Q: I was experiencing pain in my stomach area. I burped a lot and had increased and looser bowel movements. At first I was given Prilosec, but had very little improvement. I was then scheduled for colonoscopy so they did an upper GI. I had some inflammation in my stomach, so they gave me dexilant. No improvement. The next thing they ordered was a SIBO test. I tested positive for bacteria in my small intestine. I next took Xifaxan for two weeks and am now on Align. I don’t understand how I got this and exactly what it is. Could you please explain it and yes, I am much better.
A: A small intestinal bacterial overgrowth (SIBO) is a condition in which an unusually large number of bacteria (often defined as at 100,000 bacteria per ml of fluid) are present in the small intestine. Some conditions associated with SIBO include Crohn’s disease, diabetes and scleroderma. The small bowel, a/k/a the small intestine, is the portion of the GI tract that connects the stomach with the colon. The small intestine is approximately 21 feet long beginning in the duodenum, followed by the jejunum and on to the ileum. The complete gastrointestinal tract including the small intestine contains bacteria. The types of bacteria found in the small intestine are different than those found within the large intestine (the colon).
The activity of the muscles of the stomach and small intestine propel food from the stomach through the small intestine and on to the colon. Even when there is no food in the small intestine, a muscular type of activity sweeping through the small intestine and colon is important for the digestion of food but more so because it propels bacteria from the small intestine and limits the numbers that collect. When anything interferes with this progression, SIBO can result.
As mentioned above, conditions that are associated with SIBO include diabetes and scleroderma. Diabetes damages those nerves that control the intestinal muscles, while scleroderma damages the intestinal muscles directly. Partial obstruction of the small intestine may interfere with the transport of food and bacteria through the small intestine. Causes for this to occur and cause SIBO include adhesions and Crohn’s disease.
Symptoms of small intestinal bacteria overgrowth may include abdominal pain, bloating, distension, diarrhea and gas. A small number of patients with the condition may have constipation rather than diarrhea. A severe overgrowth may interfere with food digestion and cause vitamin and mineral deficiencies, along with weight loss, fatigue and body aches and pains. Symptoms may fluctuate for months, years or in some instances decades before a diagnosis is made.
Diagnosis may be made through taking a sample of fluid from the small intestine. The culturing process must be quantitative, implying the actual number of bacteria must be determined. A culture requires that a flexible tube be passed through the nose, throat, esophagus and stomach. Issues with the process are the expense and the uncomfortable process endured, not to mention the skill that is not commonly available. Then, too, the accuracy of the culture is questionable. Following the culture is a breath test that may be preferred and can be measured in a person’s breath with special analyzers. A patient must fast for 12 hours, fill a small balloon with a single breath of air and then ingests a small amount of lactulose or glucose. Breath samples are then analyzed for hydrogen and methane every 15 minutes for the three or four hours that follow. Limitations for this testing is that there is no gold standard for diagnosing SIBO since any condition that impairs the absorption or digestion of sugars and carbs in the small intestine can produce an abnormal hydrogen breath test when glucose or other dietary sugars are used for testing. Then, too, a positive hydrogen breath test does not always imply a person’s symptoms are caused by SIBO. That’s when such conditions as Crohn’s or a stricture may cause the symptoms presented.
The Align you are taking is a probiotic supplement that helps build and support a healthy digestive system, while maintaining a natural digestive balance. I cannot determine if the medication brought things under control by introducing healthy bacteria in your body or not. Nor can I determine if you might have diabetes, Crohn’s disease (inflammation of the lining of the digestive tract) or scleroderma (a hardening and tightening of the skin and connective tissues, or another disease that might have lead to the overgrowth of bacteria in your jejunum).