Small Bowel Bacterial Overgrowth

(SBBO; Bacterial Overgrowth, Small Bowel; Small Intestine Bacterial Overgrowth; SIBO; Bacterial Overgrowth, Small Intestine)
  • Definition

    Small bowel bacterial overgrowth (SBBO) occurs when there is a build-up of too much bacteria in the small bowel.
    The Small Intestines
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  • Causes

    SBBO is often caused by an abnormality in the small bowel. Food is not able to flow properly though the intestines. Conditions that may cause this include:
    • Birth defect
    • Injury
    • Surgery
    • Conditions (eg, digestive disorder)
  • Risk Factors

    Examples of conditions that may increase the risk of SBBO include:
    Other risk factors include:
    • Intestinal surgery (eg, removal of part of the small intestine )
    • An obstruction in the small intestine
    • Weakened immune system
    • Being elderly (more likely to have conditions like diverticulitis)
    Any condition that affects how food moves through the small bowel may increase the risk of SBBO.
  • Symptoms

    Not all patients with SBBO will have symptoms. But symptoms may include:
  • Diagnosis

    SBBO can be difficult to diagnose. The symptoms may be similar to other conditions. Your doctor will:
    • Ask about your symptoms and medical history
    • Do a physical exam
    • Order tests, such as:
      • Blood tests to detects nutritional deficiencies (eg, anemia , B12 deficiency )
      • Breath tests—involves fasting, eating some type of sugar, and then exhaling into a bag; the sample is analyzed to find out if there are levels of certain gases
      • Culture of intestinal fluid (aspirate)—a catheter is used to get a sample of fluid from the small bowel
  • Treatment

    The goals are to:
    • Reduce the levels of harmful bacteria in the small bowel
    • Treat the underlying condition
    Medications
    Antibiotics are often prescribed to treat SBBO. Usually treatment is temporary. But, in some cases, you may need to take antibiotics for a longer period.
    Nutritional Support
    To make sure that you get the proper nutrients, you may need to:
    • Work with a dietitian
    • Follow a special diet (eg, carbohydrate-restricted diet)
    • Take supplements (eg, iron , vitamin B12 )
    • Take probiotics
    In some cases, tube feeding is needed with a special formula.
    Surgery
    For severe cases, surgery may be needed. This is done to correct an abnormality in the small bowel.
  • Prevention

    If you have any of the conditions that are linked to SBBO, get proper treatment. This may reduce your chance of having a build-up of bacteria in the small bowel.
  • RESOURCES

    American Gastroenterological Association http://www.gastro.org/

    National Digestive Diseases Information Clearinghouse http://digestive.niddk.nih.gov/index.htm

    CANADIAN RESOURCES

    Canadian Association of Gastroenterology http://www.cag-acg.org/

    Canadian Digestive Health Foundation http://www.cdhf.ca/main.php/

    References

    Aaron S. Malabsorption. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated September 20, 2010. Accessed May 12, 2011.

    Bacterial overgrowth syndrome. Merck Manual website. Available at: http://www.merckmanuals.com/professional/sec02/ch017/ch017b.html . Updated January 2008. Accessed May 12, 2011.

    Bures J, Cyrany J, Kohoutova D, et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010;16(24):2978–2990.

    Dibaise J, Young R, Vanderhoof J. Enteric microbial flora, bacterial overgrowth, and short-bowel syndrome. University of South Alabama Gastroenterology Continuing Education website. Available at: http://usagiedu.com/articles/sibo/sibo.pdf . Published 2006. Accessed May 12, 2011.

    Lactose and glucose hydrogen breath test. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/disorders/lactose%5Fintolerence/hic%5Flactose%5Fand%5Fglucose%5Fhydrogen%5Fbreath%5Ftest.aspx . Updated November 25, 2008. Accessed May 12, 2011.

    Lin H. Small intestinal bacterial overgrowth. JAMA. 2004;292(7):852-858.

    McCoy K. Short bowel syndrome. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated September 20, 2010. Accessed May 12, 2011.

    Parrish C. Nutritional consequences of small intestinal bacterial overgrowth. University of Virginia, School of Medicine website. Available at: http://www.medicine.virginia.edu/clinical/departments/medicine/divisions/digestive-health/nutrition-support-team/nutrition-articles/DiBaiseArticle.pdf . Published December 2008. Accessed May 12, 2011.

    Small bowel bacterial overgrowth—another cause for IBS symptoms. Tennessee Society of Gastroenterology Nurses and Associates website. Available at: http://www.tsgna.org/Power.../Small%20Bowel%20Bacterial%20Overgrowth.doc . Accessed May 12, 2011.

    Small bowel bacterial overgrowth overview. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/disorders/small%5Fbowel%5Fbacterial%5Fovergrowth/dd%5Foverview.aspx . Accessed May 12, 2011.

    Vanderhoof J, Young R. Bacterial overgrowth. The Oley Foundation website. Available at: http://www.oley.org/lifeline/bacter.html . Accessed May 12, 2011.

    Vanderhoof J, Young R, Murray N, Kaufman SS. Treatment strategies for small bowel bacterial overgrowth in short bowel syndrome. J Pediatr Gastroenterol Nutr. 1998;27(2):155-160.

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