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IBS is a very common gastrointestinal problem. Often patients with IBS concurrently are diagnosed with small intestinal bacterial overgrowth (SIBO), but not always. A recent research study showed that IBS patients that test positive for SIBO do much better when treated with the antibiotic norfloxacin as compared to IBS patients without SIBO. This study enrolled 80 patients who were tested for SIBO by gut aspirate culture (the gold standard for detecting SIBO but seldom used in comparison to hydrogen breath testing because of the invasive nature of the test). While antibiotics may not be your desired cause of treatment it is worth consideration if homeopathic remedies don’t work.

This is a wonderful article because it presents many accurate facts about small intestinal bacterial overgrowth. There are too many so called SIBO “experts” who have populated the internet with self serving views that are presented as fact when in reality they are unproven.
Let’s take a look at a few truths:
1. Antibiotics are an effective treatment to eradicate SIBO but the cure is usually not permanent since the underlying cause of SIBO is not being treated.

Ongoing research continues to support the link between small intestinal bacterial overgrowth (SIBO) and Parkinson’s disease. This new article explains some of the complex cellular level reasons for the link and why SIBO helps exacerbate Parkinson’s. So it seems important to test for SIBO in patients that show early signs of Parkinson’s disease. If the test is positive it would be reasonable to pursue a treatment program to eradicate the bacteria. How much this will help with Parkinson’s symptoms is still unknown but there is no harm in eliminating the bacteria which if nothing else will improve gastrointestinal health. What is needed at this point is a study looking at whether SIBO eradication leads to better outcomes for Parkinson’s patients.

The link between rosacea and small intestinal bacterial overgrowth (SIBO) is not new but has been largely ignored by dermatologists. Until recently the publications of scientific studies of the link has been limited. However, A recent study presented at the American College of Gastroenterology Annual Scientific Meeting and reported in the Journal of the American Academy of Dermatology indicates confirms that there is a link. Furthermore, the articles states that 46% of prospective patients with rosacea had SIBO, and these patients were prescribed rifaximin, an antibiotic commonly used for traveler’s diarrhea. After rifaximin, 78% of those patients saw an improvement in their rosacea. For a hard to treat disease that is a remarkable improvement.

Small intestinal bacterial overgrowth (SIBO) is has been shown to be prevalent in people with Crohn’s Disease. This study sought to determine the prevalence and efficiency of treatment. Sixty eight (68) subjects with Crohn’s Disease were enrolled in the study. Each subject received a glucose hydrogen breath test to indentify the presence of SIBO. 26.5% of the subjects tested positive for SIBO. These patients were then treated using a combination antibiotic and probiotic regimen. The therapy successfully eliminated SIBO in 87% of the subjects.

Small intestinal bacterial overgrowth (SIBO) is has been shown to be prevalent in people with Crohn’s Disease. This study sought to determine the prevalence and efficiency of treatment. Sixty eight (68) subjects with Crohn’s Disease were enrolled in the study. Each subject received a glucose hydrogen breath test to indentify the presence of SIBO. 26.5% of the subjects tested positive for SIBO. These patients were then treated using a combination antibiotic and probiotic regimen. The therapy successfully eliminated SIBO in 87% of the subjects.

Small intestinal bacterial overgrowth (SIBO) is has been shown to be prevalent in people with Crohn’s Disease. This study sought to determine the prevalence and efficiency of treatment. Sixty eight (68) subjects with Crohn’s Disease were enrolled in the study. Each subject received a glucose hydrogen breath test to indentify the presence of SIBO. 26.5% of the subjects tested positive for SIBO. These patients were then treated using a combination antibiotic and probiotic regimen. The therapy successfully eliminated SIBO in 87% of the subjects.

Small intestinal bacterial overgrowth is a condition in known to occur in older adults. Common causes are gut motility and exposure to long term drug use (i.e., proton pump inhibitors). It is generally not thought of as a problem in children. However, a new publication questions that belief. The study enrolled 100 children that were being evaluated for abdominal pain. Each child received a hydrogen breath test. The results were that 63% of the children tested positive for SIBO. Furthermore, when treated 88% of the children reported a reduction in their pain. This study was conducted in Poland and doesn’t necessary mean that similar results would be found in American children. It would be interesting to see if a SIBO study done in American children would reveal similar results.

A comprehensive study evaluated 932 patients over a period of 5 years who had small intestinal bacterial overgrowth (SIBO) symptoms of bloating, abdominal pain, abdominal distension, weight loss, diarrhea and/or constipation. SIBIO was determined using the d-xylose breath test. The study results included:

Many practitioners share the misguided belief that a 90 minute or longer lactulose hydrogen breath test will provide a measure of distal small intestinal bacterial overgrowth (SIBO).  This is an inappropriate use of the test.  In most cases a rapid oro-caecal transit time has been misinterpreted as distal SIBO. This point was demonstrated in a 25 person study with IBS patients. The study used serial measurements of breath hydrogen and oro-caecal scintigraphy following ingestion of a test meal containing lactulose and ^99mTc.  The result was that ^99mTc had already reached the caecum in 88% of the patients before the hydrogen breath levels reached the threshold for a positive result for SIBO.  In conclusion the hydrogen breath test for SIBO will produce a large number of false positive results when testing beyond 60 minutes and is not reliable for detecting distal SIBO.