What is SIBO? Causes, symptoms and testing

Small intestinal bacterial overgrowth (SIBO) occurs when there is an increased number of bacteria in the small intestine. Excessive bacteria here can affect digestion and absorption..

Image credit: Pavel Katsperek/Shutterstock.com

However, bacteria may offer benefits, including:

• Production of trace elements
• Metabolism assistance or drug activation
• Biotransformation of bile salts
• Fermentation of indigestible polysaccharides
• Prevention of colonization of the lumen by pathogenic microbes

Watch the webinar: Gut Health: Understanding SIBO

What Causes SIBO?

A common cause of SIBO is normal dysfunction of intestinal motility. Slow movement through the intestines encourages bacterial growth. Possible reasons include:

• History of food poisoning
• Diabetes
• Some medications
• Nerve damage

The underlying cause may also be unknown. SIBO has numerous consequences, including villi moisture, carbohydrate and protein malabsorption, and B12 deficiency.

How can you test for SIBO?

The gold standard for diagnosing SIBO, culturing jejunal aspirate, has limitations. Many types of bacteria do not grow in conventional culture media, and the procedure is invasive and expensive. The hydrogen breath test was developed due to problems in assessing the small intestine. It is used to detect SIBO and malabsorption.

How can breath samples shed light on what’s happening inside the gut?

All cells produce carbon dioxide as part of their metabolism, but only bacteria produce hydrogen and methane as metabolic byproducts. These gases enter the blood through the intestinal walls. When the blood reaches the lungs, gas exchange occurs, which makes it possible to detect these gases in the exhaled air.

Image credit: Bedfont Scientific Ltd.

How to Test for SIBO or Malabsorption

GastroCH4ECK^® Gastrolizer^® estimates the amount of hydrogen or methane gases in each exhaled breath. The patient must adhere to a strict protocol before starting a breath test. This involves a restricted diet followed by a period of fasting. Failure to follow the protocol may result in a higher baseline recording or a false positive result.

Before consuming the appropriate substrate, a baseline breath pattern is recorded. The spent substrate is then mixed with 250 ml of water. The type of substrate corresponds to the test being performed. Substrates can be:

• Glucose
• Lactulose
• Sucrose
• Sorbitol

Breath samples are then recorded every 15 to 30 minutes, depending on the test. This process can take up to four hours, depending on the type of test. Depending on the type of test and results, treatment may include antibiotics or dietary changes.

Fructose malabsorption

Fructose malabsorption is a nutritional disorder of the small intestine. Most people can absorb 25 to 50 grams of fructose at a time. However, the small intestine of people with fructose malabsorption cannot adequately metabolize fructose, meaning that it then ends up in the large intestine, where resident bacteria must metabolize it.

This then increases the amount of hydrogen and methane gases offset by the bacteria. Potential causes of fructose malabsorption include:

• Inherited or acquired disorders of the fructose transport protein.
• Children consuming excessive amounts of high fructose corn syrup or fruit juices
• SIBO
• Celiac disease
• Radiation or chemotherapy
• Dumping syndrome

Clinical signs of fructose intolerance may include:

• Bloating
• Diarrhea
• Constipation
• Flatulence

There is currently no known treatment for SIBO. However, a proper diet can help. Foods high in glucose can help digest fructose.

To test for fructose intolerance, the patient should consume 25 g of fructose in 250 ml of water and then record breath samples every 30 minutes for three hours.

Lactose malabsorption

Lactose is usually hydrolyzed to glucose and galactose and then absorbed in the jejunum. Lactose must be hydrolyzed in the small intestine by lactase. If there is not enough lactase enzyme, lactose will not be completely hydrolyzed, resulting in lactose malabsorption. Signs of lactose malabsorption may include:

• Stretching
• Convulsions
• Flatulence

Lactose malabsorption is the most common type of intolerance and affects about half of the world’s population.

Watch the webinar: Gut Health: Understanding SIBO

Food allergy vs food intolerance

People often confuse food intolerances with food allergies. Food intolerances can occur as a result of changes in daily routine, hormones, or eating out. The unpredictability of symptoms can ruin someone’s life and cause them to avoid social activities. Many people suffering from this condition turn to the Internet for a quick and easy solution.

Intolerance occurs when the intestinal enzymes responsible for breaking down food are missing or damaged, or when there is a problem with the mechanism by which molecules are transported through the small intestine. Symptoms include:

• Abdominal pain
• Discomfort
• Diarrhea

Common food intolerances include:

• Lactose
• Fructose
• Sucrose
• Sorbitol

Image credit: Kreminska/Shutterstock.com

It is extremely important not to self-diagnose, as many conditions have similar symptoms to irritable bowel syndrome and SIBO but have different treatments and require different management strategies. It is always important to seek advice from a doctor or healthcare professional. Food intolerance can be diagnosed using an elimination diet or a breath test.

There is a key difference between food intolerance and food allergy. A food allergy is a reaction that involves the immune system. Symptoms may include:

• Rash
• Itching
• Difficulty breathing

People with food intolerances can consume small amounts of the food, while people with allergies should avoid these foods as consuming them can be fatal. Food allergies can be tested using a skin prick test or an elimination diet.

Health professionals currently do not recommend finger prick food intolerance tests or hair tests because they are not supported by sufficient scientific evidence.

Breath testing is the preferred approach to detect lactose malabsorption for several reasons. If patients go on an elimination diet and stop drinking milk, they may still be consuming lactose from several unsuspecting foods, including:

• Hot dogs
• Breaded chicken
• Sweets

Even if a patient tries to eliminate lactose from their diet, they may inadvertently ingest the substance.

Other testing strategies may include:

• Endoscopic biopsy (invasive and expensive)
• Blood test (repeated every 30 minutes)
• Stool acidity test (infants, young children)

Home Breath Testing Devices

Home breath testing devices have been optimized more widely since the COVID-19 pandemic to avoid queuing delays and as people feel safer taking tests at home. Home testing kits have many benefits, including:

• We live far from the clinic and it’s difficult to get there
• Difficult to get time off from work
• Problems with child care
• Difficulty leaving the house when symptoms appear.

Image credit: Kreminska/Shutterstock.com

However, a key limitation of home testing may be that the patient may collect samples incorrectly, meaning the test may have to be repeated. Patients should be given very clear and precise advice.

There are many home testing devices available today, but using any of these devices without the advice or guidance of a healthcare professional can lead to self-interpretation, misdiagnosis, and improper preparation, resulting in unnecessary avoidance of key food groups.

Home testing devices should be purchased from a reputable healthcare professional who can discuss the results or provide a report to your healthcare provider. This will ensure appropriate follow-up so that the patient does not develop nutritional deficiencies due to self-diagnosis.

Many factors are involved in the diagnosis and treatment of gastrointestinal diseases.

Watch the webinar: Gut Health: Understanding SIBO

About Bedfont^® LLC “Nauchnoe”

Bedfont^® Scientific has specialized in the design and manufacture of exhaled breath and gas monitoring instruments since 1976.

For medical gas monitoring, their Medi-Gas Check medical piping test range tests not only the quantity, but also the quality of gas supplied to patients.

Bedfont breath analyzers include carbon monoxide (CO) monitors such as the Smokerlyzer.^®used for smoking cessation, and ToxCO^®used by emergency services to diagnose CO poisoning.

NOT BREATHING^® The FeNO monitor provides accurate analysis of airway inflammation for asthma control, and the gastrolyser^® Helps identify gastrointestinal disorders and food intolerances. A quick and non-invasive breath test is a new blood test.

---

Sponsored Content Policy: News-Medical.net publishes articles and related content that may be obtained from sources with which we have existing commercial relationships, provided that such content adds value to News-Medical.Net’s core editorial ethos, which is to educate and informing site visitors interested in medical issues. research, science, medical equipment and treatments.