![]() Quigley serves as a consultant to 4D Pharma, Alimentary Health, Allergan, Biocodex, Ironwood, Salix and Vibrant receives research support from 4D Pharma, Biomerica, Takeda, Vibrant and Zealand and holds patents with and equity in Alimentary Health. Methane on breath testing is defined differently and now termed intestinal methanogen overgrowthĪntibiotics are currently the mainstay of treatmentĬonflicts of interest The authors disclose the following: E. There is evidence for SIBO being present in a subset of IBS subjectsĬulture is considered the gold standard with new guidance suggesting a cutoff of >10 3 CFU of coliforms/mL in duodenal aspirates.īreath testing (lactulose and glucose) is most commonly used to diagnose SIBO and appears to identify subjects likely to respond to treatment ![]() However, evidence suggests unexplained diarrhea might be more importantĪlthough malabsorption (steatorrhea and vitamin deficiency) can be seen in SIBO, this is uncommon in the absence of blind loops or other structural causes of SIBOĪ good rule is to consider SIBO any time there is small intestinal stasis Table 3 Takeaway Points for the Clinician Categoryīloating and gas have been thought to be traditional symptoms of SIBO Inherited immune deficiencies (eg, common variable immunodeficiencyĪcquired immune deficiency (eg, AIDS, severe malnutrition) Strictures (Crohn’s disease, radiation, surgery) Surgically-induced alterations in anatomy (Billroth II gastrectomy, bariatric surgery, end-to-side anastomosis) Long-standing use of motility-suppressing drugs I look forward to publishing the full efforts of my research in a comprehensive book on SIBO, which will integrate the dietary treatment with all the scientific research, both old and new.Table 1 Diseases and Disorders Associated With Small Intestinal Bacterial Overgrowth-A Pathophysiological Approach Abnormal small intestinal motility ![]() My mission is to share information and news about SIBO to empower people in their health. I developed this site in 2010 (there were no online resources then) to answer the questions of fellow doctors as well as anyone interested in SIBO. Thankfully, Dr Mark Pimentel, one of the pioneers of SIBO research, shared his extensive knowledge on the subject in his book, A New IBS Solution. ![]() Since then, I have devoted myself to the study and treatment of SIBO. During the process, the name SIBO had stuck. It turned out the international gastroenterology community had been doing vigorous research on this very topic since the late 1990s, discovering incredible details about the causes, mechanisms and treatments. It seemed to us to be the very same condition Gottschall had described. During research for his book, Functional Gastroenterology, he came across the condition and term, "Small Intestine Bacterial Overgrowth" (SIBO). I implemented the Specific Carbohydrate Diet (SCD) that the book recommended with incredible results, and now, with focus to devote to it, I plunged into understanding all that I could about what Gottschall had discussed.Ī few months after re-discovering BTVC, I ran into Dr Sandberg-Lewis at a lecture. Things were different when I re-read BTVC. I felt inspired, but then the next round of exams hit and it got lost in the shuffle. Never before had I read such a plausible explanation for my symptoms. It explained how bacteria that accumulate in the small intestine eat our food and make by-products that cause symptoms like bloating, pain and diarrhea as well as brain and other symptoms. My first reading had been years before during medical school, when my gastroenterology professor, Dr Steven Sandberg-Lewis, had placed it on the recommended reading list. In 2009, while trying to find the cause of my chronic gastrointestinal symptoms, I re-read Breaking the Vicious Cycle (BTVC) by Elaine Gottschall.
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