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Small intestinal bacterial overgrowth
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== Treatment == Treatment generally involves some combination of antibiotics, dietary changes, pro-kinetic agents, and probiotics.{{Citation needed| date = August 2022}} Treatment via antibiotics is most common. {{citation needed}}. === Antibiotics === Any antibiotic that is active in the small intestine may potentially affect the bacterial flora and therefore SIBO. However, certain antibiotics are used preferentially when treatment is explicitly targeting SIBO. These antibiotics may be synthetic or herbal, though synthetic antibiotics appears to be used most often.{{Citation needed| date = Aug 2022}} Treatment with antibiotics carries the risk of wiping out both abnormal and normal bacteria, which may cause problems similar to those that are trying to be cured, such as diarrhea.<ref>{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/small-intestinal-bacterial-overgrowth/diagnosis-treatment/drc-20370172 | title = Small intestinal bacterial overgrowth (SIBO) - Diagnosis and treatment|website=Mayo Clinic|language=en|access-date=2022-08-03}}</ref> ==== Synthetic ==== * [[Rifxaimin]] is the most commonly used antibiotic used for SIBO treatment. It is effective on hydrogen producing bacteria, but not methane producing bacteria. Only a small percentage of the drug is absorbed by the body, and its activity is mostly limited to the small intestine. <ref name="Bures2010">{{Cite journal | last1 = Bures | first1 = Jan | last2 = Cyrany | first2 = Jiri | last3 = Kohoutova | first3 = Darina | last4 = Förstl | first4 = Miroslav | last5 = Rejchrt | first5 = Stanislav | last6 = Kvetina | first6 = Jaroslav | last7 = Vorisek | first7 = Viktor | last8 = Kopacova | first8 = Marcela | title = Small intestinal bacterial overgrowth syndrome | journal = World Journal of Gastroenterology : WJG | volume = 16 | issue = 24| pages = 2978–2990 | date = Jun 28, 2010 | pmid = 20572300 | doi = 10.3748/wjg.v16.i24.2978 | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2890937/ }}</ref> * [[Neomycin]] is sometimes given in addition to Rifaximin when methane-producing bacteria are present.<ref>{{Cite journal | last = Low | first = Kimberly | last2 = Hwang | first2 = Laura | last3 = Hua | first3 = Johnson | last4 = Zhu | first4 = Amy | last5 = Morales | first5 = Walter | last6 = Pimentel | first6 = Mark | date = Sep 2010 | title = A combination of rifaximin and neomycin is most effective in treating irritable bowel syndrome patients with methane on lactulose breath test|url=https://www.ncbi.nlm.nih.gov/pubmed/19996983|journal=Journal of Clinical Gastroenterology|volume=44|issue=8|pages=547–550|doi=10.1097/MCG.0b013e3181c64c90|issn=1539-2031|pmid=19996983}}</ref> However, one study comparing two herbal formulations to standard treatment found herbs to be as or more effect as antibiotics for eradicating SIBO.<ref name="Chedid2014">{{Cite journal | last1 = Chedid | first1 = Victor | last2 = Dhalla | first2 = Sameer | last3 = Clarke | first3 = John O | last4 = Roland | first4 = Bani Chander | last5 = Dunbar | first5 = Kerry B | last6 = Koh | first6 = Joyce | last7 = Justino | first7 = Edmundo | last8 = Tomakin | first8 = Eric | last9 = Mullin | first9 = Gerard E | title = Herbal Therapy Is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth | journal = Global Advances in Health and Medicine | volume = 3 | issue = 3| pages = 16–24 | date = May 2014 | pmid = 24891990 | doi = 10.7453/gahmj.2014.019 | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4030608/ }}</ref> * [[Metronidazole]] ==== Herbal ==== * [[Oregano]] * [[Allicin]] === Diet === Diets have been used and/or shown to be helpful in treating or controlling SIBO include: * [[GAPS diet|GAPS Diet]] * [[Low FODMAP diet|Low FODMAP Diet]] * [[Specific carbohydrate diet|Specific Carbohydrate Diet]] * [[Elemental diet|Elemental Diet]] === Pro-kinetic Agents === Experts also recommend the use of [[prokinetic drugs]] or herbs for those for whom dysmotility is an issue.<ref name="Dukowicz2007" /> These agents include: * [[Low dose naltrexone|Low Dose Naltrexone]] (LDN) === Probiotics === The role of probiotics in treatment is controversial. One school of thought is that SIBO is not due to a "bad" bacteria, but rather a simple overgrowth of ordinary / healthy bacteria. Therefore, it would follow that probiotics would be counterproductive to treating and managing SIBO. Another school of thought is that SIBO is caused or worsened by the presence of a "bad" bacteria, or a bad mix of bacteria. Therefore, it would follow that probiotics that increase the level of "good" bacteria, or promote a healthier mix of bacteria, would be helpful in treating or managing SIBO. [[Lactobacillus casei]] has been found to improve breath hydrogen scores after six weeks of treatment.<ref name="Barrett2008">{{Cite journal | last1 = Barrett | first1 = Jacqueline S | last2 = Canale | first2 = Kim EK | last3 = Gearry | first3 = Richard B | last4 = Irving | first4 = Peter M | last5 = Gibson | first5 = Peter R | title = Probiotic effects on intestinal fermentation patterns in patients with irritable bowel syndrome | journal = World Journal of Gastroenterology : WJG | volume = 14 | issue = 32| pages = 5020–5024 | date = Aug 28, 2008 | pmid = 18763284 | doi = 10.3748/wjg.14.5020 | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2742929/ }}</ref> There is also evidence for [[VSL #3]] in the treatment of SIBO.<ref name="Meier2003">{{Cite journal | last1 = Meier | first1 = Rémy | last2 = Burri | first2 = Emanuel | last3 = Steuerwald | first3 = Michael | title = The role of nutrition in diarrhoea syndromes | journal = Current Opinion in Clinical Nutrition and Metabolic Care | volume = 6 | issue = 5| pages = 563–567 | date = Sep 2003 | pmid = 12913674 | doi = 10.1097/01.mco.0000087972.83880.d3 | url = http://www.ncbi.nlm.nih.gov/pubmed/12913674 }} </ref> However, some probiotics may exacerbate SIBO, in particular those containing [[D-Lactate]] producing strains. === Increasing Stomach Acid === In cases where SIBO is caused by low stomach acid, treatment may include dietary supplements that increase stomach acid, such as [[Betaine|Betaine Hydrochloride]].{{Citation needed | date = Jul 2022}}
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