SIBO

Question 1

What is SIBO?

Answer 1

a heterogeneous syndrome characterised
by an increased number and/or abnormal
type of bacteria in the small bowel (Bures et al, 2010)
◦ > or = 10,000 CFU of bacteria/mL of proximal jejunal
aspirate

Question 2

2 types of SIBO?

Answer 2

 Gram-positive bacteria from upper respiratory tract
and oral cavity
 Colonic/coliform bacteria- gram-negative

Question 3

SIBO
 Proposed S&S

Answer 3

◦ GIT
 Bloating
 Flatulence
 Abdominal discomfort or pain
 Frequent belching
 Diarrhoea

◦ Systemic
 Signs of malabsorption
 weight loss; steatorrhea
 Arthralgia
 Polyneuropathy (2° to B12 deficiency)
 Acne rosacea
 Macrocytic anaemia
 Iron-deficiency anaemia

Question 4

SIBO
 Normal Protective Mechanisms ?

Answer 4

◦ Gastric acid
◦ Intestinal motility
 migrating motor complex&raquo_space; moving any bacteria down to
colon
◦ Intact ileo-caecal valve
◦ Intestinal immunoglobulin (IgA) secretion - needs to be adequate
◦ Bacteriostatic properties of pancreatic and biliary
secretions

Question 5

SIBO
 Risk factors?

Answer 5

◦ Proton pump inhibitor (PPI) use
◦ Narcotic use (Choung et al, 2011)
◦ Opiate pain killers
 codeine significantly delays orocaecal transit
◦ Gastrectomy
◦ Chronic pancreatitis (Choung et al, 2011)
◦ Dysmotility (Jacobs, CossAdame, Attaluri, Valestin, & Rao, 2013)
◦ AIDS (Quigley and Abu-Shanab, 2010)
◦ Diabetic neuropathy (Quigley and Abu-Shanab, 2010)
◦ Elderly (aged >75 years)
◦ Small intestinal disorders
 Small bowel diverticula (Choung et al, 2011)
 Crohn’s disease (Choung et al, 2011)
 Coeliac disease (Ghoshal et al, 2004)
 Short bowel syndrome (DiBaise et al, 2006)
 Radiation enteropathy (Husebye et al, 1995)
 Ileocecal valve resection (Quigley and Abu-Shanab, 2010)
◦ Large bowel disorders
 acute diverticulitis

Question 6

SIBO
 Conditions that may be associated with:

Answer 6

◦ IBS
 SIBO may or may not be more common in IBS patients
(Ford et al, 2009)
 hotly debated (Spiegel, 2011)(Lin, 2004)
◦ Unresponsive coeliac disease (Tursi et al, 2003)
◦ Chronic prostatitis (Weinstock et al, 2011)
◦ Acne rosacea (Parodi et al, 2008)
◦ Systemic sclerosis (Marie et al, 2009)
◦ Fibromyalgia
◦ Rheumatoid arthritis (Henriksson et al, 1993)
◦ Liver cirrhosis (Bauer et al, 2001)
◦ NAFLD (Compare et al, 2012)
◦ Parkinson’s disease (Gabrielli et al, 2011)
◦ Restless legs syndrome (Weinstock and Walters, 2011)
 2° to iron deficiency ?
◦ Type 2 diabetes

Question 7

SIBO - Txt?

Answer 7

 Removal of contributing factors
 Anti-Microbial Therapy
 Diet manipulation?
 Probiotics?
 Prebiotics?
 Nutritional supplementation
 Small intestinal motility enhancers
 Gut healing agents