Small intestinal bacterial overgrowth and IBS have been linked. Often referred to as SIBO, the condition causes excessive bacteria in your small bowel.
Studies have shown rates of this condition in Irritable Bowel Syndrome can vary between four to seventy eight percent of people with the condition.
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The symptoms of SIBO are really the same as IBS and include:
Bacterial overgrowth is diagnosed from your symptoms and with a simple investigation known as a GHBT or Glucose-Hydrogen Breath Test.
This test is performed after an overnight fast. You are given 100g of Glucose drink and this is broken down by the bacteria in your small bowel to produce hydrogen and this is absorbed and transported to the lungs where it is breathed out.
Breath samples can be used to measure the hydrogen content of your breath. If you have excessive bacteria, the amount of glucose breakdown is increased and this can be charted over time.
A positive GHBT will also be seen if there is increased transit or movement of your stools through your small bowel too, so the test does have its limitations.
A lactose intolerance test also works on similar principles to a GHBT, except lactose is used rather than glucose.
There are two other tests which can be used in the diagnosis of this condition. A 14C Xylose test is used to check whether your small bowel absorbs ok. If it is absorbed okay, it will pass in to your urine and blood. Low levels indicate a problem with absorption in your small bowel.
You can also have a Lactulose Hydrogen breath test, a variation of the GHBT which uses lactulose rather than glucose.
A gold standard diagnosis of the condition is to have an aspirate or fluid sample taken from your bowel and measurements made of the numbers of bacteria present per ml of aspirate.
In small intestinal bacterial overgrowth and Irritable Bowel Syndrome, at least 100000 or 105 bacteria per ml should be present.
Some people are more likely to suffer from small intestinal bacterial overgrowth and IBS. These include:
SIBO is treated in several ways. These include:
1) Withdrawing any precipitant eg avoiding proton pump inhibitor drugs
2) Tight control of your diabetes if applicable
3) Probiotics – giving bacteria back to your small bowel to restore health
4) Antibiotics – yes, it’s a paradox that it can be treated with antibiotics, the very thing that might have caused the condition in the first place!
There are a variety of antibiotics that can be used in this condition. The most common ones are:
5) 4-Quinolones eg Ciprofloxacin
These antibiotics are usually given to you in “pulses” or cycles of 1-2 weeks and then 2 to 3 weeks off.
I personally tend to use probiotics in between the antibiotics to help restore the bacterial load in your small bowel.
During this time, I normally recommend a low carbohydrate diet too during the antibiotic phase so as to help prevent bacterial growth during this time.