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Small intestinal bacterial overgrowth (SIBO) occurs when excess colonic bacteria are in the small intestine. A functioning digestive system uses gastric acid, bile, motility, and other defenses to prevent the overgrowth of bacteria in the small intestine. However, if the digestive protectors are not working correctly, they can’t prevent bacterial growth.

Who Gets SIBO?

Little research exists to determine precisely how many people have SIBO. Of the few studies conducted, researchers found that 16.8% of participants with inactive Crohn’s disease also had SIBO. 

Another study found that of the participants with celiac disease, 16% had SIBO, and of those with irritable bowel syndrome (IBS), 67% had SIBO. Compared to other countries, Americans had the highest rates of SIBO. Canada has the lowest rates.

SIBO Connection to Lyme Disease

SIBO is the most common gastrointestinal disorder associated with Lyme disease. Reports estimate up to 70% of people with Lyme disease also have SIBO. Therefore, Lyme disease is an underlying cause of SIBO.

Lyme bacteria, Borrelia burgdorferi, create reactions that trigger SIBO. For example, it lives within cells in the intestinal lining. It is often found in nervous system tissue, areas that affect digestive motility, and affects the vagus nerve responsible for regulating digestive functions. Additional Lyme disease factors that lead to SIBO include:

  • Gastrointestinal inflammation
  • Antibiotic overuse
  • Coinfections that damage the digestive system
  • Immunodeficiency


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Who Should Be Tested for SIBO?

Anyone experiencing the following symptoms, which appear with Lyme disease and SIBO, should be tested:

  • Abdominal fullness
  • Abdominal pain or cramps
  • Bloating
  • Diarrhea or constipation
  • Joint pain
  • Indigestion or heartburn
  • Fatty stool
  • Unintentional weight loss
  • Gas and bloating
  • Fatigue 
  • Nausea
  • Skin rashes

A long list of functional and organic digestive diseases, liver diseases, abdominal surgeries, endocrine and metabolic diseases, nervous diseases, and rheumatic diseases are linked to SIBO. If you have one or more, getting tested for SIBO is recommended. For example, someone with a previous diagnosis of Crohn’s disease, diabetes, scleroderma, IBS, or another gastrointestinal condition may want to discuss SIBO testing with their doctor. Also, anyone who has had surgery on the small intestines, like bariatric surgery, should be tested.

What Is SIBO Testing?

Several methods are available for SIBO testing, including:

  • Breath tests

Breath tests are simple and noninvasive. They test for hydrogen or methane in your breath. Bacteria in the small intestine interact with sugar, producing hydrogen or methane chemicals that can be detected in breath. The bacteria that produce the chemicals are only supposed to be in your large intestine. If detected on your breath, they are in your small intestine.

Your doctor will have you consume a sugary drink. Then they will test your breath for hydrogen over a 90-minute timeframe, about the time it takes for the sugar to reach your small intestines.

Another breath test uses lactulose instead of glucose. Unfortunately, both versions are inaccurate much of the time. One reason is how quickly or slowly food moves through a person’s digestive system. It can take hours for someone with gastroparesis to digest food, while others may digest food much faster.

  • Jejunal aspirations or cultures

During an upper endoscopy, a doctor places a scope in your mouth and weaves it down through your throat and digestive tract. They can then take a sample that is cultured or tested for bacteria. While the jejunal aspiration test is safe, it does have limitations, like sampling the wrong type of bacteria or taking it from the wrong area. 

  • Antibiotic administration

The go-to medicine to treat SIBO is an antibiotic called Xifaxan. Doctors prescribe the antibiotic, and if symptoms disappear, it is assumed you have SIBO. Xifaxan differs from other antibiotics in that it is not absorbed into the bloodstream and instead works directly on bacteria found in the small intestine.

  • Small bowel aspirate

The small bowel aspirate test involves inserting a small tube into the nose and tracing it down to the stomach and small intestine. Once in the small intestine, the tube collects a small amount of fluid, which is later tested for bacteria. This procedure must be precise. Even then, the test may not accurately detect bacteria associated with SIBO because while there may be numerous bacteria throughout the small intestines, it can only test fluid from one area. 

  • Fecal tests

Performing stool tests can tell doctors if there is malabsorption of fat or if bacteria exist in the colon. They can also look for parasites and measure levels of yeast and inflammation. Fecal tests help doctors rule out conditions that may be causing symptoms. Still, because much of the information they gather focuses on the large intestine, they aren’t as accurate in diagnosing SIBO.

Treatment for SIBO

Antibiotics are the first line of treatment, and they may work temporarily to eliminate symptoms. However, your symptoms may return unless your doctor treats the underlying condition that triggers SIBO. 

Working with a specialist ensures the reason behind SIBO is discovered and treated properly. They also offer alternative treatment protocols for improved outcomes. Examples of SIBO protocols include the following:

  • Intravenous antibiotics, vitamins, and fluids
  • Herbal intestinal remedies
  • Removal of harmful bacteria in the digestive tract
  • Fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet
  • Probiotics to restore bacterial balance in the gut

Finding the Right Doctor

Specialists will treat the underlying cause of your SIBO symptoms to prevent recurrences. If your underlying cause is Lyme disease, your doctor may use therapeutic apheresis, hyperthermia, biofilm eradication, or immunomodulation treatments.

The right doctor for SIBO can complete all therapies in their clinic on an outpatient basis. They will have the most advanced equipment to perform the latest procedures safely and effectively as they do at Lyme Mexico Clinic.

Rather than focus on the location of the best doctor, investigate their credentials, research participation, membership in reputable international organizations, and connections with leading laboratories. Find out how they collaborate with other doctors to create a team to address your overall health.

Don’t be afraid to ask a lot of questions. You will find the most qualified doctors are happy to answer them. 

Consider traveling outside the United States, Canada, and the UK to Mexico to meet with a top clinic, Lyme Mexico. Learn more about Lyme disease or schedule an evaluation. We can discuss your symptoms and the alternative treatment options that work.


sibo testing - Lyme Mexico

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