What is SIBO?
SIBO (small intestinal bacterial overgrowth) is a condition in which an excess of bacteria builds up in the small intestine, causing symptoms such as bloating, abdominal pain, diarrhea, and nutrient malabsorption. This condition can negatively affect a patient’s digestion and overall health.
Causes of SIBO
SIBO can be caused by several conditions that alter intestinal motility, the anatomy of the intestine, or the bacterial balance. Common causes include intestinal motility disorders such as irritable bowel syndrome (IBS), abdominal surgeries that alter intestinal anatomy, diseases that decrease gastric acid production, immune system dysfunction, and prolonged use of antibiotics that affect normal intestinal flora. Other risk factors may include aging, chronic diseases such as diabetes, and the use of certain medications.
Types of SIBO
There are mainly three types of SIBO (small intestinal bacterial overgrowth), classified according to the predominant type of gas produced by bacteria in the gut:
Hydrogen-Dominant SIBO (H-SIBO)
This type of SIBO is characterized by excessive hydrogen production. Hydrogen-producing bacteria ferment carbohydrates in the small intestine, which can lead to symptoms such as diarrhea, bloating, and abdominal pain. This is the most common type of SIBO.
Methane-Dominant SIBO (M-SIBO)
In this type, elevated methane production is seen instead of hydrogen. Archaea, which are bacteria-like organisms, produce methane. Symptoms associated with methane-dominant SIBO typically include constipation, bloating, and abdominal pain. Methane can slow intestinal transit, contributing to constipation.
Hydrogen Sulfide-Dominant SIBO (H₂S-SIBO)
This type is less common and is characterized by the production of hydrogen sulfide, a gas with a characteristic rotten egg odor. Symptoms can include diarrhea, bloating, and abdominal pain, and can often be more difficult to diagnose with traditional breath tests due to the nature of hydrogen sulfide.
Each type of SIBO may require slightly different approaches in terms of treatment and dietary management, so an accurate diagnosis is crucial to the effectiveness of treatment.
How is SIBO diagnosed?
SIBO is primarily diagnosed through breath tests, which measure gases produced by bacteria in the small intestine. The two most common tests are the lactulose breath test and the glucose breath test. In these tests, the patient swallows a lactulose or glucose solution and then provides breath samples at regular intervals. An abnormal increase in hydrogen or methane levels in the breath indicates the presence of SIBO. In addition to breath tests, diagnosis may also include a detailed clinical evaluation of the patient’s symptoms and, in some cases, bacterial cultures of the small intestine contents obtained through endoscopy.
Treatment of SIBO
A nutritional treatment of SIBO consists of several phases.
Evaluation and diagnosis
This initial phase involves an accurate diagnosis using tests, such as the breath test, and a detailed evaluation of the patient’s symptoms, dietary habits, and medical history. This allows contributing factors to be identified and treatment to be personalized.
Elimination Phase
During this stage, specific diets are designed that restrict foods that can encourage excessive bacterial growth in the small intestine, such as rapidly fermenting carbohydrates (FODMAPs). This diet helps reduce symptoms and discourage bacterial overgrowth.
Food Reintroduction
After a period of seeing improvements in symptoms, reintroduction of foods is gradually started to determine which can be tolerated without causing symptoms. This step is crucial to maintaining a balanced diet and avoiding nutritional deficiencies.
Maintenance and Prevention
Once foods that the patient can tolerate are identified, a long-term eating plan is established that balances nutritional needs with preventing SIBO from returning. It may also include the use of probiotics and other supplements to maintain intestinal health.
Continuous Monitoring
Regular monitoring allows the diet to be adjusted according to the patient’s responses and to manage any recurrence of symptoms. This monitoring is essential to ensure the patient’s adaptation to the diet.
Dra. Carina Gimeno – Nutritionist
She has a degree in Medicine and Surgery from the University of Valencia, specialising in Nutrition and Dietetics. She has a Master’s degree in Human Nutrition (University of Sheffield) and a Master’s degree in Clinical Nutrition (Autonomous University of Madrid). She is accredited to carry out ISAK anthropometric studies (level 2). She has more than 20 years of experience, including being Team Leader of the Clinical Nutrition and Dietetics Unit at the Quirón Hospital in Valencia since 1999. She combines her professional activity with teaching, being a professor and director of the Master’s in Advances in Clinical Nutrition at the Cardenal Herrera University. Speaks spanish and english.
Fees
- First visit 120€ (1 hour, medical and dietary assessment)
- Second visit 80€
- Check-up visits 70€
Schedule
- Tuesdays from 10:00 to 14:00 and from 16:00 to 20:00.