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Hi all,

 

One more note on Sibo as some people have emailed that they do not know
what it is. Sibo stands for Small Intestinal Bacterial Overgrowth and is
commonly diagnosed in people with intestinal issues such as Celiac and
also people who are hypo-thyroid (due to a slow down in the villi
movement allowing bacteria to pass through where it should not be). See
below from
http://www.medicinenet.com/small_intestinal_bacterial_overgrowth/article
.htm.

 

What is small intestinal bacterial overgrowth (SIBO)? 

The small bowel, also known as the small intestine
<http://www.medicinenet.com/script/main/art.asp?articlekey=5512> , is
the section of the gastrointestinal tract
<http://www.medicinenet.com/script/main/art.asp?articlekey=25976>  that
connects the stomach with the colon. The main purpose of the small
intestine is to digest and absorb food into the body. The small
intestine is approximately 21 feet in length and begins in the duodenum
<http://www.medicinenet.com/script/main/art.asp?articlekey=3132>  (into
which food from the stomach empties), followed by the jejunum
<http://www.medicinenet.com/script/main/art.asp?articlekey=4073> , and
then the ileum
<http://www.medicinenet.com/script/main/art.asp?articlekey=6451>  (which
empties the food that has not been digested into the large intestine or
colon). 

The entire gastrointestinal tract, including the small intestine,
normally contains bacteria. The number of bacteria is greatest in the
colon (at least 1,000,000,000 bacteria per milliliter (ml) of fluid) and
much lower in the small intestine (less than 10,000 bacteria per ml of
fluid). Moreover, the types of bacteria within the small intestine are
different than the types of bacteria within the colon. Small intestinal
bacterial overgrowth (SIBO) refers to a condition in which abnormally
large numbers of bacteria (at least 100,000 bacteria per ml of fluid)
are present in the small intestine and the types of bacteria in the
small intestine resemble more the bacteria of the colon than the small
intestine. 

Small intestinal bacterial overgrowth (SIBO) is also known as small
bowel bacterial overgrowth (SBBO).

What causes small intestinal bacterial overgrowth? 

The gastrointestinal tract is a continuous muscular tube through which
digesting food is transported on its way to the colon. The coordinated
activity of the muscles of the stomach and small intestine propels the
food from the stomach, through the small intestine, and into the colon.
Even when there is no food in the small intestine, muscular activity
sweeps through the small intestine from the stomach to the colon. 

The muscular activity that sweeps through the small intestine is
important for the digestion of food, but it also is important because it
sweeps bacteria out of the small intestine and thereby limits the
numbers of bacteria in the small intestine. Anything that interferes
with the progression of normal muscular activity through the small
intestine can result in SIBO. Simply stated, any condition that
interferes with muscular activity in the small intestine allows the
bacteria to stay longer and multiply in the small intestine. The lack of
muscular activity also may allow bacteria to spread backwards from the
colon and into the small intestine. 

How does small intestinal bacterial overgrowth cause symptoms?

When bacteria digest food in the intestine, they produce gas. The gas
can accumulate in the abdomen giving rise to abdominal bloating or
distension. Distension can cause abdominal pain. The increased amounts
of gas are passed as flatus (flatulence or farts). The bacteria also
probably convert food into substances that are irritating or toxic to
the cells of the inner lining of the small intestine and colon. These
irritating substances produce diarrhea (by causing secretion of water
into the intestine). There is some evidence that the production of one
gas by the bacteria-methane-causes constipation. 

Bacteria in the small intestine, when present in large numbers, can
compete with the human host for the food that is eaten. This can lead to
malnutrition with vitamin and mineral deficiencies. In advanced cases of
SIBO, the bacteria use up enough food that there are insufficient
calories for the host, thereby leading to weight loss
<http://www.medicinenet.com/script/main/art.asp?articlekey=18262> . 

How is small intestinal bacterial overgrowth diagnosed?

Culturing bacteria from the small intestine

One method of diagnosing bacterial overgrowth is culturing (growing) the
bacteria from a sample of fluid taken from the small intestine. The
culturing must be quantitative, meaning that the actual number of
bacteria must be determined. Essentially, the bacteria in a known
quantity of fluid are counted. Culturing requires a long flexible tube
to be passed through the nose, down the throat and esophagus
<http://www.medicinenet.com/script/main/art.asp?articlekey=3326> , and
through the stomach under x-ray
<http://www.medicinenet.com/script/main/art.asp?articlekey=6032>
guidance so that fluid can be obtained from the small intestine. 

There are several problems with diagnosing SIBO by culturing. Passage of
the tube is uncomfortable and expensive, and the skill necessary to pass
the tube is not commonly available. The quantitative culturing of
intestinal fluid is not a routine procedure for most laboratories, and,
therefore, the accuracy of the cultures is questionable. Finally, with
the tube only one, or at most a few, locations of the small intestine
can be sampled. Usually it is the duodenum. It is possible that the
overgrowth involves just the jejunum or ileum, and overgrowth may be
missed if only the duodenum is sampled. Because of all these potential
problems, quantitative culturing for intestinal bacteria usually is
utilized only for research purposes. 

Hydrogen breath test (HBT) 

Bacteria that live in the colon are capable of digesting and using
sugars and carbohydrates as food. When the bacteria normally present in
the colon digest sugars and carbohydrates, they produce gas, most
commonly carbon dioxide
<http://www.medicinenet.com/script/main/art.asp?articlekey=20132> , but
also smaller amounts of hydrogen and methane. (The types of bacteria
normally found in the esophagus, stomach, and small intestine produce
little gas.) Most of the sugars and carbohydrates that we eat are
digestible and are digested and absorbed in the small intestine, never
reaching the colonic bacteria. Moreover, more than 80% of the gas that
is produced by bacteria in the colon is used up by other bacteria within
the colon. As a result, relatively little of the gas that is produced
remains in the colon, and it is eliminated as flatus (farts). Although
the overwhelming majority of the hydrogen and methane produced by
colonic bacteria is used up by other bacteria, small amounts of these
gases are absorbed through the lining of the colon and into the blood.
The gases circulate in the blood and go to the lungs, where they are
eliminated in the breath. The gases can be measured in the breath with
special analyzers (usually a gas chromatograph). 


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