The intestines are sensitive to pressure and therefore the pressure of distention can lead to abdominal pain. 26 Excess gas can then exit the body as flatulence or eructation. The quantity of gas may be extensive, causing bloating/distention. Bacterial gas leads to the IBS symptoms of bloating, pain, altered bowel movements, eructation and flatulence (Figure 1). Bacterial fermentation produces hydrogen and/or methane gas. First, bacteria can ferment food meant for the host simply by their inappropriate location in the small intestine, which allows them premature exposure to host nutrition. ![]() There are two main pathophysiological issues involved in SIBO. 23,24 The bacteria most commonly overgrown are both commensal anaerobes ( Bacteroides 39%, Lactobacillus 25%, Clostridium 20%) and commensal aerobes ( Streptococcus 60%, Escherichia coli 36%, Staphylococcus 13%, Klebsiella 11%, Escherichia coli 37%, Enterococcus spp 32%, Klebsiella pneumonia 24%, Proteus mirabilis 6.5%). ≥ 103 CFUs is now the suggested definition due to recent studies revealing ≤103 CFUs is the normal level in healthy controls. Traditionally, ≥ 105 colony-forming units (CFU) per mL of proximal jejunal aspiration has been the definition of SIBO in culturing studies. 20,21 We also suspect an important role for proper ileocecal valve function in preventing reflux of colonic bacteria into the small intestine. 19 The use of proton pump inhibitors encourages overgrowth, especially of the hydrogen producing type. 18 Also key in prevention is gastric, pancreatic, and gall bladder secretion, since hydrochloric acid, enzymes, and bile are bactericidal/static. Mechanisms by which Overgrowth is PreventedĪn important protective mechanism against SIBO is proper small intestine motility via the migrating motor complex because stasis promotes bacterial growth. Other diseases associated with SIBO include hypothyroidism, lactose intolerance, Crohn’s disease, systemic sclerosis, celiac disease, chronic pancreatitis, diabetes with autonomic neuropathy, fibromyalgia and chronic regional pain syndrome, hepatic encephalopathy, nonalcoholic steatohepatitis, interstitial cystitis, restless leg syndrome, and acne rosacea. systemic symptoms: headache, joint/muscle pain, fatigue, rosacea.constipation, diarrhea or a mixture of the two.Stool testing has no value in diagnosing SIBO. Hydrogen/methane breath testing is the most widely used method of testing for this overgrowth. When commensal bacteria (oral, small intestine or large intestine) multiply in the small intestine to the point of overgrowth, IBS is likely. ![]() These gases are not produced by human cells but are the metabolic product of fermentation of carbohydrates by intestinal bacteria. 4 Bacterial overgrowth leads to impairment of digestion and absorption and produces excess quantities of hydrogen and/or methane gas. 3 Eradication of this overgrowth leads to a 75% reduction in IBS symptoms. 1,2 It accounts for 37% of cases wherein endoscopic cultures of aerobic bacteria are used for diagnosis. SIBO is a common cause of IBS – in fact it is involved in over half the cases of IBS and as high as 84% in one study using breath testing as the diagnostic marker. ![]() Small intestine bacterial overgrowth (SIBO) is a condition in which abnormally large numbers of commensal bacteria are present in the small intestine. But what about those cases in which bloating, abdominal pain, constipation, or diarrhea remain unchanged? After more life-threatening diagnoses are ruled out, where do you turn? Often, uncovering and removing hidden food intolerances, adding mindfulness to a rushed approach to meals, or restoring production of digestive acid or enzymes is the key to resolving IBS. Our experience has been that naturopathic approaches to irritable bowel syndrome (IBS) tend to be highly successful.
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