SIBO has become a major concern in the gastrointestinal health arena.
It is the bacterial overgrowth of the small intestine, or better known by its acronym in English, SIBO. https://trends.google.es/trends/explore?geo=ES&q=sibo&hl=es.
This condition, characterized by an abnormal increase in bacterial populations in the small intestine, poses complex challenges for both diagnosis and treatment.
In this article, we will delve into some details, exploring its still unknown pathophysiology, clinical manifestations, diagnostic modalities, and evidence-based treatment strategies.

What is it about?

Small intestinal bacterial overgrowth (SIBO) is a disease of great clinical and socioeconomic importance and is caused, as the name implies, by an overgrowth of bacteria in the small intestine.
The physiological microbiota is replaced by pathogenic bacteria mainly from the large intestine, which gives rise to the phenomenon of dysbiosis.
The presence of SIBO disrupts digestion and absorption in the alimentary tract, which appears to cause inflammation.
In addition, it could affect the morphology and function of the digestive system and cause systemic complications such as osteoporosis and/or macrocytic anemia.

As is well known, the microbiota or gut microbiome is a complex polybacterial ecosystem located in the human body that affects its host in many ways.
It differs quantitatively and qualitatively according to its location in the gastrointestinal tract and whose proportion of anaerobic bacteria gradually increases towards the distal end.

Click here to read one of our articles where we delve into the subject.

What about its pathophysiology?

Unfortunately, SIBO has a little-known pathophysiology.
It is generally characterized by impaired motility, visceral hypersensitivity, abnormal brain-gut interaction, autonomic dysfunction, and immune activation.

The fermentation of dietary carbohydrates by SIBO colonizing bacteria ends up with excessive gas production, which generates the symptoms of this pathology.

Clinical manifestations

Recognizing the various clinical manifestations of SIBO is crucial for early detection and intervention.
Several studies meticulously documented the various symptoms associated with SIBO, ranging from bloating, abdominal pain, and diarrhea to nutrient malabsorption.
The nuances of symptomatology underscore the need for a nuanced approach to diagnosis and treatment.

The clinical manifestations of SIBO extend beyond commonly recognized symptoms and span a spectrum ranging from gastrointestinal discomfort to systemic manifestations that can be mistaken for other entities.

Typically, the main mechanisms that restrict bacterial colonization in the upper intestine are the gastric acid barrier, mucosal and systemic immunity, and intestinal clearance.
When these mechanisms fail, an overgrowth of bacteria develops.
Diarrhea, steatorrhea, chronic abdominal pain, bloating, and flatulence are common symptoms and are similar to those seen in irritable bowel syndrome. https://doi.org/10.1159/000103892

Diagnostic modalities

Accurate diagnosis is the cornerstone of effective SIBO management.
These studies seek to delve deeper into the complexities of testing, providing a robust framework for clinicians to accept the diagnostic challenges they face.
Quantitative cultures of the contents of the small intestine and a variety of indirect tests have been used over the years in an attempt to facilitate the diagnosis of SIBO.

Indirect testing includes breath testing and biochemical testing based on bacterial metabolism of a variety of substrates.
Unfortunately, there is no single valid test for SIBO, and the accuracy of all current tests remains limited due to the fact that cultivation is not a gold standard method.

The presence of >10 5 colony-forming units per milliliter (cfu/mL) of colonic-type bacteria in jejunal aspirate cultures is the traditionally accepted gold standard for the diagnosis of SIBO.
However, SIBO is invasive and lacks universal acceptance in terms of cut-off values for diagnosing the disease, is prone to cross-contamination of oral microbes or saliva and does not sample the most distal small intestine, and the best cut-off values for diagnosing SIBO remain under debate. In clinical practice, culture methods have largely been replaced by breath tests, which are simple, non-invasive tests for diagnosis.
These are based on the measurement of exhaled gases such as hydrogen (H2) and methane (CH4) after a carbohydrate exposure.
DOI: 10.14309/ajg.000000000000000504

The lactulose test is based on the properties of the lactulose and the fact that it is not absorbed through the small intestine, reaching the colon unaltered, where it is metabolized by the bacterial flora.
When bacteria come into contact with lactulose, they metabolize it and produce intestinal gases, such as methane and hydrogen, which can be detected and analyzed in exhaled air.
In the healthy population, bacteria are not present in the duodenum and therefore it takes at least 2 hours for lactulose to reach the colon and be metabolized.
Therefore, an increase in hydrogen concentrations in exhaled air within 90-120 minutes strongly suggests bacterial overgrowth and contamination of the small intestine. https://pubmed.ncbi.nlm.nih.gov/16567886/

Treatment Strategies

Treatment of SIBO should first focus on correcting the incorrect eating and dietary habits that normally underlie the disorder (e.g., excessive use of fast food) and then on reducing bacterial colonization of the small intestine using different methods.

In this regard, the use of locally acting non-absorbable antibiotics would be particularly useful to immediately reduce bacterial count pending the slow-acting beneficial effects of dietary measures. Decontamination of the small intestine is most successful when probiotics are prescribed (both after antibiotics and independently), which suppress opportunistic flora, protect the mucous layer, improve digestion, and stop diarrhea. https://pubmed.ncbi.nlm.nih.gov/17378388/

A study was conducted to evaluate the effect of a mixture of four probiotic species (Saccharomyces boulardii, Bifidobacterium lactis BB-12, Lactobacillus acidophilus LA-5, and Lactobacillus plantarum) on the symptoms of patients with SIBO and others with irritable bowel syndrome.

The result was that SIBO patients benefited greatly from the administration of this specific multi-strain probiotic preparation.
The study also demonstrated that many clinical aspects primarily related to improved stool shape and satisfaction of bowel function after probiotic treatment are observed among patients with irritable bowel syndrome, regardless of the presence of SIBO. https://doi.org/10.1007/s12602-018-9401-3

Salengei Food Supplements

We’ve talked about the many benefits of probiotics before, and this one is no exception.
To get a more accurate idea about these microorganisms, you can access our articles published on our blog, by clicking here and here.

Good results have also been obtained in the combination of the former together with the use of fibre. Here is our article to understand a little more about the subject.

Active Flora is a dietary supplement with bacterial strains (Megaflora-9 EVO), fibers, Saccharomyces Boulardii and aloe vera for the treatment of gastrointestinal health and especially indicated for those with a diagnosis of SIBO.

Megaflora-9 EVO is a bacterial mixture with one billion bacteria for every gram of product, which is equivalent to two capsules. Contains Bifidobacterium lactis, Enterococcus faecium, Lactobacillus acidophilus, Lactobacillus paracasei, Lactobacillus planta rum, Lactobacillus salivarius, Lactococus Lacti., so that it synergizes the effect of probiotics optimizing results.

Megaflora-9 EVO acts on 3 levels. At level 1 it does so through microbe-microbe interactions, preventing the colonization and overgrowth of potentially pathogenic bacteria.
At level 2, it creates interactions between the microbe and the intestinal epithelium.
In this way, it competes with pathogenic bacteria for adhesion to receptors and thus protects the barrier function.
Finally, at level 3, microbe-immune system interactions are reflected.
The available bacteria manage to stimulate the immune system to produce antibodies against pathogens.

On the other hand, Active Fibra Inteligente is a prebiotic food supplement, based on plants, mucilage, fibers and minerals designed to restore, optimize and maintain health and intestinal transit.
The initial dose can be started with 1 measuring spoon of 9g per day.
For the maintenance dose, 1/2 scoop of 4.5g per day is suggested.

Active Fibra Inteligente contains a complex of several medicinal plants such as dandelion root, ispagula seed cuticle, aloe vera, garcinia cambogia and boswellia Serrata resin, Icelandic moss.
Each of these plants, in addition to their medicinal properties, provides a different form of fiber.
All together they create a synergy with a powerful nutritious-prebiotic effect.

Conclusion

In conclusion, our journey through the labyrinth of SIBO has revealed its complexities, from its surely intricate and not well known pathophysiology to diagnostic challenges and treatment strategies.

The integration of findings from studies and trials conducted by researchers ensures the precision and accuracy of the information presented.
As we navigate the changing landscape of gastrointestinal health, a nuanced understanding of SIBO is paramount, offering a foundation for improving patient outcomes and paving the way for future research.

As you well know, the options offered by Salengei are not intended in any way to bypass medical advice and are only adjuvants in the treatment indicated by the appropriate professionals.

We hope again that this article has been to your liking, we wish you a very happy Holidays and that next year comes full of health, optimism and desire to continue exploring the world of wellness.