How To Treat SIBO

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There are several targets in SIBO treatment: reducing symptoms, eliminating the bacterial overgrowth itself, prevention of relapse and addressing the underlying cause. A minority of cases are easy to treat and resolve with one round of antibacterials. However, the majority of cases need several rounds of antibacterials to achieve resolution and are likely to relapse, necessitating preventative treatments to extend remission. Overall, SIBO antibacterial treatments are highly successful (up to 91-100%) at reducing symptoms, eradicating overgrowth [1] [2] [3] and improving quality of life. Probiotics may also be added as an adjunctive treatment. While SIBO can be tricky to treat, following the right steps and using a methodical approach, greatly increases success. 

What to Know Before Starting SIBO Treatment

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• SIBO test results guide treatment choice - treatment is based on gas type and severity.
• Antibacterial options for SIBO include: pharmaceutical antibiotics, herbal antibiotics and elemental diet. 
  - A standard treatment round of antibiotics and elemental diet is 2 weeks; herbal antibiotics is 4 weeks.
  - Rotating between these three treatment types is common practice and can boost effectiveness.
• More than one antibacterial treatment round is usually needed (2-5 rounds are common).
  - Bacterial and gas levels decrease over time with multiple treatment rounds.
  - Symptoms may not improve with the first treatment round (especially if gas is high).
  - Extending one treatment for long time to avoid multiple treatment rounds, often proves ineffective (effect wanes over time).
• Diet alone isn't enough to eliminate SIBO - antibacterials are needed. However, diet can greatly reduce or even eliminate symptoms.
  
• 1/3 of SIBO cases resolve completely after treatment, however 2/3 of cases will have ongoing relapses (chronic SIBO).[4]
  - SIBO is likely to relapse if the underlying cause is still present.[5]
  - Thus prevention of relapse (which includes a prokinetic), is an essential part of SIBO treatment.
  
• 100% symptomatic relief from antibacterials is not expected in the 2/3 who are chronic: 80-90% symptom relief is the goal after several rounds. However, diet and symptomatic relief treatments can boost it to 100%.
  

How To Treat SIBO: Step-by-Step

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SIBO is suspected based on digestive symptoms, signs and history.

1st and 2nd Line Treatments
Typically before SIBO is diagnosed by testing, digestive supplements and dietary changes are tried to see if they can help.

SIBO Testing
If above treatments fail, test for SIBO to find out if it's the problem.

SIBO Treatment
Once SIBO is diagnosed, choose an antibacterial treatment based on gas type (hydrogen, methane, hydrogen sulfide or mixed gases):

• Pharmaceutical Antibiotics
• Herbal Antibiotics
• Elemental Diet

​​SIBO Diet
A SIBO diet can be used at any point to help symptoms and later, to help prevent relapse.

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Free Handout

Download: step-by-step guide how to treat SIBO / IMO / ISO successfully.

Prokinetic
A prokinetic helps prevent backsliding between antibacterial treatment rounds, and once SIBO is eradicated, it helps prevent relapse.

Assess Antibacterial SIBO Treatment Results

• If symptoms are 90% better, focus on prevention of relapse.
  
• If symptoms are less than 90% better, retesting is recommended to see if SIBO is still present and more treatment rounds are needed. 
  - A common mistake is assuming SIBO is still present if symptoms are still present. Retest SIBO to be sure symptoms are not from something else (see differential diagnosis chart).
  

Find the Underlying Cause
If SIBO relapses, a) retreat the relapse with antibacterials, and b) investigate the underlying cause, because identifying and removing the underlying cause, when possible, can stop SIBO recurrence.

Video: Dr. Siebecker Explains the SIBO Algorithm

Clip of Dr. Siebecker explaining her SIBO Treatment Algorithm from a free training.
Sign up to receive ​notification of Dr. Siebecker's live events here.

SIBO Treatment Mistakes

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• Not testing to find which gases are positive and at what level.
• Thinking SIBO will respond like a typical infection and be cleared after one 2-week course of antibiotics in all cases (i.e. stopping treatment or thinking it's a tough case, if one round of treatment doesn't eliminate symptoms, or result in a negative test).
• Not retesting after treatment, if symptoms are still present. 
• Not matching antibiotic or herbal antibiotic treatment to gas type(s) (i.e. not using double antibacterial therapy for methane).
• Waiting too long between antibacterial treatment rounds (i.e. 1 month or more).
• Not using a prokinetic between treatment rounds and after SIBO is eradicated to help prevent relapse.
• Giving up when SIBO is still positive.
• Not using a methodical approach (test > treat > retest, and continue treatment rounds and retests, till 90% better or negative test).

For the most thorough discussion on SIBO treatment, please see SIBO Courses, and join Dr. Siebecker's mailing list to be notified of events & classes.

   Learn more

SYMPTOMS SYMPTOM RELIEF ANTIBIOTICS HERBAL ANTIBIOTICS ELEMENTAL DIET SIBO DIET PREVENTING RELAPSE COURSES

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