Small Intestinal Bacterial Overgrowth (SIBO)
Understanding SIBO through community experiences and medical research.
Community experiences, not medical advice
Understanding SIBO through community experiences and medical research.
Small Intestinal Bacterial Overgrowth (SIBO) occurs when there is an abnormal increase in the overall bacterial population in the small intestine, particularly types of bacteria not commonly found in that part of the digestive tract. This overgrowth can interfere with normal digestion and absorption of nutrients.
Based on experiences shared in our community:
Gatta and Scarpignato (2017) pooled 32 studies. The intention-to-treat eradication rate was 70.8% (95% CI 61.4–78.2), with high heterogeneity (I² = 89.4%). The authors judged the available studies generally poor quality and called for well-designed RCTs.
The ACG 2020 SIBO guideline (Pimentel and colleagues) cites that same pooled intention-to-treat figure of about 71%. The studies behind it are mixed in quality. A pooled rate is not a promise that antibiotics will work for you.
View Gatta on PubMed View ACG 2020 on PubMedChedid and colleagues reported a retrospective comparison, not a randomised trial: 17 of 37 people on herbal therapy had a negative follow-up breath test versus 23 of 67 on rifaximin (p=0.24). That difference was not statistically significant and does not establish herbal antimicrobials as a viable alternative.
View on PubMedLauritano and colleagues (2008) followed people whose glucose breath test had normalised after rifaximin. Recurrence of a positive breath test was 12.6% at 3 months, 27.5% at 6 months, and 43.7% at 9 months. Those figures describe recurrence over time after treatment. They are not a comparison of prokinetics (27% versus 44%).
View on PubMedThe AGA 2020 SIBO update (Quigley, Murray and Pimentel) says the definition of SIBO is imprecise. Typical symptoms are bloating, diarrhoea and abdominal discomfort. If SIBO is suspected, look for an underlying cause, correct nutrient problems, and use antibiotics when needed. Evidence for which antibiotic strategy to use is limited.
View on PubMedSIBO care is individual. Pooled antibiotic rates are not a promise that treatment will work for you.
Patient-focused education and resources for understanding and managing SIBO, including diet information and practitioner directories.
Visit ResourceEvidence-based information on low-FODMAP diet implementation, which can help manage SIBO symptoms by reducing fermentable carbohydrates.
Visit ResourceReal stories shared by our community members about managing Small Intestinal Bacterial Overgrowth.
"After two rounds of Rifaximin with limited success, I tried a combination of herbal antimicrobials (oregano oil, berberine, and neem) for 6 weeks. This approach, along with a modified low-FODMAP diet, finally gave me significant relief. I now maintain with a prokinetic (low-dose erythromycin) and careful attention to my meal spacing and timing. Intermittent fasting has also helped prevent recurrences."
"The elemental diet was challenging but effective for me. I did a 2-week course and saw my symptoms improve dramatically. After treatment, I focused on addressing the root causes of my SIBO—which turned out to be low stomach acid and slow motility. Taking betaine HCl with meals and using ginger tea and Iberogast have helped maintain my recovery. I also found that stress management through daily meditation was crucial."
"My methane-dominant SIBO was particularly stubborn. What finally worked was a combination of Rifaximin and Neomycin, followed by a careful reintroduction diet. I've found that regular use of partially hydrolyzed guar gum (PHGG) as a prebiotic helps maintain my gut health. I also do abdominal massage daily and use a squatty potty to support healthy bowel movements. Avoiding processed foods has been essential for me."