Friday, November 2, 2012
What is small intestinal bacterial overgrowth?
The ailment, also known as SIBO, is an increase in the number and/or an alteration in the types of bacteria in the upper GI (gastrointestinal) tract or gut. In other words there is an overgrowth of harmful bacteria in the small intestines. My daughter, a physician who is very interested in integrative or alternative medicine, brought this subject up to me several months ago. I have a dim recollection of hearing about it three or four years ago but paid no attention to it then.
It turns out that it may be more common than some folks realize. Information online suggests it is substantially underdiagnosed. Years and even decades can pass before someone diagnoses it. I have to wonder how many times I may have missed it myself in one of my patients.
In recent years there has been a greatly increased understanding of the role of bacteria in the gut. It has been estimated that there are 100 trillion bacteria inhabiting the normal GI tract. In general they are thought to play a positive role in the body. However there are things that can change the types of bacteria, which can produce a variety of symptoms.
Common symptoms are bloating, pain, increased bowel sounds, sometimes constipation or diarrhea.
There are also a number of causes of SIBO, such as diabetes, Crohn’s disease, autoimmune diseases, abnormalities of anatomy of the GI tract and celiac disease, which is an inability to handle gluten.
Other potential causes are the long-term use of proton pump inhibitors such as Prilosec and Nexium.
SIBO is not easy to diagnose because there are no single simple tests that point to it. However there are tests doctors can do that help in making the decision to treat the condition.
Once diagnosed, what are the treatment possibilities? Since the disease may cause nutritional deficiencies one may need to take vitamin B12 or Vitamin D. Or something like Carnation Instant Breakfast. Another part of treatment a doctor would need to prescribe — a course of antibiotics.
Several different antibiotics have been prescribed for this condition. The purpose of these antibiotics is to get rid of the harmful bacteria. The taking of a probiotic such as one of the acidopholus pills or yogurt has been recommended although there is no consensus as to how beneficial these are.
I am aware of an individual who had symptoms of SIBO for decades before a physician prescribed an antibiotic and the patient took a probiotic. There was significant improvement.
As a final note, laxatives and enemas will not help get rid of the harmful bacteria nor the symptoms.
Dr. Don Casebolt of College Place is a retired physician who is passionate about preventive medicine. He spent four years as a medical officer in the U.S. Navy, the last 2 1/2 years as a flight surgeon. He also worked on the Navajo Reservation for 22 years.