Small intestinal bacterial overgrowth, or SIBO, happens when there’s too much bacteria in the small intestine, leading to gut pain, diarrhea, bloating, and problems absorbing nutrients. The usual approach to handle SIBO involves antibiotics to tackle the bacteria and dietary supplements to address any nutritional deficiencies. Some patients might also benefit from specific diets, like an elemental or low-FODMAP diet, to prevent foods that may worsen symptoms and keep bacterial overgrowth in check.
A gastroenterologist, who specializes in digestive health, will guide your SIBO treatment, aiming to eliminate bacterial overgrowth and alleviate symptoms. Antibiotics generally work well but symptoms can return. Adjusting your diet long-term helps to manage bacteria levels. SIBO often stems from other health issues that also need attention.
Initially, antibiotics are used to eliminate excess bacteria in the small intestine. Although the FDA has not officially approved antibiotics for SIBO, gastroenterologists may prescribe certain off-label antibiotics to curb bacterial growth. Xifaxan is a common choice, especially effective if the overgrowth is hydrogen-based. It’s FDA-sanctioned for traveler’s diarrhea and IBS-related diarrhea, but not fully absorbed into the gut, reducing side effects. It’s not safe for people with liver disease, during pregnancy, or breastfeeding.
For methane-based bacterial overgrowth, your doctor might suggest combining neomycin with Xifaxan for a short period. Neomycin helps control bacterial growth and isn’t entirely absorbed into the bloodstream, making it more effective targeting bacteria in the small intestine. However, it shouldn’t be used with blood thinners like warfarin or by those with inflammatory GI conditions.
Antibiotic treatment doesn’t always prevent SIBO from coming back, especially in older adults or those with certain surgeries or conditions. If symptoms return within three months, a different antibiotic might be tried. Frequent antibiotic use can harm healthy gut bacteria and lead to antibiotic resistance.
Besides antibiotics, a SIBO-friendly diet can help reduce bacterial numbers. The low-FODMAP diet, which avoids certain carbohydrates, might relieve SIBO symptoms. While not proven to cure SIBO, the diet is helpful in managing symptoms. An elemental diet, which consists of nutrient-rich liquids, is another option that aids in nutrient absorption and limits food sources for bacteria.
Identifying and addressing nutrient deficiencies is part of dealing with SIBO, as the condition often hinders absorption of essential vitamins and minerals. Supplements can help if you’re lacking critical nutrients, especially if you have issues absorbing fats, which can lead to symptoms like oily stools.
For severe and recurrent SIBO, fecal microbiota transplant (FMT) is an experimental treatment showing promise. It’s mostly reserved for tough cases, with studies indicating it might boost gut health by restoring healthy bacteria. More research is necessary to confirm its effectiveness for SIBO.
Generally, SIBO can be managed with treatments involving antibiotics while addressing any underlying health conditions like IBS, IBD, or chronic pancreatitis. Since many experience recurring SIBO, multiple treatment rounds might be needed.
