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SIBO

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Lucia came to see me mainly to confirm that she was following the right path. She had a healthy childhood, but was treated with a year of tetracycline in high school for moderately severe acne. During the year she was on antibiotics she didn’t feel quite right, with frequent nausea, an upset stomach, and cradle cap on the back of her scalp. Cradle cap, also known as seborrheic dermatitis, is a yellowish, crusty rash that’s most common on the scalp of newborn babies, primarily as a result of yeast overgrowth. No one connected the cradle cap with Lucia’s GI symptoms or suggested they might be related to the antibiotics. In her twenties Lucia decided to see a gastroenterologist for her bouts of nausea, which had worsened after she started taking birth control pills. Biopsies taken during an upper endoscopy as part of her evaluation revealed the presence of Helicobacter pylori…

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?…

Susan: In mid-2008, I had a severe food poisoning incident with lots of diarrhea and vomiting. Later that year, I broke a toe and took Advil every day for a month. In October 2009, I started having problems being regular with my digestion. I saw a physician who gave me a course of antibiotics and proton pump inhibitors (PPIs). After taking them I was still experiencing abdominal pain and bloating. Dr. Chutkan: An episode of food poisoning can be the triggering event for small intestinal bacterial overgrowth (SIBO) because the gut flora is thrown out of balance. The pathogen crowds out a lot of the beneficial gut bacteria, and even after the infection is over people are often still symptomatic because their healthy gut bacteria remain depleted and other species start to overgrow. Non steroidal anti inflammatory drugs (NSAIDs) like Advil compound things because they make tiny holes in the intestinal…

Low FODMAPs Diet For SIBO – Is It Worth It? FODMAPs (fermentable oligo-, di-, mono-saccharides, and polyols) are difficult to digest or poorly absorbed sugars. In searching for an elimination diet to treat hives in the 1970‘s, Australian researchers created the beginnings of the low FODMAPs diet. In 2005 the diet was introduced as a diagnostic tool for irritable bowel syndrome (IBS) – if a patient felt better when eliminating FODMAPs from the diet, they most likely had IBS. The low FODMAPs diet has become the most commonly prescribed dietary intervention to treat IBS, and now SIBO – but this doesn‘t necessarily mean it‘s the most successful. Why Low FODMAPs? The poorly absorbed sugars highlighted in the low FODMAPs diet can play a role in IBS (and SIBO) symptoms. The hallmark of IBS is visceral hypersensitivity when the GI tract is distended or enlarged – which occurs when anything (food,…

Small intestinal bacterial overgrowth (SIBO) is drastically higher in those with inflammatory bowel disease (IBD – Crohn’s and ulcerative colitis). After analyzing 11 studies, including over 1,100 IBD patients and 400 controls, researchers found that IBD patients are 9 times more likely to develop SIBO. Alimentary Pharmacology Therapeutics →Takeaway: Why this incredible risk of developing SIBO in IBD patients? Scientists hypothesize that prior surgeries, gastric pH changes and compromised intestinal mucosal integrity, all common in IBD, could be to blame. If you have IBD and/or think you may be suffering from SIBO, or if you are a practitioner who treats IBD and/or SIBO, check out Dr. Chutkan’s course, the Gutbliss Guide to SIBO for an incredible compilation of clinical information on testing, diagnosing, and treating SIBO.

Prebiotic supplementation could replace the low FODMAPs diet as a treatment for functional gut disorders (IBS, constipation, functional dyspepsia, etc.). A 4-week study compared the effects of a prebiotic supplement plus Mediterranean-type diet, versus a placebo supplement plus low FODMAP diet for 2 weeks. Fecal microbiota composition, intestinal gas production, and digestive sensations were measured outcomes. After 4 weeks, both groups showed improvements in GI symptoms but only the prebiotic group showed significant improvements in microbial composition. (The FODMAP group actually showed an increase in pathogenic-associated bacteria). Two weeks after the intervention, improvement persisted in the prebiotic group but not in the FODMAP group. Gastroenterology →Takeaway: Based on 20+ years of clinical experience, Dr. Chutkan does not recommend the low FODMAP diet in her practice, including in those patients with functional GI disorders. The low FODMAP diet was created as a diagnostic tool for IBS, not as a therapeutic diet. While it may…