By Nancy Brown, 09/2017

What is SIBO?

Small Intestinal Bacteria Overgrowth (SIBO) is a condition where there is excessive bacteria in the small intestine. The bacteria interfere with digestion and absorption. Similar to Gastroparesis (GP), SIBO can cause gas and bloating, diarrhea or constipation or both, and pain. SIBO symptoms vary patient to patient.

Studies have shown that those with type 1 diabetes have less incidence of SIBO. This is likely due to better nutrition and diet management in that patient population.


Testing for SIBO

The best way to diagnose SIBO is through a hydrogen breath test (HBT). The HBT is also used to diagnose H pylori infection and carbohydrate malabsorption.

To prep for the test, one to two days prior to HBT, patients will be on a special diet that removes the food that feeds the bacteria.  Fasting is required 12 hours prior to the testing. Patients drink a sugar solution and the testing begins. Breath samples are collected for up to 5 hours.

Alternative testing procedures include blood testing to be taken after drinking the sugar solution; observation of the patient for symptoms; and taking a culture of the bacteria from a sample of fluid from the small intestine.

Treatment for SIBO

Treatment for SIBO include reducing the bacteria, diet changes and preventing future infections. Augmentin and Xifaxan are the two common antibiotics used to treat SIBO.  Xifaxan is very expensive, but very effective in reducing the bacteria.  Other antibiotics used to treat SIBO include Clindamycin, Flagyl, Cipro, Levaquin, or Bactrim.  SIBO patients may be required to take the antibiotic for one to two weeks.  Probiotics, such as lactobacilli and bifidobacterial, are sometimes prescribed for SIBO treatment.

To reduce the incidence of SIBO relapse and symptoms, those effected are encouraged to limit carbohydrates, like sugars and starches for 6 – 8 weeks. Following a Low FODMAP diet is often recommended.  FODMAP stands for Fermentable, Oligo-, Di-, Mono-saccharides And Polyols.  For additional information on Low FODMAP diets please visit Monash University. You may need to work with a nutritionist to define a GP/Low FODMAP diet.

How Do I Tell the Difference Between SIBO and a GP Flare up?

A gastroparesis (GP) flare is a period of time when you continually experience GP symptoms for consecutive days (weeks, months).  The symptoms for SIBO are similar, although with SIBO, symptoms will not go away until the bacteria is eliminated. If you have a flare, consider keeping a food diary to track what you eat. This will help you and your doctor better understand what, if anything, is triggering the symptoms.  However, the best way to determine if you are having a GP flare or SIBO is through testing. Contact your Gastroenterologist or the doctor who treats your GP to schedule a breath test.


Nancy Brown lives in Virginia with her husband of 38 years, Ed.  They’re empty nesters and are enjoying retirement.  Prior to retiring, Nancy was a Manager of Requirement Analysis at Navy Federal Credit Union.


Image credits:

Title: Google images (unrestricted use)

SIBO infographic: