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SIBO: Unraveling the Mysteries of Small Intestinal Bacterial Overgrowth

Updated: Mar 26

In recent years, a perplexing health condition known as Small Intestinal Bacterial Overgrowth (SIBO) has been gaining attention in medical circles. Despite that, SIBO remains largely misunderstood, leading to confusion among patients and practitioners alike. This article aims to shed light on the enigmatic nature of SIBO, exploring its definition, symptoms, diagnosis, and treatment options.

What Exactly is SIBO?

Small Intestinal Bacterial Overgrowth refers to the presence of an excessive number and/or abnormal types of bacteria in the upper gastrointestinal tract, specifically the small intestine. Normally, the small intestine harbors a relatively low bacterial population, ranging from 1,000 to 10,000 organisms per milliliter of intestinal fluid. When this population exceeds 100,000 organisms/mL, it signifies SIBO. Although SIBO is a relatively newly observed condition in medical literature, reports of bacterial overgrowth in the small intestine date back to the 1970s, with the term "SIBO" gaining prominence in the 1990s. [1]

Why is SIBO a Concern?

The overgrowth of bacteria in the small intestine can disrupt normal digestive processes and lead to various health issues. Excessive bacteria may compete for nutrients, causing malnourishment, while their metabolic byproducts can damage the intestinal lining, resulting in conditions like leaky gut syndrome. Moreover, SIBO has been linked to a range of other ailments, including autoimmune diseases, vitamin deficiencies, weight loss, fatigue, and skin problems. [2]

Identifying SIBO Symptoms

Recognizing SIBO can be challenging due to its diverse array of symptoms. Common signs include nausea, abdominal discomfort, bloating, flatulence, and changes in bowel habits such as diarrhea or constipation. Less common symptoms may include nutritional deficiencies, excess folate, and unintended weight loss. [3]

Navigating the Diagnosis of SIBO

Diagnosing SIBO requires careful consideration and reliable testing due to its overlap with other gastrointestinal conditions. Key diagnostic methods include endoscopy with culture of small bowel content and hydrogen/methane breath testing. However, both approaches have limitations, often yielding false-positive or false-negative results, which complicates the diagnostic process. [4],[5],[6],[7],[8]

Understanding the Causes and Risk Factors

SIBO can arise from various factors, including age-related changes, anatomical abnormalities, motility disorders, alterations in pH levels, and underlying health conditions such as irritable bowel syndrome (IBS). Certain medications, immune deficiencies, and organ dysfunctions may also contribute to SIBO development. [9],[10],[11],[12],[13],[14]

Exploring Treatment Options for SIBO

Management of SIBO typically involves targeting bacterial overgrowth through antibiotics, prokinetic agents, or dietary interventions. While antibiotics can provide temporary relief, they may not address the underlying issues and can lead to adverse effects. Probiotics and herbal antimicrobials show promise in managing SIBO symptoms, while dietary approaches like the low FODMAP diet and elemental diet aim to alleviate gastrointestinal distress by reducing fermentable carbohydrates or providing easily digestible nutrients. [15],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26]

Vegetables and croissants
Sibo and diet

Embracing a Holistic Approach to Gut Health

In conclusion, while SIBO presents challenges in diagnosis and treatment, adopting a holistic approach to gut health may offer long-term benefits. Incorporating a balanced, fiber-rich diet, stress-reducing practices like yoga, and targeted dietary modifications can support gut motility and overall well-being.



[1] Ruscio M. “Is SIBO A Real Condition?” Altern Ther Health Med. 2019 Sep;25(5):30-38.


[2] Parodi A, Paolino S, Greco A, et al. Small intestinal bacterial overgrowth in rosacea: clinical effectiveness of its eradication. Clin Gastroenterol Hepatol. 2008;6(7):759-764. 


[3] Dukowicz AC, Lacy BE, Levine GM. Small intestinal bacterial overgrowth: a comprehensive review. Gastroenterol Hepatol (N Y). 2007;3(2):112-122.


[4] Simrén M, Stotzer PO. Use and abuse of hydrogen breath tests. Gut. 2006;55(3):297-303. doi:10.1136/gut.2005.075127


[5] Corazza GR, Menozzi MG, Strocchi A, et al. The diagnosis of small bowel bacterial overgrowth. Reliability of jejunal culture and inadequacy of breath hydrogen testing. Gastroenterology. 1990;98(2):302-309. doi:10.1016/0016-5085(90)90818-l


[6] Ghoshal UC, Srivastava D. Irritable bowel syndrome and small intestinal bacterial overgrowth: meaningful association or unnecessary hype. World J Gastroenterol. 2014;20(10):2482-2491. doi:10.3748/wjg.v20.i10.2482


[7] Yao CK, Tuck CJ, Barrett JS, Canale KE, Philpott HL, Gibson PR. Poor reproducibility of breath hydrogen testing: Implications for its application in functional bowel disorders. United European Gastroenterol J. 2017;5(2):284-292. doi:10.1177/2050640616657978


[8] Walters B, Vanner SJ. Detection of bacterial overgrowth in IBS using the lactulose H2 breath test: comparison with 14C-D-xylose and healthy controls. Am J Gastroenterol. 2005;100(7):1566-1570. doi:10.1111/j.1572-0241.2005.40795.x

[9] MacMahon M, Lynch M, Mullins E, et al. Small intestinal bacterial overgrowth--an incidental finding?. J Am Geriatr Soc. 1994;42(2):146-149. doi:10.1111/j.1532-5415.1994.tb04942.x


[10] Mac Mahon M, Gibbons N, Mullins E, et al. Are hydrogen breath tests valid in the elderly?.Gerontology. 1996;42(1):40-45. doi:10.1159/000213769




[14] Dukowicz AC, Lacy BE, Levine GM. Small intestinal bacterial overgrowth: a comprehensive review. Gastroenterol Hepatol (N Y). 2007;3(2):112-122.


[15] Zhong C, Qu C, Wang B, Liang S, Zeng B. Probiotics for Preventing and Treating Small Intestinal Bacterial Overgrowth: A Meta-Analysis and Systematic Review of Current Evidence. J Clin Gastroenterol. 2017;51(4):300-311.


[16] Lauritano EC, Gabrielli M, Scarpellini E, et al. Small intestinal bacterial overgrowth recurrence after antibiotic therapy. Am J Gastroenterol. 2008;103(8):2031-2035.

[17] Collins, Brynie Slome, and Henry C Lin. “Double-blind, placebo-controlled antibiotic treatment study of small intestinal bacterial overgrowth in children with chronic abdominal pain.” Journal of pediatric gastroenterology and nutrition vol. 52,4 (2011): 382-6.


[18] Chedid V, Dhalla S, Clarke JO, et al. Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth. Glob Adv Health Med. 2014;3(3):16-24.


[19] Soifer, Luis Oscar et al. “Eficacia comparativa de un probiótico vs un antibiótico en la respuesta clínica de pacientes con sobrecrecimiento bacteriano del intestino y distensión abdominal crónica funcional: un estudio piloto” [Comparative clinical efficacy of a probiotic vs. an antibiotic in the treatment of patients with intestinal bacterial overgrowth and chronic abdominal functional distension: a pilot study]. Acta gastroenterologica Latinoamericana vol. 40,4 (2010): 323-7.


[20] Barrett JS, Canale KE, Gearry RB, Irving PM, Gibson PR. Probiotic effects on intestinal fermentation patterns in patients with irritable bowel syndrome. World J Gastroenterol. 2008;14(32):5020-5024. doi:10.3748/wjg.14.5020



[22] Chen, Chunqiu et al. “A Randomized Clinical Trial of Berberine Hydrochloride in Patients with Diarrhea-Predominant Irritable Bowel Syndrome.” Phytotherapy research: PTR vol. 29,11 (2015): 1822-7.


[23] Chedid V, Dhalla S, Clarke JO, et al. Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth. Glob Adv Health Med. 2014;3(3):16-24.


[24] Pimentel, Mark et al. “A 14-day elemental diet is highly effective in normalizing the lactulose breath test.” Digestive diseases and sciences vol. 49,1 (2004): 73-7. doi:10.1023/b:ddas.0000011605.43979.e1


[25] Magge S, Lembo A. Low-FODMAP Diet for Treatment of Irritable Bowel Syndrome. Gastroenterol Hepatol (N Y). 2012;8(11):739-745.


[26] Gibson, Peter R, and Susan J Shepherd. “Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach.” Journal of gastroenterology and hepatology vol. 25,2 (2010): 252-8.



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