What is SIBO and why is everybody talking about it?

A bloated belly after eating, digestive difficulties and abdominal pain are the three main symptoms that social media associates with SIBO. Searches for the disorder have skyrocketed on Google and the hashtag has over 600 million views on TikTok. Posts by social media influencers have contributed to this sudden interest that reached its climax in recent months.

A “viral” disorder

Bloating after eating accompanied by pain and discomfort should not be a regular part of our daily life. “In healthy people with balanced intakes, there is always an increase in gas production after meals, but it is not normal for there to be bloating”, says Javier Santos, head of the Digestive Physiology and Physiopathology research group at the Vall d’Hebron Research Institute (VHIR) in Barcelona.

If these situations only occur occasionally, the expert goes on, then there is no need to attach any importance to them. However, if the symptoms occur daily and affect quality of life, he continues, “a digestive specialist or primary care doctor should be consulted”.

The experts consulted by Verificat agree that the symptoms of SIBO are non-specific: they may be a sign of the disorder in question, or of many other functional digestive disorders such as irritable bowel syndrome or coeliac disease, among others.

Functional digestive disorders affect one in every four people, according to the Guide for Managing Functional Digestive Disorders in Primary Care. But not everything is SIBO. “The symptoms [of SIBO] are common in many people, […] and followers of these social media accounts end up identifying with the problem”, states Santos of the Vall d’Hebron (VHIR) in Barcelona.

What is SIBO?

Our intestine is colonised by billions of bacteria known as gut microbiota. These microorganisms are essential for performing a number of fundamental functions of the human body, including digestion. When there is an excessive proliferation of these bacteria, it can develop into various gastrointestinal problems, including SIBO.

Small intestinal bacterial overgrowth (i.e. SIBO) is a phenomenon caused by an abnormal increase in the bacterial population in the small intestine. What causes this imbalance? That is the million-dollar question. “SIBO is not a disease in itself, but a fairly common complication of other diseases (e.g. diabetes, irritable bowel syndrome, Crohn’s disease, some intolerances or coeliac disease), the result of poor eating habits or the inappropriate use of certain pharmaceutical products, such as antibiotics or omeprazole, which slow down bowel movements and encourage the undesirable growth of bacteria”, declares Santos.

“In order to treat SIBO we have to treat its underlying cause”, concludes Elizabeth Barba, specialist in gastroenterology at the Hospital Clinic in Barcelona.

False positives

The sheer diversity of causes and its non-specific symptoms make it near impossible to diagnose SIBO without a special test. Currently, the common test used is exhaled breath testing, which compares the amount of hydrogen and methane exhaled by the patient before and after drinking a solution of water with glucose or some other sugar.

The problem is that “these tests have as many false negatives as false positives” if they are not performed correctly, or when the patient takes antibiotics or laxatives, among other situations.

Both Santos and Barba point out that the diagnostic tool is useful when performed under the right conditions and the results are interpreted by a trained expert. And, even then, in many cases it is necessary to perform a subsequent confirmation via endoscopy and a lab culture. 

As a result, self-diagnosis is not recommended for identifying or treating SIBO given that its varied origins may involve different treatments: from changing one’s diet to the prescription of antibiotics.

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