Materiały źródłowe

• #1 Small Intestinal Bacterial Overgrowth – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK546634/

  Small intestinal bacterial overgrowth (SIBO) is the presence of excess colonic bacteria in the small intestine. […] When these protective mechanisms against excessive bacterial growth fail, small intestinal bacterial overgrowth (SIBO) can manifest. […] The etiology of small intestinal bacterial overgrowth is complex. It can be from motility, anatomic, immune, gastric hypochlorhydria, and metabolic and other systemic disorders. […] Important host defense mechanisms against bacterial overgrowth in the small intestine are gastric acid and bile, peristalsis, proteolytic digestive enzymes, intact ileocecal valve, and secretory IgA. When these protective barriers fail, SIBO occurs. […] An intact ileocecal valve and antegrade motility of the ileum prevent retrograde translocation of colonic bacteria.

• #2 Small Intestinal Bacterial Overgrowth (SIBO) and Twelve Groups of Related Diseases—Current State of Knowledge

  https://www.mdpi.com/2227-9059/12/5/1030

  Small intestinal bacterial overgrowth (SIBO) is defined as an increase in the number of bacteria (10^3–10^5 CFU/mL), an alteration in the bacterial composition, or both in the small intestine. […] Abnormal translocation of the intestinal microbiota from the large intestine to the small intestine can result in small intestinal bacterial overgrowth syndrome, abbreviated as SIBO. […] The excessive proliferation of carbohydrate-fermenting bacteria leads to gas production in the small intestine, resulting in the accumulation of carbohydrates and other products of bacterial metabolism, causing a wide range of ailments beyond the gastrointestinal tract. […] Small intestinal bacterial overgrowth (SIBO) is defined as a clinical condition caused by excessive numbers of small intestinal bacteria, predominantly including Gram-negative aerobic and anaerobic species.

• #3 Small intestinal bacterial overgrowth syndrome

  https://www.wjgnet.com/1007-9327/full/v16/i24/2978.htm

  SIBO is defined as an increase in the number and/or alteration in the type of bacteria in the upper gastrointestinal tract. […] The aetiology of SIBO is usually complex, associated with disorders of protective antibacterial mechanisms (e.g. achlorhydria, pancreatic exocrine insufficiency, immunodeficiency syndromes), anatomical abnormalities (e.g. small intestinal obstruction, diverticula, fistulae, surgical blind loop, previous ileo-caecal resections) and/or motility disorders. […] There are several endogenous defence mechanisms for preventing bacterial overgrowth: gastric acid secretion, intestinal motility, intact ileo-caecal valve, immunoglobulins within intestinal secretion and bacteriostatic properties of pancreatic and biliary secretion. […] SIBO may develop if some of the natural defensive mechanisms of a macro-organism (listed above) are disrupted.

• #4 Small Intestinal Bacterial Overgrowth

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3099351/

  Small intestinal bacterial overgrowth (SIBO) develops when the normal homeostatic mechanisms that control enteric bacterial populations are disrupted. The two processes that most commonly predispose to bacterial overgrowth are diminished gastric acid secretion and small intestine dysmotility. Disturbances in gut immune function and anatomical abnormalities of the GI tract also increase the likelihood of developing SIBO. Once present, bacterial overgrowth may induce an inflammatory response in the intestinal mucosa, further exacerbating the typical symptoms of SIBO. […] Analysis of small bowel biopsies in elderly patients with bacterial overgrowth revealed blunting of the intestinal villi, thinning of the mucosa and crypts, and increased intraepithelial lymphocytes, all of which reversed with antibiotic treatment.

• #5 Small Intestinal Bacterial Overgrowth

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3099351/

  Gastric acid suppresses the growth of ingested bacteria, thereby limiting bacterial counts in the upper small intestine. Diminished acid production (hypochlorhydria) is a risk factor for SIBO, and can develop after colonization with Helicobacter pylori or as a consequence of aging. […] Interestingly, bacterial overgrowth can lead to a false positive H. pylori diagnosis using urea-based testing given the presence of urease-positive bacterial strains. […] Normal GI motility involves a complex, tightly coordinated series of events designed to move material through the GI tract. During periods of fasting, a migrating motor complex (MMC) develops approximately every 90-120 minutes to sweep residual debris through the GI tract. Several studies have demonstrated that abnormalities in the MMC may predispose to the development of SIBO.

• #6 SIBO: Symptoms, Diagnosis, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/21820-small-intestinal-bacterial-overgrowth-sibo

  All of this leads to poor digestion of fats and poor absorption of nutrients, especially calcium and fat-soluble vitamins. The result is a variety of gastrointestinal symptoms in the short term, and malnutrition in the longer term. Over time, vitamin and mineral deficiencies can cause lasting damage to your bones and nervous system. […] Your body maintains the balance of flora in your gut through a complex network of chemical and mechanical functions. For SIBO to occur, one or more of these functions must not be working correctly. SIBO has a variety of causes. These include chemical functions like low stomach acid and certain medications, and mechanical functions like small intestine dysmotility and structural problems in your small intestine. […] Low stomach acid (hypochlorhydria) reduces your bodys ability to moderate bacterial growth.

• #7 Bacterial Overgrowth Syndrome: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/212861-overview

  Protective factors help maintain the upper gastrointestinal (GI) tract’s bacterial balance, with abnormalities predisposing to bacterial overgrowth. Integrated motor processes like the migrating motor complex and migrating action potential complex clear bacteria and undigested substances from the upper intestine. Disruption of these processes can lead to diarrhea and weight loss, as anatomic defects can hinder peristaltic action. […] Gastric acid and bile play roles in destroying microorganisms, whereas secretions from the intestine, pancreas, and bile aid in bacterial elimination in the small intestine. Mucosal integrity, mucin layer, immunoglobulins, and immune cells help protect the gut from bacterial invasion. Normal flora like Lactobacillus maintains a low pH to prevent overgrowth but can contribute to an abnormal luminal environment that allows the passage of enteric bacteria between the proximal and distal bowel.

• #8

  https://www.tropicalgastro.com/printerfriendly.aspx?id=3138

  Anatomical alterations in small bowel (post-operative, disease related, etc.) can lead to bacterial overgrowth by promoting stasis of luminal contents. Examples include blind loops, diverticula, adhesions and strictures. Ileocaecal (IC) valve is an important anatomical barrier between ileum and colon and protects proximal reflux of colonic contents and bacteria. […] GI tract is protected from bacterial pathogens by integrity of mucosal surface and innate and adaptive immune system. Disruption of gut barrier function and impaired immune response (e.g., IgA secretion) may predispose to SIBO. […] Diagnosis of SIBO requires demonstration of an increase in the number of bacteria or increase in their metabolic byproduct. Elevated serum folate levels and low vitamin B12 levels, although non-specific, may support a diagnosis of SIBO. Quantitative culture of small bowel aspirate: Quantitative small bowel aspirate culture is considered the gold standard test for diagnosing SIBO.

• #9 Small Intestinal Bacterial Overgrowth (SIBO) – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/malabsorption-syndromes/small-intestinal-bacterial-overgrowth-sibo

  Small intestinal bacterial overgrowth can result from alterations in intestinal anatomy or gastrointestinal motility, or lack of gastric acid secretion. […] Anatomic alterations of the stomach and/or small intestine promote stasis of intestinal contents, leading to bacterial overgrowth. […] Intestinal motility disorders associated with diabetic neuropathy, systemic sclerosis, amyloidosis, hypothyroidism, and idiopathic intestinal pseudo-obstruction can also impair bacterial clearance. […] The excess bacteria consume nutrients, including carbohydrates and vitamin B12, leading to caloric deprivation and vitamin B12 deficiency. […] The bacteria deconjugate bile salts, causing failure of micelle formation and subsequent fat malabsorption. […] Severe bacterial overgrowth also damages the intestinal mucosa. […] Anatomic alterations in stomach or intestines or intestinal motility disorders lead to gastrointestinal stasis and thus bacterial overgrowth. […] Bacteria deconjugate bile salts, causing fat malabsorption.

• #10 Small intestinal bacterial overgrowth – Wikipedia

  https://en.wikipedia.org/wiki/Small_intestinal_bacterial_overgrowth

  There is an overlap in findings between tropical sprue, post-infectious IBS and SIBO in the pathophysiology of the three conditions and also SIBO can similarly sometimes be triggered by an acute gastrointestinal infection. […] As of 2020, there is still controversy about the role of SIBO in the pathogenesis of common functional symptoms such as those considered to be components of IBS. […] More commonly, the small bowel may have anatomical problems, such as out-pouchings known as diverticula that can cause bacteria to accumulate. […] After surgery involving the stomach and duodenum (most commonly with Billroth II antrectomy), a blind loop may be formed, leading to stasis of flow of intestinal contents. This can cause overgrowth, and is termed blind loop syndrome. […] The use of proton pump inhibitors, a class of medication used to reduce stomach acid, is associated with an increased risk of developing SIBO. […] Finally, abnormal connections between the bacteria-rich colon and the small bowel can increase the bacterial load in the small bowel.

• #11

  https://journals.lww.com/ctg/fulltext/2019/10000/small_intestinal_bacterial_overgrowth__clinical.2.aspx

  Small intestinal bacterial overgrowth (SIBO) is characterized by the presence of an abnormal amount of bacteria in the small intestine together with a constellation of GI symptoms. […] Several factors are associated with or predispose patients to SIBO, including small intestinal dysmotility. A study using duodenal aspirate/culture demonstrated that patients with small intestinal dysmotility were at increased risk of SIBO (103 colony-forming units [cfu]/mL threshold, odds ratio [OR], 3.6; P = 0.0003; 105 cfu/mL threshold, OR, 2.7; P = 0.005). […] PPIs may predispose patients to bacterial overgrowth by decreasing gastric acid. An initial study reported that 56% of 25 patients with peptic ulcers who received omeprazole had SIBO compared with none of 15 controls referred for diagnostic endoscopy (P = 0.0003).

• #12 Small Intestinal Bacterial Overgrowth

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3099351/

  Small bowel motility disorders also predispose to the development of SIBO, because bacteria may not be effectively swept from the proximal bowel into the colon. Disruption of the MMC is associated with bacterial overgrowth in an experimental model. […] Structural abnormalities in the GI tract provide an ideal environment for bacterial colonization and overgrowth. GI tract surgeries that create a blind loop predispose to bacterial stasis and overgrowth due to abnormal motility and ineffective clearance of retained food and secretions. […] Patients who are immunodeficient, whether due to an abnormal antibody response or T-cell response, are prone to bacterial overgrowth. […] Long-standing celiac disease can disturb gut motility, leading to small intestine dysmotility. […] A common complication of bacterial overgrowth is cobalamin (vitamin B12) deficiency.

• #13 How to Recognize and Treat Small Intestinal Bacterial Overgrowth?

  https://www.mdpi.com/2077-0383/11/20/6017

  There are many protective mechanisms to ensure small intestinal microbiota homeostasis and prevent excessive bacterial colonization. When these mechanisms are overwhelmed, insufficient, or absent, this may lead to SIBO. […] Other risk factors for SIBO are age (the risk increases with age), female sex, and concomitant diseases of other organs and systems; apart from the comorbidities listed above, these include irritable bowel syndrome (IBS), celiac disease, and liver diseases. […] The primary goal of SIBO treatment is to eradicate microorganisms from the small intestine in order to reduce symptoms. Further treatment goals are to maintain remission, prevent possible recurrences, and correct any nutritional and vitamin deficits. […] The purpose of antibiotic therapy is not to eradicate completely (which is not always possible) the bacteria colonizing the small intestine but to modulate the small intestinal microbiota in a manner that leads to improvement of SIBO symptoms.

• #14 Small intestinal bacterial overgrowth: Etiology and pathogenesis – UpToDate

  https://www.uptodate.com/contents/small-intestinal-bacterial-overgrowth-etiology-and-pathogenesis/print

  Small intestinal bacterial overgrowth (SIBO) is a condition in which colonic and oro-pharyngeal bacteria are seen in excess in the small intestine. When present, this overabundance of organisms can result in intestinal symptoms and, in extreme cases, malabsorption. Small intestinal dysbiosis is defined as changes in the composition, density, and function of the microbes in the intestine. SIBO is a type of small intestinal dysbiosis. […] This topic will review the etiology and pathogenesis of SIBO. […] The microbiology of the terminal ileum represents an intermediary zone between the aerobic flora found in the stomach and proximal small bowel and the dense population of anaerobic organisms found in the colon. In the distal ileum, gram-negative bacteria begin to outnumber gram-positive organisms. The concentration of organisms may be as high as 109/mL and includes coliforms and anaerobic bacteria such as Bacteroides, Bifidobacterium, Fusobacterium, and Clostridium. If the ileocecal valve is dysfunctional or surgically absent, the microbiology of the terminal ileum resembles that of the colon.

• #15 Small intestinal bacterial overgrowth syndrome

  https://www.wjgnet.com/1007-9327/full/v16/i24/2978.htm

  In most patients, SIBO is not caused by a single bacterial strain. In general, there is an extension of colonic bacteria into the small bowel. […] SIBO may be accompanied by both maldigestion and malabsorption. Bacteria in SIBO might significantly interfere with enzymatic, absorptive and metabolic actions of a macro-organism. […] SIBO is regularly associated with increased serum endotoxin and bacterial compounds stimulating production of (pro)inflammatory cytokines. […] Small intestinal bacterial overgrowth has a negative impact not only on the function but also on the morphological structure of the small bowel. […] Microscopic inflammatory changes (especially in the lamina propria) and villous atrophy are found regularly. […] In some patients with short bowel syndrome, bacterial overgrowth can, to some extent, paradoxically exert a favourable effect on the macro-organism.

• #16

  https://link.springer.com/article/10.1007/s11908-024-00847-7

  Patients with culture proven SIBO demonstrate significant alterations in the gut microbiome. Recent works by Leite et al. reveal significant decreases in the overall diversity of the gut microbiome in patients with SIBO when sterile catheter collected duodenal aspirates were examined using 16S rRNA sequencing and metagenomic shotgun sequencing. […] Patients with culture positive SIBO were found to have decreased alpha-diversity and decreased beta-diversity, the latter of which was more prominent in samples that grew 105 CFU/mL compared to those growing 103 to 105 CFU/mL. […] Findings that members of the Enterobacteriaceae are vital drivers in the pathogenesis of SIBO are further supported by another study by Barlow and Leite et al., which sought to identify microbes that disrupted the normal bacterial communities and dominated over other taxa when present.

• #17

  https://link.springer.com/article/10.1007/s11908-024-00847-7

  The increase in microbes belonging to Enterobacteriaceae, Escherichia, and Clostridium was more strongly associated with SIBO than microbial load, suggesting that overgrowth of these groups may be more responsible for causing disease than increased microbial load of other microbes. […] Ultimately, the decreases in microbial diversity and increased presence of pathogenic bacteria can contribute to the disease state by destruction of the intestinal barrier, increasing intestinal permeability, increased release of bacterial endotoxins, and translocation of colonic bacteria into the small bowel.

• #18

  https://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2002&PID=2580

  The proximal small intestine normally contains few bacteria. In small intestinal bacterial overgrowth (SIBO) there is proliferation of abnormal numbers of bacteria in the lumen of the upper small intestine. The definition of what is considered an abnormal number of bacteria in the dog is still under discussion. […] SIBO may develop if the normal host defence mechanisms, such as gastric acid secretion, intestinal peristalsis, the ileocaecal valve, intestinal immunoglobulin secretion, and mucus barrier are impaired. […] Bacteria or their secreted products can directly damage the mucosa or indirectly impair absorption by competing for nutrients and by changing intraluminal factors such as the concentration of conjugated bile acids. […] The species of bacteria in duodenal juice of dogs with SIBO varies markedly, with coliforms, staphylococci, enterococci, and Clostridium and Bacteroides spp. predominating. Anaerobic overgrowth is most common, found in approximately 70% of dogs with SIBO. […] Chronic SIBO may cause permanent functional damage to the intestinal mucosa. This may explain the poor response to treatment of some dogs, and also the need for indefinite dietary management with controlled diets after apparent successful antibiotic therapy in some dogs with chronic SIBO.

• #19 Small Intestinal Bacterial Overgrowth – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK546634/

  An abnormally high number of bacteria is identified in SIBO. Overabundant bacteria in the small intestines do not always correlate with disease activity. […] Clinical manifestations only occur when inflammation from invasive strains of bacteria is present. […] Invasive strains of bacteria can produce enzymes or endotoxins, which damage the epithelial cell layer, resulting in symptoms. […] Bacterial overgrowth can even affect bowel motility. […] In SIBO, the endoscopic and histopathological appearance of the mucosa is usually healthy. […] The prognosis depends on the etiology of the underlying condition, which is causing small intestinal bacterial overgrowth. […] Most cases have a good prognosis, rarely require hospital admissions, and are associated with complications. […] Severe chronic small intestinal bacterial overgrowth can result in significant weight loss and severe malnutrition, leading to substantial morbidity and mortality. […] If left untreated, SIBO can lead to intestinal failure.

• #20 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Small-Intestinal-Bacterial-Overgrowth-Pathophysiology.aspx

  Small intestinal bacterial overgrowth (SIBO) is a pathological overgrowth of gut bacteria upwards or rather in a retrograde fashion, into the upper gastrointestinal tract. This has many consequences, which reflect upon both intestinal and extraintestinal homeostasis. […] The occurrence of SIBO shows that normal regulatory mechanisms that keep bacterial populations in the small and large intestines have been disturbed in some way. […] Once bacteria from the colon grow into the small intestine and colonize it, this may result in mucosal inflammation usually on a microscopic scale. This in turn leads to atrophy of the intestinal villi, with infiltration by lymphocytes. […] Once colonic bacteria overgrow in the proximal small bowel, fermentable carbohydrates are acted upon by proliferating coliforms or oral bacteria to form excessive gas in the intestine. This in turn causes the typical symptoms such as bloating, flatulence, abdominal cramps and altered bowel movements. This is actually a type of dysbiosis.

• #21 SciELO Brazil – DIAGNOSIS AND TREATMENT OF SMALL INTESTINAL BACTERIAL OVERGROWTH: AN OFFICIAL POSITION PAPER FROM THE BRAZILIAN FEDERATION OF GASTROENTEROLOGY DIAGNOSIS AND TREATMENT OF SMALL INTESTINAL BACTERIAL OVERGROWTH: AN OFFICIAL POSITION PAPER FR

  https://www.scielo.br/j/ag/a/c9QqsJxzW9xNJxDPN5sL8ck/

  Small intestinal bacterial overgrowth (SIBO) is a condition characterized by an abnormal increase in bacterial population in the small intestine, leading to symptoms such as bloating, abdominal pain, distension, diarrhea, and eventually malabsorption. […] The pathophysiology of SIBO involves the interplay between bacterial overgrowth and the hosts immune and digestive systems. Overgrowth leads to fermentation of undigested carbohydrates, resulting in the production of gases like hydrogen and methane, which contribute to symptoms such as bloating and abdominal discomfort. Additionally, bacterial metabolites can cause direct mucosal injury, leading to malabsorption and nutrient deficiencies. […] Several factors increase the risk of SIBO, including gastrointestinal motility disorders, reduced gastric acid secretion, structural abnormalities in the small intestine, and immune deficiencies. Conditions such as diabetes, systemic sclerosis, Crohn’s disease, and chronic opioid use, among others, are commonly associated with these risk factors, predisposing individuals to bacterial overgrowth.

• #22 Small Intestinal Bacterial Overgrowth (SIBO) – Intestinal Diseases – Gastrointestinal Diseases – Gastroenterology – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.4.12.

  Small intestinal bacterial overgrowth (SIBO) is a condition in which the small bowel is colonized by excessive numbers of aerobic and anaerobic microbes that normally colonize the colon. […] Etiology and pathogenesis: There are several mechanisms that prevent bacterial colonization of the small intestine, such as low gastric pH, gastrointestinal (GI) motility, enzymes in pancreatic and biliary secretions, integrity of the intestinal mucosa, direct effects of commensal bacteria, decreased secretion of IgA, and the ileocecal valve. When any of these mechanisms is altered, the risk for SIBO increases: […] Motility disorders, diabetes, and chronic pancreatitis are estimated to account for ~90% of cases of SIBO. […] SIBO leads to: […] 1) Deconjugation of bile salts and impaired digestion of fats, with consequent steatorrhea and malabsorption of fat-soluble vitamins (specifically vitamins A, D, and E, but not vitamin K, as it is produced by luminal bacteria).

• #23 Small Intestinal Bacterial Overgrowth (SIBO) – Intestinal Diseases – Gastrointestinal Diseases – Gastroenterology – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.4.12.

  2) Depletion of vitamin B12, leading to megaloblastic anemia. Vitamin B12 is used by anaerobic bacteria to produce inactive cobamides, which in turn decrease vitamin B12 absorption in the ileum by competing for its binding sites. […] 3) Protein malabsorption. […] 4) Inflammation in the small bowel, villous atrophy, and disturbance of disaccharide digestion leading to lactose intolerance, which contributes to diarrhea.

• #24 Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy

  https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl16126

  Though the pathophysiology of IBS remains largely enigmatic, evidence from recent studies does show that dysbiosis may contribute to development of symptoms, at least in a subset of patients. […] Host response to SIBO also depends on its genetic make-up as evidenced by a recent case-control study on 209 patients with IBS and 273 healthy subjects. […] Increased number of enterochromaffin cells was found in the mucosa of colon and rectum among patients with IBS than healthy controls. […] Immune activation in response to SIBO recruits increased number of intraepithelial lymphocytes, mast cells and enterochromaffin cells.

• #25 Role of Small Intestinal Bacterial Overgrowth in Functional Gastrointestinal Disorders

  https://www.jnmjournal.org/journal/view.html?uid=1058&vmd=Full

  Functional dyspepsia (FD) and irritable bowel syndrome (IBS) are the most common functional gastrointestinal disorders (FGIDs) with a significant burden on patients quality of life. […] Recently, small intestinal bacterial overgrowth (SIBO) has been suggested as a possible etiological mechanism, especially in IBS. […] SIBO is a condition in which there is overgrowth of bacteria in the small intestine; it is associated with symptoms such as chronic diarrhea, bloating, abdominal distention, and flatulence. […] Bacterial overgrowth may also affect directly the sensori-motor function of the gut. […] In a recent study, mucosal interleukin (IL)-1 and levels were higher in IBS patients with SIBO than those without SIBO, and associated with abdominal bloating, suggesting that SIBO may lead to bloating via gut inflammation.

• #26

  https://www.vin.com/apputil/content/defaultadv1.aspx?meta=&pId=11147&id=3846192

  Bacteria or their secreted products can directly damage the mucosa or indirectly impair absorption by competing for nutrients and by changing intraluminal factors such as the concentration of conjugated bile acids. […] The species of bacteria in duodenal juice of dogs with SIBO varies markedly, with coliforms, staphylococci, enterococci, and Clostridium and Bacteroides spp. predominating. […] Definitive diagnosis of SIBO is based on results of microbiologic culture of duodenal juice, obtained usually at endoscopy or alternatively via intra-operative permucosal aspiration. […] Chronic SIBO may cause permanent functional damage to the intestinal mucosa. This may explain the poor response to treatment of some dogs, and also the need for indefinite dietary management with controlled diets after apparent successful antibiotic therapy in some dogs with chronic SIBO.

• #27 SIBO: Symptoms, causes, treatment, and diet

  https://www.medicalnewstoday.com/articles/324475

  Small intestinal bacterial overgrowth (SIBO) occurs when large numbers of bacteria colonize the small intestine. […] Gastric secretions and the forward movement of food through the digestive system prevent too many bacteria from growing in the small intestine. However, if these functions do not work effectively, bacteria can multiply. […] When the small intestine doesnt empty effectively, excessive bacteria ferment all the food that comes through causing unpleasant symptoms for some people. […] Dysbiosis is when a persons microbiome becomes imbalanced, containing too many harmful species of microbes or not enough beneficial species. […] Researchers believe that people who take proton pump inhibitors (PPIs), have autoimmune gastritis, or have undergone a gastrectomy have an increased risk of hypochlorhydria and SIBO.

• #28 Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy

  https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl16126

  The pathogenesis of irritable bowel syndrome (IBS), once thought to be largely psychogenic in origin, is now understood to be multifactorial. One of the reasons for this paradigm shift is the realization that gut dysbiosis, including small intestinal bacterial overgrowth (SIBO), causes IBS symptoms. […] Recent realization that SIBO may be associated with symptoms of IBS, led to a paradigm shift in understanding the pathogenesis of this condition, hitherto thought to be related largely to psychological factors, to more organic nature. […] In SIBO, bacterial fermentation of diet in the lumen produces hydrogen, methane and carbon dioxide gases, which may contribute to symptoms like distension, flatulence, abdominal pain, and bloating. […] SIBO is more often associated with diarrhea than constipation-predominant IBS. Mechanism of diarrhea in patients with SIBO include de-conjugation of bile salts, enterotoxic effect of bacterial metabolites, increased small intestinal permeability, deficiency of vitamin B12 and low grade inflammation resulting from immune activation in the small intestinal mucosa.

• #29 Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy

  https://www.gutnliver.org/journal/view.html?uid=1068

  The pathogenesis of irritable bowel syndrome (IBS), once thought to be largely psychogenic in origin, is now understood to be multifactorial. One of the reasons for this paradigm shift is the realization that gut dysbiosis, including small intestinal bacterial overgrowth (SIBO), causes IBS symptoms. […] Between 4% and 78% of patients with IBS and 1% and 40% of controls have SIBO; such wide variations in prevalence might result from population differences, IBS diagnostic criteria, and, most importantly, methods to diagnose SIBO. […] Although quantitative jejunal aspirate culture is considered the gold standard for the diagnosis of SIBO, noninvasive hydrogen breath tests have been popular. […] Several therapeutic trials targeting gut microbes using antibiotics and probiotics have further demonstrated that not all symptoms in patients with IBS originate in the brain but rather in the gut, providing support for the micro-organic basis of IBS. […] A recent proof-of-concept study showing the high frequency of symptom improvement in patients with IBS with SIBO further supports this hypothesis.

• #30 Role of Small Intestinal Bacterial Overgrowth in Functional Gastrointestinal Disorders

  https://www.jnmjournal.org/journal/view.html?uid=1058&vmd=Full

  The symptoms of SIBO and IBS overlap, since SIBO can lead to similar physiologic changes as those observed in patients with IBS. […] Some research data indicated an increased prevalence of SIBO in IBS, and an improvement in IBS symptoms with antibiotic treatment. […] However, the link between SIBO and IBS is not definitive. […] First, the relationship between these 2 conditions is largely based on HBT, and the frequency of SIBO varies considerably from 4% to 78% in patients with IBS, and from 1% to 40% among healthy controls due to the lack of standardization of HBT. […] Secondly, it remains unclear whether SIBO is a cause of IBS, or instead a bystander associated with other abnormalities underlying IBS. […] Finally, antibiotics may reduce IBS symptoms by affecting colonic bacteria rather than, altering small intestinal bacteria. […] Thus, controversy remains regarding the relationship between SIBO and IBS.

• #31 Prevalence, risk factors, and treatment of small intestinal bacterial overgrowth in children

  https://www.e-cep.org/journal/view.php?number=20125555650

  The prevalence of SIBO varies widely depending on test method and study size, it is reportedly approximately 2.5%22%. […] SIBO occurs more often in IBS with diarrhea (IBS-D) than in those with IBS with constipation (IBS-C). […] The principles of treatment are identification and targeting of underlying conditions, symptom control, and nutritional supplements. […] Antibiotics, including rifaximin, metronidazole, neomycin, norfloxacin, amoxicillin, and tetracycline, are used to treat SIBO. […] Rifaximin, a nonabsorbable antibiotic, has been widely used to eradicate SIBO. […] Pediatric SIBO shows wide symptom and severity spectra ranging from IBS-like symptoms to malabsorption or malnutrition. […] Disturbances in intestinal motility or altered intestinal anatomy are predisposing factors.

• #32

  https://mygi.health/education/diseases/sibo

  SIBO is diagnosed when there is an excessive amount of bacteria within the small intestine. […] Any condition which impairs the normal transit or motion of the small intestine can increase the likelihood of getting SIBO, including lack of adequate stomach acid, damage to the intestine by toxins, or a decrease in the speed at which the small intestine transfers waste to the colon. […] The pathogenesis of irritable bowel syndrome (IBS), once thought to be largely psychogenic in origin, is now understood to be multifactorial. One of the reasons for this shift is the realization that gut dysbiosis, including SIBO, causes IBS symptoms. […] The general emerging consensus is that SIBO may signify the underlying mechanism for a particular sub-set of IBS patients. […] Evidence that SIBO may be an underlying cause for IBS comes from two main findings.

• #33 SIBO: Symptoms, Diagnosis, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/21820-small-intestinal-bacterial-overgrowth-sibo

  Overuse of certain medications can upset the normal balance of flora. […] Small intestine dysmotility means that waste is retained for too long in your small intestine before emptying into your large intestine. This allows the small intestine bacteria to continue to multiply, while the large intestine bacteria may make their way into your small intestine. […] Structural problems in your small intestine can inhibit motility and the regular clearing of residual bacteria and create extra nooks and crannies for bacteria to build up. […] Common symptoms of SIBO including gas, bloating, abdominal pain and distension are uncomfortable enough. But left unmanaged, SIBO can cause more serious complications with long-term consequences. Malabsorption of fats, proteins and carbohydrates can lead to malnutrition and vitamin deficiencies.

• #34 Small intestinal bacterial overgrowth (SIBO) – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/small-intestinal-bacterial-overgrowth/symptoms-causes/syc-20370168

  The breakdown products following bacterial digestion of food can also trigger diarrhea. […] The overgrowth of bacteria can result in B-12 deficiency that can lead to weakness, fatigue, tingling, and numbness in your hands and feet and, in advanced cases, to mental confusion. […] Damage to your central nervous system resulting from B-12 deficiency may be irreversible. […] Over time, damage to your intestine from abnormal bacterial growth causes poor calcium absorption, and eventually may lead to bone diseases, such as osteoporosis.

• #35 Small Intestinal Bacterial Overgrowth (SIBO) and Twelve Groups of Related Diseases—Current State of Knowledge

  https://www.mdpi.com/2227-9059/12/5/1030

  Mucosa-associated bacterial taxa related to SIBO have recently been identified which may serve as potential biomarkers or therapeutic targets for SIBO. […] Dysbiosis was observed in the mucosa-associated gut microbiome of patients with SIBO, but not in the fecal microbiome. […] Different gastrointestinal tract sections in SIBO+ and SIBO− patients were found to be colonized by different bacteria. […] The spectrum of SIBO symptoms includes not only those affecting the digestive tract (e.g., chronic watery/fatty diarrhea, bloating, abdominal pain, constipation, absorption disorders, malnutrition, weight loss, inflammatory changes in the intestines, and atrophy of intestinal villi) but also headaches, mood changes, general malaise, vitamin deficiencies (B12, B1, B3), increased levels of vitamin K and folic acid, D-lactic acidosis, skin symptoms, changes in the liver, and arthralgia. […] This review fills the evidence gap on SIBO. It presents a biological–medical approach to the problem, clearly shows the groups and diseases with a proven strong relationship with SIBO, and indicates groups within which research should be continued.

• #36 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Small-Intestinal-Bacterial-Overgrowth-Pathophysiology.aspx

  Ammonia overproduction occurs as the intraluminal proteins are also digested. Other toxic compounds induce mucosal inflammation and worsen small intestinal mucosal permeability. […] Finally, SIBO is more toxic in patients programmed to produce less IL-1 receptor antagonist genes, but higher proinflammatory cytokines, such as IL-6 or tumor necrosis factor-alpha.

• #37 SIBO (Gut Bacteria Problem) Test, Symptoms, Causes, Treatment

  https://www.medicinenet.com/small_intestinal_bacterial_overgrowth_sibo/article.htm

  Any illness or disease that affects the body’s defense mechanism puts a person at risk for SIBO, but the majority of people develop SIBO because of an intestinal motility problem. […] As the disease progresses, bacterial overgrowth inhibits the body’s ability to properly absorb nutrients from the diet. This can lead to vitamin and electrolyte abnormalities, protein deficiencies, and difficulties with fat absorption. […] The inability to absorb vitamin B12 can lead to symptoms of pernicious anemia, including a low red blood cell count and peripheral neuropathy. […] Small intestine bacterial overgrowth is usually associated with another underlying illness. Even with appropriate treatment, the relapse rate is high and often depends upon how well the underlying illness is managed and controlled.

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