Title: Navigating the Microbial Maze: Small Intestinal Bacterial Overgrowth (SIBO) Unveiled Description: Delve into the intricate world of Small Intestinal Bacterial Overgrowth (SIBO) with this comprehensive PowerPoint presentation. From understanding the root causes to exploring symptoms, diagnosis, and treatment options, this presentation provides a thorough examination of SIBO's impact on gut health. Uncover the latest research on SIBO, delve into effective diagnostic methods, and gain insights into potential complications and prognosis. Learn how lifestyle changes, dietary modifications, and innovative treatments play pivotal roles in managing and preventing SIBO. Featuring real-life stories from individuals grappling with SIBO, this presentation bridges the gap between scientific knowledge and patient experiences. Whether you're a healthcare professional, researcher, or someone interested in gastrointestinal health, this PowerPoint serves as a valuable resource for unraveling the complexities of Small Intestinal Bacterial Overgrowth. Equip yourself with the knowledge needed to navigate the microbial maze within the small intestine and empower individuals to take control of their gut health.

1. Small Intestine Bacterial
Overgrowth (SIBO)
Rahul Valath 33Bi

2. Introduction
• SIBO is defined as the presence of excessive numbers of bacteria in
the small bowel causing gastrointestinal (GI) symptoms. These
bacteria are usually coliforms, which are typically found in the colon
and include predominantly Gram-negative aerobic and anaerobic
species that ferment carbohydrates producing gas.
• In contrast to the large intestine, the concentration of the bacteria in
the small intestine rarely exceeds 1000 organisms/mL. Gastric acid
secretion and intestinal motility limit the overgrowth of bacteria in
the small intestine
• When these protective mechanisms against excessive bacterial
growth fail, small intestinal bacterial overgrowth (SIBO) can manifest

3. Condt.
• The proximal small intestine typically contains relatively few bacteria due to the
presence of stomach acid and the effects of peristalsis
• Lactobacilli, enterococci, facultative anaerobes, and gram-positive anaerobes are
predominantly organisms in the small intestine.
• The concentration of organisms rarely exceeds ten organisms/mL in the jejunum.
Bacteroids, Lactobacillus, Clostridium, and bifidobacteria, the predominant
organisms in the colon, are seldom seen in the proximal small intestine
• The terminal ileum microbiome is intermediate between the proximal small
intestine (aerobic flora) and colon (densely anaerobic); in the absence of an
ileocecal valve terminal ileum, the microbiome is similar to the colon with ten
organisms/ml.
• When the protective mechanisms (peristalsis, stomach acid) against excessive
bacterial growth fail, small intestinal bacterial overgrowth (SIBO) can manifest

4. Factors that prevent the development of SIBO in healthy Individual

5. Etiology
• The etiology of small intestinal bacterial overgrowth is complex. It can
be from motility, anatomic, immune, gastric hypochlorhydria, and
metabolic and other systemic disorders
• Important host defense mechanisms against bacterial overgrowth in
the small intestine are gastric acid and bile, peristalsis, proteolytic
digestive enzymes, intact ileocecal valve, and secretory IgA. When
these protective barriers fail, SIBO occurs.
• Gastric acids and bile destroy and prevent bacteria from passing
through the intestines after ingesting food. So, SIBO is associated with
achlorhydria.

6. • Also, proteolytic enzymes digest and degrade bacteria in the intestines. So,
chronic pancreatic insufficiency is associated with SIBO.
• SIBO is associated with disorders of abnormal gastrointestinal motility, such
as irritable bowel syndrome, narcotic use, post-radiation enteropathy,
hypothyroidism, diabetes mellitus, and scleroderma.
• Anatomic abnormalities lead to stasis of the bowels, which may predispose
them to SIBO. Such anatomic disorders may include small intestinal
diverticulosis, bowel strictures, post-operative adhesions, gastric bypasses
with blind intestinal loops, and ileocecal resection
• Immunodeficiency disorders, such as acquired immune deficiency
syndrome, combined variable immunodeficiency, and IgA deficiency, are
associated with an increased risk of SIBO.

7. Epidemiology
• The actual prevalence of small intestinal bacterial overgrowth is vastly
unknown. Irritable bowel syndrome, intestinal motility disorders, and
chronic pancreatitis are the most predominant cause of SIBO and
account for 80-90% of cases.
• SIBO is more prevalent in the female population and elderly
individuals.
• The incidence of SIBO increases with age, secondary to
hypochlorhydria and intestinal dysmotility. In many cases, more than
one cause for SIBO can be identified

10. Pathophysiology
• The most common species in SIBO include streptococci, Bacteroides,
Escherichia, Lactobacillus, Klebsiella, and Aeromonas.
• The excess bacteria consume nutrients, including carbohydrates and
vitamin B12, leading to caloric deprivation and vitamin B12 deficiency.
However, because the bacteria produce folate, this deficiency is rare.
The bacteria deconjugate bile salts, causing failure of micelle
formation and subsequent fat malabsorption. Severe bacterial
overgrowth also damages the intestinal mucosa.
• Fat malabsorption and mucosal damage can cause diarrhea.

11. Pathophysiology

15. Symptoms
• The most common symptom of SIBO is bloating.
• Evidence suggests that abdominal pain, bloating, gas, distension,
flatulence, and diarrhea are the most common symptoms described
in patients with SIBO and prevalent in more than two-thirds of
patients.
• In severe cases, nutritional deficiencies including vitamin B12, vitamin
D, and iron deficiencies can occur

16. Diagnosis

17. Treatment

18. Dietary Modification
• Low FODMAP Foods ( A low FODMAP diet restricts certain
carbohydrates, but this isn’t the typical low-carb diet. It only
eliminates high FODMAP foods and can be individualized, so you only
restrict those that trigger your symptoms)
• Reduction in fermantable products
• Low fibre food
• Avoiding Alcohol Sugars
• Avoiding Probiotics likes Inulin.