This may include the elimination or substitution of drugs known to decrease intestinal motility (mainly narcotics) and optimizing treatment of diabetes Nonsurgical conditions associated with intestinal stasis should be corrected when possible. Treatment should be addressed at improving the underlying disease when possible but more often than not is not possible, not practical, or not very effective. The mainstay of treatment of small bowel bacterial overgrowth is antibiotic therapy. TREATMENT OF SMALL INTESTINAL BACTERIAL OVERGROWTH In SBBO, the presence of numerous bacteria in the small intestine leads to rapid digestion and release and an early peak of exhaled hydrogen. Normally, this does not occur until the sugar reaches the colon where bacteria are present. Bacteria in the GI tract will digest the sugar and release hydrogen, which is then absorbed and exhaled. A sugar that is not absorbable by humans (usually lactulose is used) is ingested and repeated measurements of breath hydrogen are done over time. The patient breathes into a device that measures the amount of hydrogen in the breath. To detect SBBO, the most often utilized test is hydrogen breath testing. The diagnosis can sometimes be made based on symptoms and the medical history. This variation of bacterial types and quantity in patients may account for the fluctuating and alternating symptoms often seen in IBS. Also, the quantity of bacterial overgrowth can wax and wane with time. For example, some bacteria produce methane, which can slow colonic motion and lead to constipation. Different bacterial strains may produce different byproducts of their metabolism each of which can elicit different symptoms. An interesting observation is that there are a variety of intestinal bacteria that can predominate in patients with SIBBO. Many of the symptoms of small bowel bacterial overgrowth are consistent with those of irritable bowel syndrome. SBBO may cause or contribute to Irritable Bowel Syndrome (IBS) in some patients. When SBBO causes symptoms, they often include: abdominal bloating, abdominal discomfort, nonbloody diarrhea, and in severe cases weight loss. Some patients with irritable bowel syndrome have SBBO with no identified reason. Medications such as narcotics slow bowel motility.
Medical conditions such as diabetes and scleroderma can affect peristalsis. Surgery that bypasses intestinal segments and creates a blind loop (for example, done to treat ulcers or for weight loss) or creates intestinal pouches (Crohn’s disease) or leaves areas of obstruction or narrowing (for example, adhesions) may lead to SBBO.
Anything that causes disruption of this normal activity or otherwise restricts intestinal flow can lead to stasis, allowing bacteria to flourish on the residual intestinal contents and leading to bacterial overgrowth.Īltered intestinal peristalsis can occur due to an effect of bowel surgery, several disease states, a side effect of medications, or develop without any apparent underlying cause. Later and often during sleep, spontaneously occurring peristaltic motion serves to clean out residual particles and debris. Normally, the small intestine is quite active propelling contents (peristalsis) after eating. Also as a consequence of bacterial metabolism, certain breakdown products are released by the bacteria that can cause symptoms for the human host. Excessive numbers of bacteria there can themselves digest the nutrients, leaving less for human absorption. The small intestine is where food and nutrients are absorbed into the body. Normally, there are relatively few bacteria in the small intestine, especially when compared to the colon (large intestine), which normally harbors large numbers of bacteria. Small bowel bacterial overgrowth (SBBO) also called small intestinal bacterial overgrowth (SIBO) occurs when there is abnormal growth and accumulation of bacteria in the small intestine.
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