SIBO Pt 1

Question 1

What are the most common symptoms of SIBO?

Answer 1

• Bloating (Belching, Flatulence)
• Pain
• Diarrhea, Constipation or Both
• Food Reactions (GI or Systemic: leaky gut) (LGS Sx: h/a, jt P, skin, resp, brain)
• Fatigue, Anxiety, Brain Fog
• GERD
• Nausea, Food Sits in Stomach
• Steatorrhea/Fatty Stool
• Underweight

Question 2

In SIBO, the small intestine is overgrown with what type of bacteria (commensal vs. pathogenic)?

Answer 2

COMMENSAL

Question 3

Key indicators of SIBO are?

Answer 3

• When GI Sx develop after acute gastroenteritis (food poisoning)
• When antibiotics give dramatic temporary improvement of GI symptoms
• When GI symptoms develop after taking opiates
• When probiotics containing prebiotics worsen GI symptoms
• When fiber worsens constipation & other GI symptoms
• When mucopolysaccharide gut healing supplements worsen GI symptoms
• When gluten-free diet worsens GI sx or gives insufficient improvement in Celiac Disease
• When carbohydrates worsen GI symptoms
• When GI symptoms would be present without a restricted diet
• Chronic low ferritin with no other cause
• When the pancreas is obscured by a gas bubble on CT scan

Question 4

What are the two main pathophysiological problems in SIBO?

Answer 4

1. Small Intestine Fermentation

2. Small Intestine Damage

Question 5

In SIBO, constipation is usually caused by?

Answer 5

Altered BM’s
• Methane> Constipation
• Hydrogen> Diarrhea/Mixed

Question 6

SIBO can cause what conditions?

Answer 6

• IBS
• Dyspepsia
• Leaky Gut
• GERD
• Lactose Intolerance (2°)
• Fructose Malabsorption (2°)
• Anemia (Fe/B12) or low ferritin
• Omega 3 deficiency
• Vit D deficiency

Question 7

The general underlying causes of SIBO are_________?

Answer 7

Agreed Upon
– Deficient MMC (most common)
– SI Structural Alterations
– Immune Deficiency

Debated (but Accepted/Certain Risk Factors)
– Hypochlorhydria
– Absent/Inefficient Ileocecal Valve

Unknown
– Bile, Enzymes

Question 8

Damage to the interstitial cells of Cajal, will cause what small intestine function to become deficient?

Answer 8

MMC

Question 9

Clinically, the most common risk factor/cause of SIBO is ___________ ?

Answer 9

Deficient MMC

Question 10

Proton Pump Inhibitors (PPI’s) are a risk factor for SIBO because?

Answer 10

GERD → Rx: PPIs → hypochlorhydria → increase bact load