Quantification of hydrogen and methane gas in breath samples is the most inexpensive, non-invasive and probably the most widely available test for a diagnosis of bacterial overgrowth within the United Kingdom. The purpose of this test is to try and replicate an environment within the small bowel that would occur on a day-to-day basis in patients with small intestinal bacterial overgrowth and then measure the production of gases that are resultantly produced in the small bowel to quantify whether there is indeed SIBO. There is no universally-acceptable gold standard test for SIBO and the use of the lactulose breath test has become extremely common over the past few years. At The London Gastroenterology Centre we offer a simple and non-invasive way of testing for it by using a simple breath test. The diagnosis of bacterial overgrowth still remains an area of controversy with several different modalities being proposed. Patients with underlying connective tissue disorders such as fibromyalgia, Ehlers-Danlos syndrome and rheumatoid arthritis may also be more likely to suffer from relapsing symptoms of small intestinal bacterial overgrowth. A small number of people who take acid suppression medication drugs such as proton pump inhibitors that reduce the amount of acid going into the small bowel might also get bacterial overgrowth, although this remains disputed.
Several medications slow gut motility such as narcotic pain killers and anti-diarrhoeal agents. Importantly, it can occur in normal individuals, although some people may have anatomical abnormalities such as previous small bowel resection surgery or gastric bypass. Several risk factors have been identified for SIBO. The subsequent gas production in SIBO can cause problems with digestion, absorption of food and damaging the membranes in the lining of the small intestine leading to symptoms. They feed off small molecule fermentable carbohydrates and sugars that we ingest. In SIBO, bacteria that normally live within the large bowel start to grow within the small bowel. The small intestine is not normally colonised by bacteria. This is predominantly because there is a lack of consensus and clarity internationally regarding the natural history of the disease, the best modality for diagnosing it but also a lack of robust data on the optimum treatment algorithm for these patients. For many years patients with SIBO symptoms have been diagnosed and labelled with irritable bowel syndrome. Once a patient develops SIBO they can present with a constellation of symptoms including bloating, abdominal discomfort, gas, diarrhoea and fatigue, amongst many others. The small intestine is normally devoid of any bacterial colonisation but changes in the environment within the small bowel can lead to overgrowth of bacteria which can manifest with a myriad symptoms which are the hallmark of SIBO. The hallmark of SIBO is that the small intestine becomes colonised with normal occurring gut flora.
SIBO (small intestinal bacterial overgrowth) is a relapsing and remitting condition that may affect up to 10-15% of the general population.
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