Treatment

SIBO relapse and recurrence

Medically reviewed by:
Dr James Freeman

In a study involving 80 patients[1] with Small Intestinal Bacterial Overgrowth (SIBO), recurrence rates three, six, and nine months after successful treatment with antibiotics were 13, 28, and 44 per cent, respectively.[2] Recurrence was more likely in older adults, those with a history of an appendectomy, and those taking proton pump inhibitor antacid medication.

There are several reasons SIBO recurs

1. You were not adequately treated the first time

You have not been prescribed enough antibiotics or antimicrobials to effectively kill off enough of the bacteria in your small intestine. As a result, you have relapsed. Although your treatment partially worked, it was an inadequate dosage/or duration of treatment for the bacteria load you had present.

2. You were diagnosed with the wrong type of SIBO

There are three different types of SIBO:

• hydrogen-dominant
• methane-dominant
• sulphide-dominant

The significance of your fermentation gas profile is that it directly reflects how various organisms within your gut microbiome are interacting.

It has been observed that different treatment protocols are more or less effective for these variants of SIBO. Specific herbal antimicrobials and/or antibiotics are used depending on what type of SIBO you have. Optimal post treatment protocols also vary according to the type of SIBO. For example, someone with methane dominant SIBO should probably focus on gut motility supplements post treatment to prevent reoccurrence.

3. You did not successfully repopulate your gut to a healthy state post treatment

Think of your gut like a garden. Your intestines are the soil/foundation, and to have a healthy gut, you need a diverse range of plants growing and living in harmony. When there is a high level of biodiversity of the microbes in your gut, your microbiome tends to be more stable.

When you take antibiotics or antimicrobials, you kill bacteria. That is a good thing in the case of small intestinal bacterial overgrowth, but you need to understand the importance of effective repopulation post-treatment.

4. You have an underlying condition that slows gut motility that needs addressing and treating

There are multiple conditions that can slow gut motility. Sometimes a patients ongoing reccurrence because there is an underlying issue that hasn’t been addressed, predisposing them to reccurrence.

5. You always had, or have developed SIFO alongside or instead of SIBO

Small Intestinal Fungal Overgrowth (SIFO) and SIBO are different. They both impact the functioning of the small intestine, but they respond to different treatments. There is not enough data yet, but it is probable that when we treat SIBO we expose individuals to the risk of developing SIFO.

If you have ever developed thrush after a course of antibiotics you have seen fungal overgrowth on your outsides. Thrush can also develop in the small intestine, and this is effectively what SIFO is although the Candida albicans organism is not necessarily the main or only issue.

6. You snack an excessive amount

Snacking is not inherently bad for you. It is beneficial for some people. However, if you have problems with your small intestine, it might be worth evaluating how often you snack between meals.

The migrating motor complex is essential to the health of your small intestine. It aids in controlling the number of bacteria in your small intestine. It cycles through roughly every 90 minutes, acting like the house cleaner for the small bowel. Every time you eat, you inhibit its ability to do its job as effectively.

7. You spend a lot of time sitting down

Sitting reduces blood flow to the digestive tract, which slows GI motility. This allows food to remain in the small intestines longer, which means bacteria can take up residence (and grow in numbers) where it shouldn’t, which is a recipe for SIBO recurrence.

8. You got food poisoning and you have
semi-permanent intestinal damage that needs
time to recover

SIBO in both its initial instance and recurrence can be triggered by food poisoning. How this happens is quite interesting. E. coli, Campylobacter jejuni, Shigella, and Salmonella produce a substance called cytolethal distending toxin (CDT) [2] which can damage cells in the intestines and impair MMC function.

¹ https://www.uptodate.com/contents/small-intestinal-bacterial-overgrowth-management/abstract/12
² https://pubmed.ncbi.nlm.nih.gov/23106005/

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Treatment

SIBO relapse and recurrence