SIBO Treatment

What is SIBO?

Treatment of SIBO Disease : SIBO, which stands for Small Intestinal Bacterial Overgrowth, is the overgrowth of bacteria in the small intestine.

How does SIBO Disease develop?

There are typically far fewer FLORA bacteria in our small intestine compared to our large intestine. SIBO can develop for many reasons, including: Frequent use of antibiotics, prolonged use of antibiotics, chemotherapy, radiotherapy, prolonged cessation of oral feeding (intensive care period, etc.), nutritional deficiency, malnutrition, renal failure, diabetes, excessive use of drugs that reduce stomach acid, cirrhosis, pancreatitis, excessive alcohol consumption, immunosuppressive therapy, chronic diarrhea, heavy metal poisoning, pesticides (agrochemicals), digestive system surgeries, severe systemic infections, etc. The development of SIBO and the disruption of the intestinal FLORA balance is usually followed by the development of Leaky Gut Syndrome and other autoimmune diseases.

WHAT IS FLORA?

Certain parts of the human body are inhabited by microorganisms which peacefully live with us, do not harm us, contribute to the vital functions of the region in which they live, cause health problems when not present, whose functions cannot be compensated in any other way, which constantly renew themselves, whose diversity increases under favorable living conditions, and whose number and biodiversity decrease in some unfavorable conditions. Their generic name is FLORA.

What is at stake is the flora of the digestive tract. The digestive system refers to the tract from the mouth to the anus. The digestive system is home to members of the flora throughout the mouth, throat, larynx, esophagus, stomach, small and large intestine, with unique functions at each site. Those are specific to the site they occupy and cannot inhabit or live in other sites.

The number of flora bacteria identified in the human digestive tract to date is 1054. Flora diversity is among the most important factors affecting quality of life.

HOW MANY TYPES OF FLORA BACTERIA DO HUMANS HARBOR IN THE ENTIRE DIGESTIVE SYSTEM?

The most important factor in this is the environmental conditions.  Whereas the diversity of flora in those living in large metropolitan areas is as low as 50-60, this figure tends to increase in rural areas. In Turkey, people on average have a flora diversity of around 100 to 110 species throughout the entire digestive tract.

A high level of biodiversity of the digestive tract flora is directly proportional to a healthy, high quality and long life. Our flora members have diverse functions and are therefore indispensable for our health.

WHAT IS THE FUNCTION OF FLORA? WHY DOES IT MATTER TO US?

Each part of our body has its own flora, which are the most crucial structures that fight against pathogens coming from outside. In cases where the flora of a given site is reduced, destroyed or extinct, the site gets invaded by pathogenic microorganisms. The flora of the digestive tract is of critical importance in the formation of a gel-like secretion called mucus, which coats the entire lining of the digestive tract, in the site they inhabit. In the absence of mucus, what we eat and drink as well as all the secretions of the digestive system come into direct contact with the surface of the digestive system (mucosa) and cause erosion in the parts they come into contact with. The flora is indispensable for the acid-base balance, enzymatic function, synthesis function and digestive activities of the site they inhabit. Without flora, these functions get impaired. Any disruption of the flora in any given site not only disrupts the function of that site, but also causes disruptions in the functions ahead and behind it.

IS THE FLORA OF EVERY HUMAN BEING THE SAME?

No. Each human being’s flora is influenced by numerous factors. Like a fingerprint, each person has their own flora.

The process of acquiring flora starts from the moment we are born and lasts a lifetime. The diversity of flora may increase or decrease due to various factors such as infancy, childhood, adolescence, fertility, pregnancy, breastfeeding, stresses, treatments, diseases, nutrition, etc. Yet, in all people, the period between the ages of 20 and 30 is when the flora is at its highest quality and diversity. The biodiversity of flora decreases with aging and predisposes to many diseases.

WHAT HAPPENS WITHOUT FLORA?

It is impossible to live without flora.

WHAT IS THE SELECTIVE PERMEABILITY OF THE INTESTINES?

Our small intestine is about 8 meters long. As our intestines have a curved structure (villi) inside, they have a very large absorption surface area. The average internal absorption surface area of our intestines is 16,000-18,000 m2 on average. This area is as big as a large football stadium. The villi also incorporate microvillus structures with a curved absorption surface to increase the surface area. Microvilli are lined with a single row of endothelial cells. These cells are tightly interlocked. Those tight junctions are called “Tight Junctions (zonula occludens)”. The protein “ZONULIN” plays an essential role in establishing and maintaining a tight junction. The digested nutrients are absorbed by these cells and then pass into the bloodstream. Our intestines are selectively permeable. This particular feature of our intestines prevents harmful substances, microbes, incompletely digested macromolecules from passing through the intestines into the bloodstream. The surface of this intestinal absorption layer, which is covered with mucosa, is covered with a gelatinous secretion called “MUCUS”, which is produced by the endothelium forming the mucosa. This mucus prevents direct contact of intestinal contents (food, digestive secretions) with the mucosa. This protects the intestinal absorption surface from external factors. The flora of the region is a must for the formation of MUCUS. In the absence of mucus, the endothelium of the mucosa is damaged and as a result, the selective permeability of the intestine is impaired, resulting in the condition called “LEAKY GUT SYNDROME”. As a consequence of leaky gut syndrome, our defense system is alarmed by the passage of substances that should not pass through the intestines into the bloodstream and tries to destroy them. And this starts the allergic process. While attempting to destroy the pathogens that pass into the bloodstream, our defense system gets out of control after a while and begins to perceive its own tissues as foreign (harmful) and attacks its own tissues as well. This is what is called AUTOIMMUNITY and the resulting diseases are called AUTOIMMUN DISEASES (Arthritis, Vasculitis, Gout, Psoriasis, Eczema, Vitiligo, Hashimoto’s Disease, etc.).

WHAT IS LEAKY GUT SYNDROME?

Leaky Gut Syndrome is a condition that occurs with the loss of the selective permeability of the intestine due to the disruption of mucus production after flora damage and the consequent damage to the mucosa.

WHAT HAPPENS WHEN YOU DEVELOP SIBO?

When you develop SIBO, your small intestine produces more flora and pathogenic bacteria than it should normally have. Consequently, the function of the intestines is impaired. You may experience digestive and absorption disorders. As most of the food you eat is consumed by increased bacterial colonization, you suffer from malnutrition and disorders associated with deficiencies of all nutrients. Those with SIBO usually have limited DIVERSITY OF FLORA BACTERIA. The more diverse the flora bacteria, the less likely you are to develop SIBO.

WHAT ARE THE SYMPTOMS OF SIBO?

If you suffer from the following symptoms, you should suspect SIBO. Abdominal pain, constipation, diarrhea, intestinal discomfort, abdominal bloating, indigestion, chronic fatigue, depression, itching, food allergies, weight loss, food intolerances (milk, gluten, etc.) and autoimmune diseases caused by the disease are suggestive of SIBO disease.

HOW IS SIBO DIAGNOSED?

The disease is most easily diagnosed with the SIBO breath test. The test involves the administration of glucose and lactulose and the measurement of methane and hydrogen from breath. Although the testing procedure is easy, it can produce false-negative and false-positive results.

Another and the most reliable test is the endoscopic examination of the contents of the small intestine.

Another test involves microbial analysis of the feces. It is a reliable indirect test, although not as reliable as intestinal sampling.

WHY IS SIBO IMPORTANT?

SIBO is important because of the diseases it triggers.

HOW IS SIBO TREATED?

The disease is mostly treated with long-term (2-4 weeks) multiple antibiotic use. The aim of treatment is to reduce bacterial colonization. Treatment is often followed by relief in patients. However, since the entire digestive system flora will also be disturbed by the treatment, serious flora damage symptoms are observed. The other most common complication is treatment-related diarrhea. Sometimes, the resulting diarrhea may become chronic. The antibiotic treatment is supplemented with the use of probiotics.

As a treatment, our clinic recommends FLORA TRANSPLANTATION. Because having a healthy, diverse and rich flora prevents the development of SIBO and pathogen invasion in our digestive system. Transplanting a healthy flora also eliminates the need for probiotics or prebiotics.

WHAT IS A FLORA TRANSPLANT?

Flora transplantation is the process consisting of collecting flora samples from at least one healthy FLORA DONOR under general anesthesia through endoscopy and colonoscopy from approximately 30 different anatomical regions of the digestive system, with each region being washed with serums suitable for its own characteristics and aspirated back, subjecting these samples to some series of specific procedures, and then transplanting them endoscopically and colonoscopically to the equivalent anatomical regions of the patient under general anesthesia.

Please contact us for further information about endoscopic treatments for obesity and flora transplantation.