It is estimated that the global prevalence of IBS is 11%. The most common cause of IBS is small intestinal bacterial overgrowth (SIBO) — in fact, a whopping 60-80% of IBS is due to this common condition, totalling a possible 500 million people worldwide.
Many of the cases remain undiagnosed but patients are actively searching for answers online. According to Google, Australians seem to be at the leading edge of this search for information on SIBO, second only to the USA.
As the director of an online breath testing facility and SIBO specialist, I have been educating practitioners for the past five years through webinars and masterclasses, and I regularly present at overseas SIBO conferences.
Though SIBO awareness is growing, I still find that, generally, there is a lot of misinformation as to the proper diagnosis, treatment and management of SIBO.
SIBO is a complex condition with a relapse rate of greater than 60%. The cause of relapse can be multifocal, meaning that in many cases SIBO is caused by an underlying driver and failure to identify and properly treat this cause can lead to a revolving door of treatment for many patients. “Doc, I still have symptoms” or “the medicine worked for a while but now I’m back to square one” are common SIBO patient statements.
The underlying drivers can be many, but one of the main causes of SIBO for many patients is “post-infectious IBS”. Groundbreaking research lead by Dr Pimentel and his team at Cedars-Sinai Hospital in LA have shown that the normal cleansing mechanism of the small intestine (known as the migrating motor complex) is impaired in patients with this type of IBS due to the presence of autoantibodies which arise after food poisoning in many people.
This impairment leads to the improper sweeping out of bacteria, resulting in bacterial fermentation in the small intestine. Like a stagnant river leading to algae blooms, a slowed or impaired flow in the small intestines gives rise to bacterial blooms. Patients with IBS symptoms following a case of gastroenteritis are at much high risk of SIBO relapse after treatment without proper management.
Besides post-infectious IBS, other underlying factors in developing SIBO are manifold. Adhesions, other chronic diseases, medications, and digestive deficits can all affect the function of the small intestine. Bacterial fermentation produces hydrogen and/or methane gas which can be captured with a simple breath test easily done at home. Besides understanding the absolute rise of a gas, breath testing is also important so the type of gas can be identified. Methane dominant patients tend to be constipated, whilst hydrogen dominance can cause diarrhoea or constipation in patients.
Treatment of SIBO is highly specific. It varies with the type of gas produced, and usually includes the use of specific antibiotics or herbal antimicrobials followed by prokinetic medication to restore normal motility in the small intestine, as well as a low fermentation diet.
SIBO research has increased exponentially over the past few years, leading to better understanding and improved clinical outcomes. Many patients are actively looking to find “SIBO-literate” practitioners who understand the nuances of treatment and management and so I’m delighted to see that Dr Steven Sandberg-Lewis is be on the program at the 5th BioCeuticals Research Symposium. Dr SSL, as he is affectionately known, has been a leader in SIBO education in the US.