Small Intestinal Bacterial Overgrowth (SIBO) Flashcards
Small Intestinal Bacterial Overgrowth (SIBO):
What is is?
Nutrient malabsorption associated with excessive proximal small intestinal bacteria
Small Intestinal Bacterial Overgrowth (SIBO):
Contributing factors?
• Disorders of antibacterial mechanisms:
- PPI use
- Atrophic gastritis
- Pancreatic exocrine deficiency eg. Cystic fibrosis
- Immunodeficiency syndromes (AIDS, IgA deficiency)
- Coeliac disease
- Tropical sprue
• Anatomic abnormalities:
- Small bowel adhesions, strictures, tumours, diverticulae
- Previous bowel surgery
- Inflammatory Bowel disease (particularly of loss of ileocecal valve)
- Short bowel syndrome
• Motility disorders:
- Medication induced (opioids, anticholinergics, antidiarrhoeal, GLP-1 agonists)
- Gastroparesis
- Connective tissue diseases (RA, systemic sclerosis)
- Hypothyroidism
- Liver disease
- Parkinsons
- Elderly
Small Intestinal Bacterial Overgrowth (SIBO):
Symptoms?
- Bloating
- Abdominal pain
- Flatulence
- Diarrhoea
Small Intestinal Bacterial Overgrowth (SIBO):
Any relationship to IBS?
Seems to be significant cross over with IBS with a number of studies demonstrating that IBS patients who have positive lactulose breath test result who are treated for SIBO have a reduction in symptoms.
Small Intestinal Bacterial Overgrowth (SIBO):
Diagnosis?
1) Hydrogen breath test - ideally using Glucose not lactose (like for lactose intolerance)
- Avoid ABx for 4 weeks prior to testing
- Avoid fermentable foods prior
- Avoid smoking day of test
- Limit physical activity during test
OR
2) Intestinal aspirate testing (Gold standard but invasive)
Small Intestinal Bacterial Overgrowth (SIBO):
Management?
Management:
1) Treat underlying diseases to prevent recurrence
2) Eradicate bacterial overgrowth - Antibiotics
- Rifaximin 1200mg or 1600mg daily for 7 – 10 days, single or cyclical courses
- Could use tetracycline, norfloxacin, augmentin duo forte, erythromycin
*High relapse rates – 40%
