

When we think about gut health, we often focus on common digestive concerns like acidity, constipation, or IBS (Irritable Bowel Syndrome). However, there’s another lesser-known but increasingly diagnosed condition that can cause significant digestive discomfort — Small Intestinal Bacterial Overgrowth, commonly known as SIBO. At Kaizen Gastro Care Clinic, the best gastroenterologists in Pune, Dr. Vikrant Kale and his team, are dedicated to helping patients understand this complex condition and find effective solutions for relief. In this blog, let’s break down what SIBO is, its common symptoms, causes, diagnosis, and how it can be managed with modern gastroenterology expertise.

What is SIBO?

Small Intestinal Bacterial Overgrowth (SIBO) refers to an excessive growth of bacteria in the small intestine, where bacterial numbers are normally much lower compared to the large intestine. These bacteria interfere with digestion and nutrient absorption, leading to different gastrointestinal and systemic symptoms. Normally, the small intestine has a relatively low bacterial load due to gastric acid, digestive enzymes, and normal gut motility, keeping bacterial counts under control. However, certain conditions can disrupt this balance, allowing bacteria from the colon to relocate or overgrow in the small intestine.

What Causes SIBO?

Several factors can increase the risk of developing SIBO:

Impaired Gut Motility: Conditions like diabetes, scleroderma, or hypothyroidism can slow the movement of food and waste through the small intestine.
Structural Issues: Previous abdominal surgeries, bowel strictures, or diverticula can create areas where bacteria collect.
Low Stomach Acid: Reduced acid levels (due to age, medications like proton pump inhibitors, or certain diseases) allow bacteria to survive and travel into the small intestine.
Immune System Disorders: Weakened gut immunity can fail to control bacterial growth.
Irritable Bowel Syndrome (IBS): Studies have found a significant overlap between IBS and SIBO.

Understanding the underlying cause is vital for treating SIBO effectively and preventing recurrence.

Common Symptoms of SIBO:

SIBO symptoms often overlap with other gastrointestinal conditions like irritable bowel syndrome (IBS), making it difficult to diagnose without proper testing. The common symptoms include:

Bloating and abdominal distension: One of the hallmark symptoms is due to excessive bacterial fermentation of undigested food in the small intestine.
Excessive gas and belching: Bacteria ferment carbohydrates, producing hydrogen and methane gases, which can lead to discomfort.
Diarrhoea or constipation: Depending on the dominant type of bacteria, SIBO can cause diarrhoea (hydrogen-producing bacteria) or constipation (methane-producing bacteria).
Abdominal pain or cramps: Due to gas accumulation and inflammation.
Fatigue and weakness: Resulting from malabsorption of crucial nutrients.
Unintentional weight loss: Specifically, if malabsorption is severe.
Nutritional deficiencies: Including deficiencies of vitamin B12, iron, and fat-soluble vitamins (A, D, E, K), leading to related systemic symptoms like anaemia, neuropathy, or bone health problems.
Steatorrhoea (fatty stools): Bacterial deconjugation of bile acids leads to fat malabsorption, resulting in foul-smelling, greasy stools.

If you are experiencing these ongoing symptoms, consulting with a stomach specialist in Pune, like Dr. Vikrant Kale, can help identify the root cause and begin proper treatment.

How is SIBO diagnosed?

At Kaizen Gastro Care, we focus on accurate diagnosis using clinical history and appropriate investigations. Common diagnostic tests include:

Breath tests (Hydrogen Breath Test): This is the most widely used non-invasive test for SIBO. Patients drink a sugar solution, and breath samples are collected over 2-3 hours. Elevated hydrogen or methane levels suggest bacterial overgrowth.
Small intestine aspirate and culture: Though considered the gold standard, this is invasive and rarely performed routinely.
Blood tests and stool analysis: To evaluate nutritional deficiencies or rule out other conditions.

Treatment Approaches for SIBO:

The treatment of SIBO is multi-dimensional, aiming to decrease bacterial overgrowth, correct nutritional deficiencies, and address underlying causes to prevent recurrence.

Antibiotic Therapy:

The cornerstone of SIBO treatment is the use of antibiotics to reduce bacterial load. The commonly specified antibiotic is Rifaximin, which is minimally absorbed and acts locally in the gut, with fewer systemic side effects. In cases where methane-producing bacteria are involved, a combination of rifaximin with neomycin may be used for better efficacy.

Nutritional Support:

Due to malabsorption, many patients need nutritional supplementation, especially for:

Vitamin B12 injections or oral supplementation
Iron therapy for anaemia
Fat-soluble vitamin supplementation if fat absorption is impaired

Dietary Modifications:

Diet plays a crucial role in symptom management and recurrence prevention. The low FODMAP diet, which reduces fermentable carbohydrates, can decrease bacterial substrates and ease bloating and gas. Some patients benefit from an elemental diet, which provides easily absorbable nutrients while starving bacterial overgrowth.

Prokinetic Agents:

If reduced gut motility is the cause, prokinetic medicines (e.g., low-dose erythromycin, prucalopride) may be prescribed to improve small bowel movement and reduce bacterial stasis.

Treating Underlying Conditions:

Managing root causes is essential to prevent relapse. For example:

Optimising diabetes management
Treating hypothyroidism
Managing anatomical abnormalities surgically if required

Probiotics and Herbal Therapies:

While research is ongoing, certain probiotics may help restore gut flora balance and reduce SIBO symptoms. Herbal antimicrobial protocols (e.g., oregano oil, berberine) have shown promising results in some studies but should only be used under medical guidance.

Prognosis and Recurrence:

SIBO tends to recur, especially if the underlying cause persists. A structured treatment plan, along with dietary and lifestyle changes, can significantly reduce recurrence rates and enhance quality of life. Regular follow-ups with your gastroenterologist are crucial for monitoring signs and adjusting treatment.

When to Consult a Gastroenterologist?

If you have persistent bloating, gas, abdominal pain, and unexplained nutrient deficiencies, it is important to seek evaluation by a specialist. Early diagnosis and treatment can prevent complications such as severe malnutrition, weight loss, and osteoporosis. At Kaizen Gastro Care Clinic, Dr. Vikrant Kale offers expert evaluation, accurate diagnosis with breath testing, and comprehensive treatment plans tailored to each patient’s unique health condition.

Conclusion:

Small Intestinal Bacterial Overgrowth (SIBO) may be common but is often overlooked. Identifying its symptoms and seeking expert care is key to relief and recovery. With proper testing, tailored treatment, and a focus on the root cause, most patients can find lasting improvement. If you’re struggling with unexplained digestive discomfort, book a consultation with Dr. Vikrant Kale at Kaizen Gastro Care Clinic today. Your gut deserves expert care and a fresh start!