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Is it SIBO or early signs of IBS?

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The exact meaning of small intestinal bacterial overgrowth or SIBO – and how (or if) it is connected to conditions like irritable bowel syndrome and diabetes — has been debatable in the medical community, and isn’t that well understood.

Many doctors and gastroenterologists take it from acid reflux and bloating to diarrhoea to IBS and they forget about SIBO.

But the way gastroenterologist Michael Cline, DO, thinks about it is that it’s a side effect of something else that is going awry in the body.

When I talk about SIBO, I don’t talk about it as a disease – I talk about it as a symptom of another problem.

Instead of treating it like a disease, I try to find out why someone has it.

This means, if you have persistent SIBO, there’s probably something that’s making the small intestine a place where bacteria are incline to collecting.

For instance, there could be a motility disorder that’s blocking food from moving through the digestive tract properly, causing bacteria to become stagnant and overgrow.

SIBO also occurs in people who have had intestinal surgery that affects how their bowels function, for that same reason.

People with diabetes also get SIBO, Dr. Cline says. High blood sugar plus warm intestines equals bacterial growth.

Breath test for small intestinal bacterial overgrowth (SIBO)

SIBO can produce a rundown of generic GI complaints, like bloating, gas, diarrhea or constipation, or a feeling of fullness, similar to IBS.

These same symptoms often occur with other digestive conditions, they alone aren’t enough to know that SIBO is present.

It’s usually confirmed with a breath test that measures gas produced in the intestines over time. The test involves drinking a sugary concoction and breathing into a breathalyzer device several times.

But the test has limitations, Dr. Cline says. There’s isn’t a universally accepted range of “normal” or “abnormal” results, which leaves a lot up to interpretation.

This leads to false positives and negatives.

Then there’s the challenge of actually rebalancing the gut flora.

The next step is identifying what caused the bacterial overgrowth to occur in the first place.

If a patient is very symptomatic, we’ll try an antibiotic and then embark on a motility or anatomy evaluation.

A workup could include bloodwork, imaging, endoscopy and other diagnostic tests.

But the main problem is:

Despite it’s widely recognized now many patients with IBS could have SIBO, understanding of the condition commonly is still poor among doctors and gastroenterologists, so people are rarely referred for it, according to Nick Boyle, a reflux surgeon based in Tunbridge Wells.

And due to this reason, patients who have been suffering from these symptoms for years and are said to have IBS or reflux and that they live with it, when actually they have SIBO, which is treatable and curable, claims the researcher.

This contrasts with IBS, for which there is no cure — although antispasmodics, laxatives, and other treatments can help manage symptoms.

One of the most common reasons for the problem, as highlighted by Mr. Boyle, are Proton-pump inhibitor (PPI) drugs prescribed to cure heartburn and acid reflux.

Well, there is still controversy about how common SIBO is, how best to test for it and treat it.

There are also questions over the link to PPIs, with studies, including one in the journal Gastroenterology in 2016, showing that patients with IBS had SIBO even when they didn’t take acid-suppressant pills.

Image Credit: Getty

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