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Small intestinal bacterial overgrowth (SIBO)

Proliferatio bacterialis intestini tenuis · Bakteriální přerůstání v tenkém střevě (SIBO)

What it is

Too many colon-type bacteria in the small bowel ferment food early — after surgery, with slow motility, or with low stomach acid.

Symptoms & signs

  • Bloating soon after meals
  • wind and belly pain
  • diarrhoea
  • fatty stools and weight loss
  • B12 deficiency

🚩 Get help if…

  • see a doctor soon Losing weight without trying
  • see a doctor soon Blood in the stool or black stools
  • see a doctor soon Diarrhoea that wakes you at night
  • see a doctor soon Numb hands or feet or pale tiredness

Where it strikes

Medical treatment

  • Breath test (hydrogen and methane) or jejunal aspirate
  • rifaximin for 2 weeks
  • other antibiotics (co-amoxiclav, metronidazole)
  • treat the cause: motility, strictures, diabetes, PPI review
  • prokinetics against relapse

Natural & lifestyle

  • Low-FODMAP diet short term
  • space meals so the gut's cleaning waves can work
  • correct B12, iron and vitamin D

Emerging & experimental

  • Elemental diet (trials positive but small)
  • methane-targeting treatment (lovastatin lactone)
  • faecal microbiota research

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Herbal antimicrobials (oregano, berberine, allicin) — a 2014 study found them as effective as rifaximin early / small studies
  • Probiotics — trials disagree; some worsen bloating mixed evidence
  • Carnivore and zero-fibre diets — anecdotal anecdotal / traditional

ICD codes