The small intestine is responsible for breaking down and absorbing food. Small intestinal bacterial overgrowth (SIBO) results in premature bacterial decomposition of food by bacteria and archaea, which leads to gas formation and abnormal, sometimes toxic, degradation products in the upper digestive tract.
Normally, only very few bacteria are present in the stomach and small intestine. Although millions of bacteria are brought into the stomach with every swallow from the mouth, stomach acid, bile acids, digestive enzymes and the intestinal motility movements in the upper gastrointestinal tract prevent these bacteria from surviving and colonizing . The clinical picture is not new. About a hundred years ago, bacterial overgrowth was detected in patients following abdominal surgery. Those affected complain of nausea, abdominal bloating, possibly combined with abdominal pain and changes in stool consistency. Extraintestinal symptoms include drowsiness (brain fog), muscle twitching (including eye twitching), dizziness and non-alcoholic fatty liver disease. The disease can also begin with a severe intestinal infection. The rapid increase in the incidence of the disease, especially in young patients without previous surgery, alerts that it may also be an infection with multi-resistant bacteria.
The diagnosis is made using the SIBO breath test. In collaboration with his research laboratory at the Medical University of Vienna, Prof. Gasche and Dr. Evstatiev are investigating the possibility of visualizing SIBO using transabdominal bowel sonography, capsule endoscopy and structural electron microscopy. Similar to irritable bowel syndrome, patients with SIBO often develop biofilm formation, which makes these bacteria resistant to antibiotic therapy. Modern therapeutic approaches have since been directed against these severe microbiological changes in the intestinal microbiome and include endoscopic cleansing procedures (bioflush) and fecal microbiota transfer (FMT). Further antibiotic therapy is usually not recommended.
