Why SIBO is underdiagnosed

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Why SIBO is underdiagnosed

Medically reviewed by:
Dr James Freeman

1) IBS, IBS-C, IBS-D, or IBS-M are much easier diagnoses to make

2) Routine gut testing and colonoscopies/endoscopies often shows normal results

3) The gut has been historically hugely misunderstood. Much of what we know has only been discovered in the last few decades, which means there are practicing doctors today who still don’t understand the best treatment options for SIBO and, unfortunately, some who don’t even know what it is. The umbrella diagnosis of “IBS” has led to dismissing patents concerns.

4) Finding the right natural treatment option that’s proven and backed by science is challenging. There are many gimmicky products available on the market, some that do more harm to those with SIBO than good.

5) Access to the correct and affordable treatment can be challenging, with insurance companies often refusing to cover the costs for one round, let alone more than one, which is often required. High-quality supplements often can be expensive, although they tend to be a much cheaper alternative to the most studied and effective antibiotic. Studies suggest they may be as effective in treating SIBO as the best and most studied drug and can be an excellent alternative for antibiotic non-responders or those wanting to take the natural route.

6) Many medical professionals dismiss gut issues and automatically suggest generic lifestyle changes that don’t address SIBO.

7) It is often “Symptom treated”. Meaning, patients adapt their lifestyles to “not trigger” their SIBO in such an intense way while never addressing the root cause or killing the bacteria, leading to years of struggle.

Dr Q and A with DR James Freeman (B.Sc. MB,BS Dean’s Roll of Excellence for outstanding academic achievement, founder of pioneering telemedicine company GP2U Telehealth in Australia. Also founder of a company that provides equitable access to medication)

Why is SIBO so under diagnosed?

It’s under recognised that it exists. One of the main drugs that’s used to treat SIBO isn’t approved for this specific use in many countries and doesn’t work to address underlying issues. It’s also often refused by insurance and costs anywhere from 500-5000 dollars for two weeks depending on where you live with many people requiring more than one course.

Herbal antimicrobials have been shown to be equally as effective with added benefits around microbiota composition and root cause issues like motility. The natural alternative can be a great option for people who want to take a natural approach and address underlying issues like dysbiosis or antibiotic non-responders/chronic relapses.

If there is no treatment due to access or lack of understanding about the best method, there is no ability to offer it to a patient.

Why do so many doctors give the diagnosis of IBS without getting to the root cause?

Doctors look for what they know how to look for. We have fecal MCS microscopy culture and sensitivities in terms of available commonly used tests. We have feces testing, but the thing is feces grow lots of things. Some we recognize as problematic like campylobacter and salmonella, but others that may be problematic, particularly when overpopulating the wrong area, we consider unproblematic, and we pay no attention to them. Some things also just do not grow.

We test for calprotectin, which indicates inflammatory bowel disease (Crohn’s disease and ulcerative colitis). Until the recent uprise breath testing, there is no widely used test that will diagnose SIBO. We would estimate less than 1% of GPs understand how to diagnose, test, and treat SIBO. We read the medical literature daily, and the topic only started emerging in recent years, and it hasn’t been greatly highlighted.

FixSIBO Why SIBO is underdiagnosed 01

Why is breath testing not widely available?

Due to the lack of education around SIBO, it’s until recently that it started to become more common. Many governments do not fund breath testing, so patients will be out of pocket for all testing. The third type of SIBO was only recently discovered, so mass testing adoption for it is yet to occur.

Quote from a gastroenterologist at Johns Hopkins University: “SIBO was thought of as very rare before. In fellowship, the way we were trained was that this is something rare, like in those who’ve had surgeries causing a blind loop syndrome or have connective tissue disease such as scleroderma. We were just labeling patients [without classic risk factors] with IBS before, and they were not better because there was an underlying cause.”[1]

1 Frost, n.d.

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