SIBO syndrome – what is it?

What is small bowel bacterial proliferative syndrome? What are the causes, symptoms, treatment and recommendations? In today’s article we have prepared for you the most important information about SIBO syndrome.

Let’s start by explaining what the gut microflora is. It is a group of microorganisms that reside in our digestive tract, mainly bacteria. Intestinal bacteria perform a number of beneficial functions for our body. We can mention the fermentation of dietary fibre, the assimilation of nutrients, the production of vitamins K and B, the role in the immune system or the formation of a protective barrier against unfavourable substances.

If we are dealing with an excessive amount of bacteria in the small intestine, we are talking about the occurrence of small intestine bacterial overgrowth syndrome (SIBO). It is considered to be the number of bacteria exceeding 105 in 1 γ or 1 ml of intestinal content. Such a condition usually leads to the appearance of gastrointestinal complaints and their complications.

Causes of SIBO

Factors that cause excessive growth of bacterial microflora can include:

• inhibition of gastric acid secretion, often as a result of long-term therapy with proton pump inhibitors,
• disruption of pancreatic enzyme secretion,
• anatomical abnormalities of the gastrointestinal tract such as diverticula, tumours and intestinal strictures,
• immunological disorders, immunoglobulin A deficiency.

SIBO is often observed in people with irritable bowel syndrome (IBS), Crohn’s disease, celiac disease, non-alcoholic fatty liver disease, cirrhosis, diabetic neuropathy and cystic fibrosis.

What are the symptoms of small bowel bacterial proliferative syndrome

Symptoms include:

• fatty or osmotic diarrhoea,
• excessive bloating and intestinal gas,
• iron or vitamin B12 deficiency anaemia,
• unintentional weight loss,
• symptoms of mineral and vitamin deficiencies,
• swellings.

In some people, SIBO may not show any symptoms of disease.

Diagnosis of SIBO syndrome

Most commonly, a glucose breath test is performed to diagnose this syndrome. After drinking a glucose solution, the level of hydrogen excretion, which is produced by bacteria present in the intestine, is measured in the patient’s exhaled air.

Also, a culture of the contents of the small intestine is performed, which is able to fully diagnose small intestinal bacterial proliferative syndrome.

Treatment and dietary recommendations

Antibiotic therapy

First of all, the cause of the bacterial proliferation must be determined. In most cases, antibiotic therapy is introduced, which acts on aerobic and anaerobic bacteria. In the event of a recurrence of SIBO, a second course of antibiotics is introduced.

Probiotics

During antibiotic therapy, probiotic therapy is also often introduced, using appropriate strains of bacteria. It aims to regenerate the beneficial intestinal microflora.  Most often preparations of the Bifidobacterium family are taken.

Diet in SIBO syndrome

In small bowel bacterial proliferative syndrome, it is crucial to ensure an adequate energy supply. This is to avoid unintentional weight loss and lead to malnutrition. It is also important to pay attention to an adequate supply of vitamins and minerals in the diet, especially vitamin A, D, E, B12 and iron.

In the case of vitamin D, supplementation is most often introduced. Vegetable oils should be included in the diet, especially linseed oil, castor oil, olive oil, rapeseed oil, as well as nuts, seeds and oily sea fish. Vitamin B12 is found in meat, eggs and dairy products. Rich sources of iron include meat (especially liver, beef and pork), legumes and eggs.

The LOW FODMAP diet may be helpful in SIBO-related ailments. It is a diet in which easily fermentable carbohydrates are limited, as increased bacterial fermentation may cause such ailments as bloating, excessive gas and diarrhoea.

The LOW FODMAP diet eliminates products such as onions, garlic, legumes, brassica vegetables, dairy products, apples, pears, watermelon, plums, nectarines, rye, wheat, xylitol, fructose, among others. In the next stage, these products are reintroduced in moderate quantities.

It is worth noting that the diet should be individually selected, because in the case of people with SIBO, the list of badly tolerated products is often a very individual matter.

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