Small Intestinal Bacterial Overgrowth (SIBO) is a condition characterised by an excessive growth of bacteria in the small intestine, leading to various digestive disturbances. While the large intestine naturally contains a vast number of bacteria, the small intestine typically has fewer organisms. In SIBO, this balance is disrupted, resulting in symptoms such as bloating, diarrhoea, nausea, and malabsorption of nutrients.¹

Who Can Develop SIBO and How?

Several factors can predispose individuals to SIBO:

• Motility Disorders: Conditions that impair the movement of the small intestine, such as diabetes or scleroderma, can lead to bacterial overgrowth.
  
  
• Structural Abnormalities: Anatomical changes like diverticula, surgical blind loops, or resections (e.g. removal of the ileocecal valve) can create environments favourable to bacterial spread.
  
  
• Immune System Disorders: Immunodeficiency conditions can reduce the body's ability to control bacterial populations in the gut.
  
  
• Medications: Such as proton pump inhibitors, which reduce stomach acid, have been associated with an increased risk of developing SIBO.^2,3

Symptoms of SIBO

The manifestations of SIBO are often similar to other gastrointestinal disorders, making diagnosis challenging. Common symptoms include:

• Bloating and abdominal distension
• Diarrhoea or constipation
• Abdominal pain or discomfort
• Excessive gas
• Nausea
• Fatigue and weakness
• Unintended weight loss in severe cases

These symptoms result from the bacteria metabolising nutrients, leading to malabsorption and inflammation of the small intestine.^4,5

Conventional Management Strategies

Traditional approaches to managing SIBO focus on reducing bacterial overgrowth and addressing underlying causes:

1. Antibiotics
   A course of antibiotics, such as Rifaximin, is commonly prescribed to decrease bacterial populations. Treatment duration is typically around one week.
   
   
2. Addressing Underlying Conditions
   Identifying and treating root causes, such as motility disorders or structural abnormalities, is crucial to prevent recurrence.⁶

Holistic Management Strategies

Complementary and alternative approaches may offer additional benefits:

1. Dietary Modifications
   Implementing a low-FODMAP diet can help reduce symptoms by limiting fermentable carbohydrates that feed bacteria.
   
   
2. Probiotics
   Introducing beneficial bacteria may help restore a healthy balance in the gut microbiome.
   
   
3. Herbal Antimicrobials
   Some herbal supplements possess antimicrobial properties that may assist in controlling bacterial overgrowth.
   
   
4. Lifestyle Changes
   Regular exercise and stress management techniques can support overall digestive health.^7,8

Check out our latest video with Julia Davies as she explores gut bacteria overgrowth and its associated symptoms.

It's essential to consult with a healthcare professional before initiating any treatment plan, as SIBO symptoms overlap with other conditions, and misdiagnosis can lead to inappropriate management. Recent discussions have highlighted concerns about the potential over-diagnosis of SIBO, emphasising the need for thorough evaluation.^9,10

In summary, SIBO is a complex condition with a range of symptoms and potential causes. A comprehensive approach that combines conventional and holistic strategies, tailored to the individual's needs, offers the best chance for effective management and improved quality of life.