Did You Know?

SIBO or Reflux?

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Did you know that small intestinal bacterial overgrowth (SIBO) is often mistaken for acid reflux? In my practice, at least half the patients who come in with a reflux diagnosis are actually suffering from SIBO. Why is the mistaken diagnosis so common? The symptoms of the two conditions are very similar and even identical in some cases. 

Burning upper abdominal pain that can feel like acid reflux is one of the commonest manifestations of SIBO. High levels of gas produced by bacteria in the upper GI tract can cause the lower esophageal sphincter to open inappropriately, mimicking acid reflux. To further complicate matters, acid suppressing drugs like proton pump inhibitors (PPIs) are a common cause of SIBO, but since SIBO symptoms are often misdiagnosed as acid-reflux, PPIs are frequently used to treat SIBO, perpetuating the cycle of symptoms.

So how can you tell the difference to gain a proper diagnosis? If you’ve been diagnosed with acid reflux and are on an acid-blocking medication but are still experiencing reflux symptoms, you could well have SIBO. Other common symptoms of SIBO, besides reflux-like symptoms, include abdominal pain/cramping, bloating, Candida overgrowth or chronic yeast problems, constipation, diarrhea, gas, and headaches. 

Additional, non-specific symptoms that may be associated with SIBO include: acne, eczema, rosacea, allergies and chronic food sensitivities, bad breath and gum disease, brain fog, depression or anxiety, difficulty losing weight, fatigue, food cravings, food intolerances, frequent colds, flu or sinus infections, joint pain, nausea/vomiting, nutritional deficiencies, rashes, stomach bugs or episodes of food poisoning, vaginal itching and/or discharge (bacterial vaginosis), and weight loss. Of course, these symptoms are very non-specific and can be caused by a wide range of conditions so you can’t base the diagnosis of SIBO on symptoms alone. 

To help distinguish between SIBO and reflux, you can ask your doctor for a hydrogen breath test. While this test isn’t a definitive gauge, if your test comes back positive, and you have risk factors for SIBO like excessive antibiotic or acid suppression use, you could have SIBO, not acid reflux, and it may be time to get off those acid blockers for good!

Robynne Chutkan, MD, FASGE, is the founder of Gutbliss Rx. She is an integrative gastroenterologist and the bestselling author of Gutbliss, The Microbiome Solution, and The Bloat Cure. Educated at Yale and Columbia, she’s been on the faculty at Georgetown University Hospital since 1997 and is the founder of the Digestive Center for Wellness, an integrative gastroenterology practice incorporating microbiome analysis and nutritional counseling as part of the therapeutic approach to digestive disorders. An avid runner, snowboarder, and yogi, she is passionate about helping her patients live not just longer lives, but dirtier ones!

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