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Small Intestinal Bacterial Overgrowth:
The human intestinal microbiota has a complex ecology, and it has the most abundant microbial population in the human body. It is also characterized by its diversity and complex interaction. Per Bures et al. (2010), any disbalance in the intestinal microbiota will have serious health consequences. One of the most commonly developed syndromes due to bacteria overgrowth is called SIBO small intestinal bacteria overgrowth. It is defined as an alteration of bacteria in the upper gastrointestinal tract and is one of the most common forms of disbalances in the gut. The duodenum and jejunum contain a small number of bacteria, such as lactobacilli and enterococci gram-positive bacteria. However, high amounts of coliform gram negative bacteria are found in the small bowel of people with SIBO.
Sorathia et al. (2015) reported that gastric secretion and intestinal motility limit the overgrowth of bacteria in the small intestine. Furthermore, when the protective intestinal mechanism fails, small bacteria overgrowth will develop. During ingestion of food, gastric acid and bile destroy and prevent bacteria from passing through the intestines. Gastric secretion is one of the endogenous defense mechanisms in the body for SIBO. Moreover, small bacteria overgrowth is also associated with pancreatic insufficiency, irritable bowel syndrome, narcotic use, post-radiation, hypothyroidism, diabetes mellitus, bacteria translocation, and bariatric surgery. Furthermore, immunoglobulin A is found in abundance in the gastrointestinal tract, and it also prevents bacteria overgrowth from developing, having intestinal immunodeficiency IgA will trigger small bacteria overgrowth in healthy people (Sorathia et al. 2015).
Per Sorathia et al. (2015) research have identified the most common species of SIBO as Streptococcus, Escherichia coli, lactobacillus and Bacteroides. Symptoms and clinical manifestations of SIBO include bloating, flatulence, diarrhea, weight loss, fat and carbohydrates malabsorption. Vitamin deficiencies such as B1, B3, and B12 from ileal mucosa damage to cobalamin binding sites are also common. Moreover, 45 percent of patients have recurrent SIBO after antibiotic therapy, with higher percentage alterations with the continuing use of proton pump inhibitors (antacid medication) (Sorathia et al. 2015).
Rao et al. (2019) presented a metanalysis of patients registered with SIBO from 1985 to June 8th, 2018. They found a total of 23 references on predisposing factors and four on diagnostic testing for SIBO. The study recognized that the prevalence of SIBO is challenging to estimate because it occurs in a broad spectrum of diseases in the GI tract. What we have learned so far is that SIBO correlates with IBS, and it is more prevalent in women and older individuals. The less invasive diagnostic method for SIBO is breath testing. During the breath testing, patients ingest a carbohydrate substance that is metabolized, and once it is exposed to the GI microbes, it will trigger the production of methane and hydrogen. Glucose and lactulose are also used during breath testing for detecting SIBO (Rao et al. 2019). Effective treatment of SIBO includes eradication of bacteria with the use of antibiotics or other methods following the 4 R’s, Remove, Replace, Reinoculate, Repair, and Rebalance.
(Rao et al. 2019).
Bures, J., Cyrany, J., Kohoutova, D., Förstl, M., Rejchrt, S., Kvetina, J., Vorisek, V., & Kopacova, M. (2010). Small intestinal bacterial overgrowth syndrome. World journal of gastroenterology, 16(24), 2978–2990. https://doi.org/10.3748/wjg.v16.i24.2978
Sorathia SJ, Rivas JM. Small Intestinal Bacterial Overgrowth. [Updated 2019 Aug 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546634/
Rao, S., & Bhagatwala, J. (2019). Small Intestinal Bacterial Overgrowth: Clinical Features and Therapeutic Management. Clinical and translational gastroenterology, 10(10), e00078. https://doi.org/10.14309/ctg.0000000000000078
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