SIBO: what it is, symptoms and how this disease of the small intestine is treated

Diarrhea, bloating and abdominal pain, gas.

It could be simple indigestion, but it could also be a disorder of the small intestine that we're hearing more and more about: SIBO, which stands for bacterial overgrowth in the small

.

As its name indicates, it is the increase of bacteria in that organ.

The fact that it is a term that -given the arrival of medicine on social networks and the amplification of medical topics- is very widespread, has its pros

In favor: more people can be attentive and consult in case of symptoms.

Against: it is a disorder that is paradoxically underdiagnosed and overdiagnosed at the same time.

SIBO: what are its causes

This is how the head of the Gastroenterology Service of the Favaloro Foundation, Fabio Nachman, understands it, who explains that this disorder is usually related to irritable bowel syndrome, inflammatory bowel disease, fatty liver and celiac disease.

The doctor explains that SIBO occurs when

certain mechanisms of the body

• The

  acidic PH

  of the stomach (which prevents bacteria from increasing)

• Pancreatic enzymes

  (

  natural chemicals that help break down fats, proteins, and carbohydrates)

• The

  immune system

  ,

• Peristalsis or

  movement of the small intestine

  .

  “Inclusively, there is a peristalsis called migratory movement, when the intestine is also empty and prevents a remora, preventing bacteria from growing”, Nachman explains.

• The indemnity of the valve that joins the small intestine with the colon, which is called the

  ileocecal valve

  and whose role is to prevent bacteria from ascending from the colon to the intestine.

Nachman urges consulting in the presence of symptoms and not normalizing them.

Photo Shutterstock.

It can also occur as a result of a change in the flora that

which can "climb" to the small intestine.

"Sometimes, we can't see the mechanism that is failing, but generally, when we see a picture in which we notice that one of these mechanisms is failing, we are going to check if it is bacterial overgrowth," explains Nachman,

And he adds some examples: “when one suppresses gastric acid because they have removed the stomach, because they take antacids, or because they have hypochlorhydria [N of the R: low level of stomach acidity]”, he graphs.

Also, in diabetic patients who have had major disorders for a long time, or hyperglycemia, which affects the nervous part of the intestinal system that prevents the intestine from moving, he indicates.

"Some pictures affect either the nervous part or the muscular part of the intestine, which leads to a movement disorder, peristalsis. There are many pictures that have to do with this," he summarizes, and clarifies that everything that affects the bowel movement can cause SIBO.

Now, what

is this picture suspected of?

"In general, when there is bacterial overgrowth, the patient suffers from abdominal distension, gas and pain, and what is most common is diarrhea, which

to occur more precisely because there may be some malabsorption of nutrients, this inactivates bile salts and leads to times to malabsorption of fats and can even lead to malabsorption of vitamin B12”, he warns.

Regarding whether there are something like warning signs, he states: “What I always say is

the symptoms when one has a condition.

In general, when there is abdominal pain or diarrhea, that patient should consult and there we will see what degree of compromise they have, if they are really having malabsorption due to this bacterial overgrowth or not”.

To diagnose SIBO you need to perform an expired air test.

Photo Shutterstock.

How SIBO is diagnosed

How is it diagnosed?

How to know that we may be suffering from SIBO?

“In general, the gold standard is the

.

You can also do gene sequencing to find out what kind of bacteria they are, but it's very difficult, you have to have a lot of experience, which is why it's practically only used in research.

The most practical and daily thing is to carry out an exhaled air test.

This is a study that is carried out using a device called a chromatograph, which what it does is

”, he introduces.

And it details that the patient must blow into a chromatograph and then he is given glucose.

Subsequently, hydrogen is measured or

can also be measured, in which case there is controversy, since this measurement could lead to an overdiagnosis of SIBO, since as Nachman indicates, there may be the presence of methane gas in the colon.

“If there is inlet methane, that could nullify the overgrowth diagnostic integration.

And here is the serious problem of this pathology that is sometimes

, since many patients out there have trivial symptoms such as constipation, diarrhea, bloating and have methane and are diagnosed with SIBO and it is not always like that: methane can be in the colon”, he expands.

A 3D view of the bacteria that can inhabit the small intestine.

Photo Shutterstock.

This means that, although SIBO is heard more frequently, it cannot be determined if its incidence is increasing.

Even so, he analyzes: "I don't think it is growing, but now

and many more suspect it, and the issue of social networks and globalization has warned about this entity and now many doctors and nutritionists suspect it. ".

And he adds: "I believe that there is an

, and a misuse of antibiotics. We have a serious problem in a little more than 20 years, due to really worrying bacterial resistance."

How SIBO is treated

“When it is really diagnosed that it is a bacterial overgrowth, the treatment is

In general, one that has little absorption and remains in the intestinal lumen for a long time is chosen, to later try to see if the cause that is generating the bacterial overgrowth can be resolved, "he points out.

 "Unfortunately, there are patients in whom the intestine

and with some frequency it will cause bacterial overgrowth, which will lead them to carry out antibiotic schemes with certain frequency," he adds.

The role of food, what about prebiotics?

Can diet play a role?

Are there foods that are best avoided so as not to encourage bacterial overgrowth?

"There is a

, patients who really have SIBO, when faced with the intake of carbohydrates, may have symptoms," she introduces.

"But - he contrasts - there are more complex carbohydrates, such as prebiotics, which can sometimes give symptoms of

, and they are precisely those that usually help promote beneficial intestinal flora, which is the one that consumes a large part of the oxygen in the intestine , important because it synthesizes butyric acid, and in the long run it improves the intestinal flora”, he concludes.

***

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