Small intestinal bacterial overgrowth (SIBO) occurs when overgrown bacteria are in the small intestine. Excess bacteria here can affect digestion and absorption.

Image credit: PawelKacperek/Shutterstock.com

However, bacteria can provide benefits, including:

• Micronutrient production
• Metabolism support or medicinal activation
• Biotransformation of bile salts
• Non-digestible polysaccharide fermentation
• Prevention of luminal colonization by pathogenic microbes

Watch the webinar: Mastering Gut Health – Understanding SIBO

What causes SIBO?

A common cause of SIBO is normal bowel motility dysfunction. Slow movement through the intestines favors the growth of bacteria. Possible causes include:

• History of food poisoning
• Diabetes
• Some medicines
• Nerve damage

The underlying cause may also be unknown. SIBO has many consequences, including villus damping, carbohydrate and protein malabsorption, and B12 deficiency.

How can SIBO be tested?

The “gold standard” for diagnosing SIBO—jejunal aspirate culture—has limitations. Many species of bacteria do not grow in routine culture media, and the procedure is invasive and expensive. The hydrogen breath test was designed because of the challenges of evaluating the small intestine. It is used to detect SIBO and food malabsorption.

How can breath samples elucidate what is happening inside the intestines?

All cells produce carbon dioxide during metabolism, but only bacteria produce hydrogen and methane as metabolic byproducts. These gases are transferred into the blood through the intestinal walls. When the blood reaches the lungs, an exchange of gases takes place, which allows these gases to be detected in the exhaled breath.

Image credit: Bedfont Scientific Ltd.

How to do a SIBO or malabsorption test

GastroCH4ECK^® Gastrolizer^® it assesses the amount of hydrogen or methane gas in each exhaled breath. Before the breath test begins, the patient must follow a strict protocol. This includes a restricted diet followed by a period of fasting. Failure to follow the protocol may result in a larger record or a false positive result.

Before drinking the relevant substrate, a baseline breath sample is recorded. The consumed substrate is then mixed with 250 ml of water. The type of substrate corresponds to the test performed. Substrates can be:

• Glucose
• Lactulose
• sucrose
• Sorbitol

Breath samples are then recorded every 15 to 30 minutes, depending on the test. This process can take up to four hours, depending on the type of test. Depending on the type of test and the results, treatment may include antibiotics or dietary changes.

Fructose malabsorption

Fructose malabsorption is a dietary disability of the small intestine. Most people can absorb between 25 and 50 g of fructose at a time. However, the small intestine of people with fructose malabsorption cannot adequately absorb fructose, which means it then travels to the large intestine, where the resident bacteria must metabolize it.

This then increases the amounts of hydrogen and methane gases offset by the bacteria. Potential causes of fructose malabsorption include:

• Inherited or acquired abnormalities of the fructose transporter protein
• Excessive use of corn syrup or high fructose fruit juice by children
• SIBO
• celiac disease
• Radiation or chemotherapy
• The dumping syndrome

Clinical signs of fructose intolerance may include:

• bloating
• Diarrhea
• Constipation
• flatulence

There is currently no known cure for SIBO. However, a proper diet can help. Foods high in glucose can help fructose absorption.

To test for fructose intolerance, a patient must consume 25g of fructose in 250ml of water before taking breath samples every 30 minutes for three hours.

Lactose malabsorption

Lactose is usually hydrolyzed into glucose and galactose, then absorbed in the jejunum. Lactose must be hydrolyzed in the small intestine by lactase. If the lactase enzyme is deficient, lactose will not be completely hydrolyzed, leading to lactose malabsorption. Signs of lactose malabsorption may include:

• distention
• Cramps
• flatulence

Lactose malabsorption is the most common type of intolerance and affects about half of the world’s population.

Watch the webinar: Mastering Gut Health – Understanding SIBO

Food allergies vs. food intolerances

People often confuse food intolerance with food allergies. A food intolerance can result from a change in routine, hormones or eating out. The unpredictability of symptoms can disrupt someone’s life and cause them to avoid social activities. Many people suffering from this condition turn to the internet for a quick and easy solution.

An intolerance occurs when the intestinal enzymes responsible for breaking down food are missing or defective, or there is a problem with the mechanism that transports molecules through the small intestine. Symptoms include:

• Abdominal pain
• Discomfort
• Diarrhea

Common food intolerances include:

• Lactose
• Fructose
• sucrose
• Sorbitol

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It is critical not to self-diagnose, as many conditions have similar symptoms to irritable bowel syndrome and SIBO, but have different treatments and require different management strategies. It is always essential to visit a doctor or healthcare professional for advice. A food intolerance can be diagnosed through an elimination diet or a breath test.

There is a key difference between a food intolerance and a food allergy. A food allergy is a reaction that involves the immune system. Symptoms may include:

• Rash
• itch
• Breathing difficulties

People with food intolerances can consume a small amount of the food, while people with allergies should avoid these foods, as their consumption can be fatal. Food allergies can be tested by skin prick or an elimination diet.

Health professionals do not currently recommend finger prick and hair analysis tests for food intolerances because sufficient scientific evidence does not support them.

Breath testing is the preferred approach for identifying lactose malabsorption for several reasons. If patients continue with an elimination diet and stop drinking milk, they may still consume lactose from several unsuspected foods, including:

• Hot dog
• Bread chicken
• Sweets

Even if the patient tries to eliminate lactose from the diet, he may ingest the substance unintentionally.

Other testing strategies may include:

• Endoscopic biopsies (invasive and expensive)
• Blood test (repeated every 30 minutes)
• Stool acidity test (infants, young children)

Home breath test devices

Home breath testing devices were widely optimized following the COVID-19 pandemic to avoid delays on waiting lists and because people felt safer doing the tests at home. There are several advantages to home test kits, including:

• I live far from the clinic and difficulties to get there
• Difficulties in obtaining work leave
• Child care issues
• Difficulty leaving the house when experiencing symptoms

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However, a key limitation of home testing may be that the patient may not collect their samples correctly, meaning that the test may need to be repeated. Patients should be given very clear and precise instructions.

Many home testing devices are now available, but using any of these devices without the advice or guidance of a healthcare professional can lead to self-interpretation, misdiagnosis, and incorrect preparation, leading to unnecessary avoidance of key food groups.

Home testing devices should be obtained from a reputable healthcare professional who can discuss the results or provide a report for the attending physician. This will ensure proper follow-up so that the patient does not develop a nutritional deficiency due to self-diagnosis.

Several factors are involved in the diagnosis and treatment of gastrointestinal conditions.

Watch the webinar: Mastering Gut Health – Understanding SIBO

About Bedfont^® Scientific Ltd

Bedfont^® Scientific has been specializing in the design and manufacture of exhaled breath and gas monitoring instruments since 1976.

For medical gas monitoring, their Medi-Gas Check medical line testing range checks not only the quantity but also the quality of the gas administered to patients.

Bedfont breath analyzers include carbon monoxide (CO) monitors such as the Smokerlyzer^®used for smoking cessation and ToxCO^®used by emergency services to diagnose CO poisoning.

NOT the breath^® The FeNO monitor provides an accurate analysis of airway inflammation for asthma control and Gastrolyzer^® range helps detect gastrointestinal disorders and food intolerances. Fast and non-invasive, the breath test is the new blood test.

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