Bacterial overgrowth: nutrition as part of the therapeutic concept

Peer-reviewed | Manuscript received: May 11, 2016 | Revision accepted: January 7, 2017

Small Intestinal Bacterial Overgrowth (SIBO)

Continuation from Ernährungs Umschau issue 4/2017

SIBO diagnostics

A particular challenge in diagnosing SIBO is the wide variety of causative diseases, which may overlap with the symptoms of the bacterial overgrowth itself. In addition, the clinical picture differs depending on the bacterial species, the location of the bacterial overgrowth and the density of the bacteria [18]. Therefore a SIBO diagnosis should be considered in all patients with the aforementioned non-specific gas-related complaints, including micronutrient deficiencies and steatorrhea. An anamnestically important information is the above mentioned fact that SIBO is not a primary condition, but rather a secondary caused by the pathological changes in the intestines, as described above [30].

Breath tests

Breath gas tests measure the release of gases through exhaled air during the intraluminal, bacterial metabolism of an administered test substance. This preferential test method is non-invasive, requires little effort and is most cost-effective [13]. The normalization of a positive test result following specific therapy confirms efficacy of that therapy and is associated with an improvement of the symptoms [31].

The most commonly used breath tests today are hydrogen breath tests with lactulose as test substance. Lactulose cannot be broken down by enzymes in the human body and consecutively reaches the colon, where its fermentation increases hydrogen (H₂) concentration. Hence, an observable increased H₂ concentration indicates the fermentation of lactulose in the small intestine and/or in the colon.

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