Treatment - how is SIBO treated? What medications work, is a diet necessary?

The treatment of SIBO is individual and complex for each patient. It includes lifestyle modification, diet and drug therapy. SIBO is treatable, but can often recur. It therefore requires specialist treatment, diagnosis of the cause and close doctor-patient cooperation.

The prognosis is mainly determined by the underlying disease that led to the onset of SIBO.

Medical treatment

Antibiotics, prebiotics and probiotics are commonly used to treat SIBO. A combination of antibiotics can be used to achieve a response to the specific type of bacteria that caused the imbalance in the patient's gut flora.

Results of studies in recent years have shown that the antibiotic rifaximin reduces the incidence of SIBO to some extent in approximately 80% of patients.

The exact duration of antibiotic use is individual but short-term. Most physicians recommend administering rifaximin for 7-10 days, either as a single dose or cyclically.

During antibiotic treatment, a regular supply of probiotics and prebiotics is necessary to support the balance of the gut microbiome.

They have a number of beneficial effects such as strengthening the barrier function of the gut, inhibiting pathogens, modulating the inflammatory response and reducing visceral hypersensitivity.

Lifestyle modification

Lactose- and gluten-free diets, supplementation of necessary vitamins and minerals are common in the diet. Many patients report relief from digestive discomfort and abdominal pain after dieting.

Nutritional support is used in cases of significant weight loss and risk of malnutrition.

In particular, fermentable carbohydrates that are poorly absorbed in the small intestine are a risk. In the case of SIBO, overgrown bacteria start to break down these carbohydrates too early, specifically already in the small intestine.

This results in bloating, diarrhoea or abdominal pain. Eliminating the intake of these carbohydrates in the diet can alleviate some of the digestive symptoms of SIBO.

Currently, the so-called FODMAP diet has an important role to play. This word stands for "fermentable oligo-, di-, mono-saccharides and polyols".

F - Fermentable - foods that can be broken down by microorganisms such as bacteria or yeast

O - Oligosaccharides found in cereals or in substances contained in legumes

D - Disaccharides, e.g. lactose found in dairy products

M - Monosaccharides, e.g. fructose found in fruit and vegetables

P - Polyols - substances used as sweeteners in foods

Foods higher in FODMAPs that should be avoided in your diet:

• Garlic, onions
• Legumes (peas, beans, lentils...)
• Cereals (barley, rye)
• Honey, agave
• Dairy products containing lactose
• Apples, pears, figs
• Sweetened drinks
• Dried fruit

Appropriate foods during the SIBO diet:

• Leafy vegetables
• Peppers, tomatoes, carrots
• Meat and fish
• Quinoa
• Potatoes
• Eggs
• Tofu
• Gluten-free cereals (corn, rice...)
• Some fruits (grapes, strawberries, blueberries...)