Your bloating and diarrhoea might NOT be IBS: Expert reveals the tell tale signs of common digestive issue SIBO

Millions of people with a debilitating digestive problem may have been misdiagnosed with irritable bowel syndrome, putting them at risk of vitamin deficiencies, kidney problems and even cancer, experts warn.

The condition, known as SIBO, which occurs when bacteria in the small intestine rapidly multiplies, is on the rise in the UK. 

However the symptoms, which include diarrhoea and flatulence, are often mistaken for IBS, blocking access to effective treatments – including diet plans and antibiotics.

Some patients are even told their symptoms are ‘in their head’, and prescribed antidepressants, the Daily Mail reported last year. 

As such, experts are now calling for better awareness of the gastrointestinal issue and encouraging patients to get a second opinion if they suspect SIBO. 

So what exactly is SIBO, how do you know if you have it, and what is the best treatment to keep bad bacteria at bay? 

‘The way the gut works is that when we eat food, our stomach acid destroy all the bacteria before it continues on to the small intestine’ Professor David Sanders explains. 

What remains then passes into the large intestine which is home to the gut microbiome – a thriving community of beneficial bacteria – which helps produce essential vitamins and breaks down hard-to-digest nutrients like fibre. 

By contrast, the small intestine typically contains very few bacteria. But in people with SIBO, bacteria will escape into the small intestine, resulting in stomach pain and bloating. 

As food moves through the small intestine, these bacteria start fermenting it – producing gas as a by-product, which it essentially what causes the discomfort. 

Experts say there a a number of reasons why this might happen – most of which are linked to the body’s inability to digest food. 

People with reduced stomach acid – which ordinarily destroys bacteria – are at an increased risk of SIBO, Prof Sanders says. 

This includes both people who naturally produce less stomach acid, and those on commonly prescribed heartburn medications, called Proton Pump Inhibitors (PPIs).

‘We need acid to kill the bacteria that’s on whatever we eat,’ Prof Sanders told The Telegraph. 

But one in five people in the UK are thought to have taken a PPI, such as omeprazole and lansoprazole, at some point with prescriptions tripping over the past two decades as a result of poor diets – which experts say could be driving the trend. 

However, SIBO is not only linked with a lack of stomach acid. It can also be caused by anatomic abnormalities which interfere with food slowing through the intestines. 

‘Anyone with an anatomical defect that creates little pouches and cul de sacs, where bacteria can hide, instead of moving through the gut, are more likely to develop SIBO,’ Prof Sanders explains. 

This can be the result of surgery or a condition like diverticulosis which leads to the formation of small pouches in the walls of the intestine. 

SIBO can also occur when the gut slows down too much, meaning it takes longer for foods to be digested and transported into the large intestine.

Prof Sanders says: ‘Anything that slows down gut transit gives bacteria a sporting chance of getting hold.’  

For this reason, women who have had a baby via C-section, people with diabetes, and the elderly are at an increased risk.  

It is also thought that weight-loss jab users are more likely to develop the condition,  as the weekly injections work by slowing down the digestive process.

There is also some evidence to suggest that food poisoning can result in SIBO by slowing down digestion.  

Common symptoms include bloating, distended stomach, gas, excessive flatulence, diarrhoea and unintentional weight loss – with diarrhoea and bloating being the most important symptoms for diagnosis. 

Ordinarily, once more serious conditions like bowel cancer are ruled out, patients will perform a stool test, before undergoing a gastroscopy, where a tube with a camera is threaded down the throat to the stomach. 

This is considered the gold standard, but more often patients will be offered a breath test – which is less invasive, less expensive and crucially, less reliable. 

The test – taken after a patient is given a solution to drink – measures a patient’s hydrogen and methane levels, produced by excess bacteria, on the breath. 

A peak suggests the presence of bacteria in the small intestine. 

But, Prof Sanders, warns: ‘This is very controversial in the world of gastroenterologists, because the result is affected by the motility of the gut. 

‘If the solution hammers through your small bowel and reaches the colon – the microbiome – and starts breaking down there instead, the peak in your carbon breath test could lead to a false diagnosis.’

So whilst some gastroenterologists believe SIBO is widely underdiagnosed, others say it could actually be being over-diagnosed – hence the rise in cases – due to the unreliability of tests.  

Either way, once identified, the main SIBO treatment is an antibiotic called rifaximin, which research shows can eliminate the bacteria overgrowth in the small intestine. 

The £2 tablet is taken three times a day for between two and eight weeks, with some patients experiencing an improvement in symptoms in just a matter of weeks, 

However, it’s not risk free and can kill off some healthy gut bacteria, leading to a host of other problems. 

But left untreated, there is some evidence that it can lead to a number of serious health conditions. A 2106 study involving more than 200 cancer patients found a significant link between the condition and the development of pancreatic, bile duct and colon cancers.  

There is also good evidence that herbal antimicrobials such as berberine and oregano can work as well as antibiotics – especially when first line treatment hasn’t worked. 

In order for treatment to work, however, a patient will also need to tackle gut fermentation. 

Most will be placed on a low FODMAP diet, which limits fibre intake and in doing so starves the bacteria which triggers the symptoms. 

FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols and refers to a long list of foods including wheat, beans, pulses, milk and apples. 

However, the goal is to get patients back to eating a more balanced diet, reintroducing foods food groups gradually to help identify any triggers. 

Probiotics might also help in restoring the gut microbe’s delicate balance, Prof Sanders says, but this isn’t a specific treatment for SIBO.  

Whichever treatment method you go for, however, experts agree that it’s important to address any underlying causes of SIBO, whether that’s coming off PPIs or working to speed up your digestion.