Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
What is small intestinal bacterial overgrowth (SIBO)?
The small bowel, also known as the small intestine, is the
section of the
gastrointestinal tract
that connects the stomach with the colon. The main purpose of the small
intestine is to digest and absorb food into the body. The small intestine is
approximately 21 feet in length and begins in the duodenum (into
which food from the stomach empties), followed by the jejunum, and then the
ileum (which empties the food that has not been digested into the large
intestine or colon).
The entire gastrointestinal tract, including the small
intestine, normally contains bacteria. The number of bacteria is greatest in the
colon (at least 1,000,000,000 bacteria per milliliter (ml) of fluid) and much
lower in the small intestine (less than 10,000 bacteria per ml of fluid). Moreover,
the types of bacteria within the small intestine are different than the types of
bacteria within the colon. Small intestinal bacterial overgrowth (SIBO) refers
to a condition in
which abnormally large numbers of bacteria (at least 100,000 bacteria per ml of
fluid) are present in the small intestine and the types of bacteria in the small
intestine resemble more the bacteria of the colon than the small intestine.
Small intestinal bacterial overgrowth (SIBO) is also known as small bowel
bacterial overgrowth (SBBO).
The gastrointestinal tract is a continuous muscular tube
through which
digesting food is transported on its way to the colon. The coordinated activity
of the muscles of the stomach and small intestine propels the food from the stomach,
through the small intestine, and into the colon. Even when there is no food in the
small intestine, muscular activity sweeps through the small intestine from the stomach
to the colon.
The muscular activity that sweeps through the small intestine is important for
the digestion of food, but it also is important because it sweeps bacteria out
of the small intestine and thereby limits the numbers of bacteria in the small
intestine. Anything that interferes with the progression of normal muscular activity
through the small intestine can result in SIBO. Simply stated, any condition
that interferes with muscular activity in the small intestine allows the bacteria to
stay longer and multiply in the small intestine. The lack of muscular activity also
may allow bacteria to spread backwards from the colon and into the small
intestine.
Many conditions are associated with SIBO. A few are common.
Neurologic and muscular diseases can alter the normal activity of the intestinal muscles. Diabetes
mellitus damages the nerves that control the intestinal muscles.
Scleroderma
damages the intestinal muscles directly. In both cases, abnormal muscular
activity in the small intestine allows SIBO to develop.
Partial or intermittent obstruction of the small intestine interferes with the transport of food and
bacteria through the small intestine and can result in SIBO. Causes of obstruction
leading to SIBO include adhesions (scarring) from previous surgery and
Crohn's
disease.
Diverticuli (out-pouchings) of the small intestine that allow
bacteria to multiply inside diverticuli.
Small Intestinal Bacterial Overgrowth - Symptoms ExperiencedQuestion: Please describe the symptoms, and treatment of your small intestinal bacterial overgrowth.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Gas or "intestinal gas" means different things to different people. Everyone has gas and eliminates it by belching or farting (passing it through the rectum).
Crohn's disease is a chronic inflammatory disease,
primarily involving the small and large intestine, but which can
affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are
common symptoms.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
In lactose intolerance, the digestive system cannot digest lactose (the main sugar in milk). Symptoms of lactose intolerance include diarrhea, flatulence, abdominal pain, abdominal bloating, abdominal distention, and nausea. There are several tests to diagnose lactose intolerance. Treatment is generally made with dietary changes, supplements, and adaptation to small amounts of milk.
IBS (irritable bowel syndrome) is a common gastrointestinal disorder involving abnormal gut contractions (motility) characterized by abdominal pain,
bloating, mucous in stools, and irregular bowel habits with alternating diarrhea
and constipation, symptoms that tend to be chronic and to wax and wane over the
years. Treatment options include medication and lifestyle changes such as diet, exercise, and stress management to control symptoms. Also called spastic colitis, mucus colitis, nervous colon syndrome.
Dyspepsia (indigestion) is a functional disease in which the gastrointestinal organs, primarily the stomach and first part of the small intestine, function abnormally. It is a chronic disease in which the symptoms fluctuate infrequency and intensity. Symptoms of dyspepsia include upper abdominal pain, belching, nausea, vomiting, abdominal bloating, early satiety, and abdominal distention (swelling). These symptoms are most often provoked by eating.
Scleroderma is an autoimmune disease of the connective tissue. It is characterized by the formation of scar tissue (fibrosis) in the skin and organs of the body, leading to thickness and firmness of involved areas. Scleroderma is also referred to as systemic sclerosis, and the cause is unknown. Treatment of scleroderma is directed toward the individual features that are most troubling to the patient.
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