Because the MMC is deactivated when eating, Mark Pimentel, MD, director of the gastrointestinal motility program at Cedars-Sinai Medical Center and author of A New IBS Solution, suggests, “Those prone to SIBO should avoid in-between meal snacking to allow the cleansing wave to adequately divert unwanted waste from the small intestine.” This process involves the migrating motor complex (MMC), which produces a cleansing wave to help remove waste from the small intestine, often referred to as the “housekeeper of the gut.” The MMC occurs about every 90 to 120 minutes during times of fasting. Normally, the small intestine involves complex and coordinated movements to properly digest foods. In regard to SIBO and its impact on weight and nutritional status, Gerard Mullin, an associate professor of medicine and director of integrative GI nutrition services at Johns Hopkins Hospital, says, “Small intestinal bacterial overgrowth can cause malabsorption and wasting.”ĭiminished gastric acid secretion and disordered gastrointestinal motility of the small intestine are likely the most common contributors to SIBO. Low levels of B12 are common as anaerobic bacteria utilize this vitamin.5 Vitamin K deficiency is rare as bacterial microflora produce this vitamin.4 Elevated serum folate levels may present as the result of bacterial synthesis. Some bacteria produce toxins that damage the intestinal mucosa.2 Bacterial overgrowth has been associated with increased intestinal permeability and bacterial translocation.3 Chronic diarrhea due to fat maldigestion and malabsorption may contribute to vitamin A, D, and E deficiencies. Microbes that metabolize bile salts to insoluble compounds may lead to fat malabsorption and inflammation, while bacteria that prefer to metabolize carbohydrates produce marked bloating. The symptoms of SIBO vary depending on the type and amounts of microbes present in the small intestine. Constipation may also be present but appears to be less common in this disorder. SIBO produces myriad gastrointestinal symptoms, including excess intestinal gas, bloating and abdominal distention, diarrhea, and pain.
Dietitians should be well versed in this disorder and subsequent nutritional intervention. While gastrointestinal microflora confer many healthful benefits, including vitamin synthesis, enhanced digestion, and improved immune function, bacterial overgrowth is an increasingly recognized contributor to gastrointestinal symptoms, malabsorption, and malnutrition. Small intestinal bacterial overgrowth (SIBO) is a condition in which excessive amounts of bacteria (typically the colonic type) infiltrate the small intestine.1 Under normal conditions, the small intestine shelters far fewer and different types of bacteria compared with the colon. Small intestinal bacteria overgrowth (SIBO) antibiotics glucose breath test lactulose breath test metabolomics metagenomics rifaximin.Small Intestinal Bacterial Overgrowth - What to Do When Unwelcome Microbes Invade In the near future, metagenomics and metabolomics will help to overcome the uncertainties of SIBO diagnosis and the pitfalls of therapeutic management, allowing the design of a personalized strategy based on the direct insight into the small intestinal microbial community. The therapeutic approach to SIBO is oriented towards resolving predisposing conditions, and is supported by antibiotic treatment to restore the normal small intestinal microflora and by modifications of dietary habits for symptomatic relief.
Diagnosis of SIBO is challenging due to the low specificity of symptoms, the frequent association with other diseases of the gastrointestinal tract and the absence of optimal objective diagnostic tests. Gastric acid secretion and intestinal clearance provide the qualitative and quantitative partitioning of intestinal bacteria small intestinal bacteria overgrowth (SIBO) occurs when these barrier mechanisms fail.
A huge number of bacteria are hosted in the gastrointestinal tract, following a gradient increasing towards the colon.
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