Small intestinal bacterial overgrowth, also known as SIBO, is a condition in which an abnormally high number of bacteria colonize the small intestine. This area of the digestive tract, normally low in bacteria, plays a crucial role in nutrient absorption. However, if too many bacteria are present, this can lead to various symptoms.

Causes of SIBO: The main causes of SIBO (Small Intestinal Bacterial Overgrowth) are varied and include impaired intestinal motility, anatomical changes, immune system disorders and stomach acid deficiency. These factors create an environment in which bacteria can grow excessively in the small intestine. In this small intestinal malcolonization, the slow transport of intestinal contents allows certain normal intestinal bacteria to grow excessively, resulting in diarrhea and poor nutrient absorption (malabsorption).the excess bacteria consume important nutrients such as carbohydrates and vitamin B12, which can lead to lower calorie intake and vitamin B12 deficiency. They also break down bile salts, which can lead to problems with fat absorption, diarrhea and nutritional deficiencies.

Symptoms of SIBO: The most common symptom of small intestinal overgrowth is bloating, but the symptoms of SIBO can be varied and include abdominal pain, diarrhea, weight loss and malnutrition. As the bacteria consume nutrients, this can lead to poor absorption of vitamins and minerals. Some people also suffer from steatorrhea with pale, soft, bulky greasy and unusually foul smelling stools.

Diagnosis of SIBO: The medical diagnosis of SIBO is based on characteristic symptoms, especially in patients with previous surgical interventions or specific diseases.

To determine the exact type and quantity of bacteria in the small intestine, the doctor can take a fluid sample by endoscopy. Alternatively, a breath test is usually carried out in which hydrogen or methane is measured, which is produced during the bacterial decomposition of certain types of sugar. The breath sample is taken after consuming a sugar solution at certain time intervals over several hours. A significant increase in hydrogen or methane in the breath indicates a small intestinal colonization.

Treatment of SIBO: Combating bacterial overgrowth in the small intestine requires precise and effective measures. Treatment of SIBO aims to reduce excessive bacterial growth and alleviate symptoms. Among the various treatment options, antibiotics play a crucial role. A targeted SIBO diet can also help to alleviate symptoms such as bloating, abdominal pain and digestive problems.

• Systemic antibiotics: Systemic antibiotics such as quinolones and tetracyclines are widely used in SIBO treatment. These drugs work throughout the body, which is particularly important if the bacterial overgrowth is extensive. Your doctor will determine the appropriate form and dosage depending on your individual situation.
• Locally acting antibiotics: For cases where targeted treatment in the gut is required, antibiotics that do not enter the bloodstream are used. Rifaximin is an outstanding example of this. It effectively combats the excessive bacterial population in the small intestine without being widely distributed in the body, which minimizes the risk of side effects. Gentamycin/Polymyxin SDD capsules are another option for local SIBO therapy. These targeted capsules release their antibacterial action directly in the gut to reduce excessive bacterial colonization.
• SIBO diet
  • Low FODMAP Diet (Low FODMAP Diet): The basis of the SIBO diet is often a low FODMAP diet. FODMAPs are fermentable carbohydrates that can exacerbate the symptoms of SIBO. By limiting foods such as onions, garlic, wheat and legumes, the burden on the small intestine is reduced.
  • Low carbohydrate diet: A low carbohydrate diet is crucial as bacteria in the small intestine feed on carbohydrates. Reducing carbohydrate intake controls the growth of bacteria. Choose complex carbohydrates such as quinoa and sweet potatoes instead of refined options.
  • Small, frequent meals: To avoid overloading the gut, eating smaller portions at regular intervals is recommended. This supports gentle digestion and prevents excessive fermentation in the small intestine.
  • Probiotic foods: The integration of probiotic foods such as yogurt, kefir and fermented vegetables can help to support the intestinal flora. These foods contain "good" bacteria that promote balance in the gut.
  • Water and herbal teas: Adequate hydration is important to keep the gut healthy. Drink plenty of water and soothing herbal teas to aid digestion.
  • Customization: Every patient is unique and therefore the SIBO diet should be customized. Dr. Schlosser, together with our nutritionist, will support you and develop a tailor-made nutrition plan for your SIBO diet.

Tips for patients with SIBO:

• Follow your doctor's instructions regarding medications and diet.
• Avoid foods high in sugar and carbohydrates to inhibit bacterial growth.
• Supplement your diet with the necessary vitamins and minerals if you are deficient.

Important points for SIBO: Anatomical changes in the stomach or intestines or intestinal motility disorders lead to gastrointestinal stasis and thus to bacterial overgrowth.

• Bacteria deconjugate bile salts, leading to fat malabsorption.
• The diagnosis is made with the help of a glucose-hydrogen or lactulose-hydrogen breath test or a quantitative culture of the intestinal aspirate.
• Treatment consists of the administration of oral antibiotics or a special SIBO diet (high-fat and low-carbohydrate)