Small intestine bacteria are different than those contained in the colon.
In SIBO you have a bacterial growth in the small intestine at least 10 to 15 times more than the norm and, at the same time, a modification of the strains of the bacterial population that tends to resemble that of the colon.
All conditions that interfere with the peristaltic movement of the small intestine from the top downwards prevent a perfect elimination of bacteria that can, thus, multiply in the lumen of the small intestine.
The pathological conditions favoring SIBO include:
1 Neurological / muscular diseases (ex.: scleroderma)
2 Diabetes Mellitus
3 Diverticula of the small intestine
4 Crohn’s disease or segmental Ileitis
5 Some intestinal surgery outcomes
6 Intestinal pseudo-obstruction or Ogilvie’s syndrome
7 Decrease of gastric acidity (spontaneous or induced proton pump inhibitors)
The presence of a high amount of bacteria in the small intestine causes a modification of the bile acids resulting in malabsorption of dietary fat. The bacteria also determine a direct damage on gastrointestinal tube cells with the role of absorption.
Diagnosis can be difficult due to the overlapping of symptoms with those of irritable bowel syndrome.
Currently, for its diagnosis a lactulose, glucose or xylose Breath Test is used to detect the amount of hydrogen exhaled due to early fermentation by the bacteria from the small intestine.
The drug that seems to be the most effective is Rifaximin: non-absorbable antibiotic with activity against gram-positive and gram-negative aerobic and anaerobic.
Normally a 7-10 day cycle is prescribed, with frequent, rapid, improvement in symptoms.
Recently treatments were compared that had been conducted for 7 days, with increasing daily doses of Rifaximin (600 mg, 800 mg, 1200 mg, 1600 mg). The success rates vary from a minimum of approx. 16% (for the lower dose) to maximum values of approx. 60% for the 1200 mg dose and up to a maximum that exceeds 80% (for the maximum dose of 1600 mg ).
The recurrence of symptoms after therapy is, however, frequent: for this reason one may resort to cyclical treatments and probiotics.These results indicate that at the neural level, parents’ preferences have a significant influence on the development of the children’s decision-making capacity, with effects that are felt in the long term.