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Small intestinal bacterial overgrowth syndrome, also known by the acronym SIBO, is a condition in which there is an excessive development of bacteria in the small intestine, reaching values similar to the amount of bacteria present in the small intestine. large intestine.
Although bacteria are important for food digestion and nutrient absorption, when they are in excess they can cause intestinal problems, resulting in symptoms such as excess gas, constant feeling of a bloated belly, abdominal pain and constant diarrhea, for example. In addition, by altering the absorption of nutrients, in some people, it can result in malnutrition, even if the person is eating properly.
This syndrome is curable and can be treated, in many cases, with changes in diet and lifestyle, but it can also include the use of antibiotics prescribed by the gastroenterologist.
Excessive presence of bacteria in the small intestine can cause symptoms such as:
- Tummy pain, especially after eating;
- Constant feeling of a swollen belly;
- Periods of diarrhea, interspersed with constipation;
- Frequent feeling of indigestion;
- Excessive intestinal gas.
Although the syndrome can cause periods of diarrhea and constipation, it is more common for the person to have chronic diarrhea.
In the most severe cases of SIBO, the intestine can lose part of its ability to absorb nutrients and, in this way, malnutrition can arise, even if the person is eating properly.When this happens, the person may experience excessive tiredness, weight loss and even anemia.
How to confirm the diagnosis
The most used way to confirm the diagnosis of bacterial overgrowth syndrome in the small intestine is to perform a breath test, in which the amount of hydrogen and methane present in the expired air is evaluated. This is because the excess of bacteria in the small intestine releases this type of gases in a greater amount than is considered normal. Thus, breath testing is a non-invasive and non-direct way of identifying a possible case of SIBO.
To do this test you have to fast for 8 hours and then go to the clinic to exhale into a tube. After that, the technician delivers a special liquid that must be drunk and, from that moment, other expirations are collected in new tubes every 2 or 3 hours.
Typically, people with SIBO have increased amounts of hydrogen and methane in their expired air over time.And when that happens, the result is considered positive. However, if the test is not conclusive, the doctor may ask for other tests, especially the removal of a sample of the fluid present in the small intestine, to evaluate, in the laboratory, the amount of bacteria.
Some causes that may be at the origin of SIBO are changes in gastric acid production, anatomical defects of the small intestine, changes in pH in the small intestine, changes in the immune system, changes in gastrointestinal motility, changes in enzymes and commensal bacteria.
This syndrome can also be related to the use of some medications, such as proton pump inhibitors, anti-motility agents and some antibiotics.
Furthermore, this syndrome may be related to some diseases such as viral gastroenteritis, celiac disease, Crohn's disease, low stomach acid levels, gastroparesis, nerve damage, cirrhosis, portal hypertension, irritable bowel syndrome, bypass procedures or certain surgeries, for example.
How the treatment is done
Treatment for this syndrome should be guided by a gastroenterologist, however, the follow-up of a nutritionist may also be necessary. This is because the treatment may include:
1. Use of antibiotics
The first step in treating SIBO is to control the amount of bacteria in the small intestine and, therefore, it is necessary to use an antibiotic, prescribed by the gastroenterologist, but which is usually Ciprofloxacin, Metronidazole or Rifaximin.
Although in most cases the antibiotic can be used in the form of pills, when the syndrome is causing malnutrition or dehydration, it may be necessary to stay in the hospital for a few days to receive saline or parenteral nutrition, which is done directly in the vein.
2. Diet changes
A diet capable of curing SIBO is still unknown, however, there are some dietary changes that seem to alleviate symptoms, such as:
- Eat small meals throughout the day, avoiding meals with a lot of food;
- Avoid high-sugar foods and drinks;
- Avoid foods that seem to make symptoms worse, such as foods with gluten or lactose.
In addition, several doctors also indicate that following a FODMAP type diet, where foods that undergo fermentation in the intestine are removed and that are therefore less absorbed, can be ideal for quickly relieving symptoms. See how to make a FODMAP type feed.
3. Taking probiotics
Although more studies are needed to prove its effectiveness, the use of probiotics seems to help the gut rebalance its natural flora, reducing excess bacteria.
However, probiotics can also be ingested naturally through food, through fermented foods such as yogurt, kefir or kimchi, for example.