Matilda Hagan, M.D., an inflammatory bowel disease specialist at Mercy Medical Center in Baltimore, Maryland, talks about a mystery disease that could be the cause of serious gut trouble.
Interview conducted by Ivanhoe Broadcast News in October 2016.
I want to talk a little bit about gut bacteria it’s something that we’re starting to hear more about, can you tell me what it is and what it causes?
Dr. Hagan: Bacteria are a normal part of the gut. In fact, in the large intestine there is a very large population of bacteria. Gut bacteria is what we call the microbiome and we’re learning more and more about that every day. That being said, there are bacteria that makes its way in to the small intestine which normally does not have a large population of bacteria and that we term specifically small intestinal bacteria overgrowth.
Now the gut bacteria can be helpful, is the small intestine bacteria when it gets to that point is it no longer helpful for a person’s health? Can you tell me a little bit about that?
Dr. Hagan: That’s exactly correct. Part of our normal function is to have bacteria in the gut, particularly the large intestine and only small amounts in the small intestine. When they become a larger population they are no longer helpful as you said before. What does that mean? Essentially, there are multiple conditions that can predispose to that. Anybody who’s had intestinal surgeries that can create pouches and or lose of the valve between the large and small intestine, that can happen. Certain conditions that affect how the gut moves (gut motility); things like diabetes, scleroderma, and even conditions that cause significant constipation where things just aren’t moving along as well as they should (stasis) can make small intestinal bacteria over growth more likely. If the amount of stomach acid produced or pancreatic enzymes are low that can also put a person at risk for bacteria overgrowth. People can get symptoms related to that. The common symptoms are they could have a lot of bloating, they may even complain of sometimes belching, they may have abdominal cramps. If it’s bad enough they may have diarrhea related to it. If it gets essentially very severe people could have malabsorption and can have weight loss related to it.
This has some letters, initials or an acronym associated to it, can you tell me about that?
Dr. Hagan: SIBO is the most common acronym that you would hear and essentially it stands for small intestinal bacterial overgrowth.
That’s something that most people have not heard of, is that correct is this something pretty new that we’re talking about?
Dr. Hagan: Well it’s something that we’re educating people more and more about every day. People may have certain conditions where diarrhea may be part of their disease, such as people with inflammatory bowel disease like Crohn’s disease. They may still be very, very symptomatic, abdominal pain, diarrhea; and when you look their disease might be inactive and this could be another condition that is sort of underlying and that needs to be addressed. Bottom line, in someone with chronic diarrhea, you should consider small intestinal bacterial overgrowth as a potential reason for their symptoms especially if they have risk factors.
Since this has symptoms that are similar to other things you said you might have diarrhea or bloating how do you diagnose SIBO? How do you know what’s going on in there?
Dr. Hagan: The symptoms are essentially nonspecific. I can give you several conditions that would look exactly the same. Having a suspicion for it is the first step. In terms of testing we do one or two things. There is a formal breath test that one can do and that’s a process in which we have the patients come in, do a small prep beforehand. They get feed a sugary solution and then every fifteen to twenty minutes or so we have them blow in to a little tube and collect gas that essentially reflects the bacteria breaking down the sugar. We have an expectation of what normal should be because normally there should be a certain amount of time before you hit the large intestine which is where we expect the large population to be anyway. Getting a high collection of the gases that we’re interested in any sooner than what we expect for the large intestine makes that test positive. And that’s called a hydrogen breath test using glucose or lactulose.
So a noninvasive breath test?
Dr. Hagan: Correct.
Is that the best way to get an indication of what’s going on?
Dr. Hagan: That is sort of the easier approach. The true and true gold standard is not used in clinical practice much just because it requires invasive testing. That would be to do one of our endoscopic procedures and get to the region of the small intestine we call the jejunum and collect a small sample of fluid we call aspiration and analyze that to truly get the bacteria concentration. The breath test is easy enough to do and it can be done quickly enough in clinic that tends to be what we do. The alternative is that sometimes if we suspect that this is what’s going on, we tell the patient: “Well, we could do the breath test and even though it’s not invasive it actually takes about three hours or so”. So depending on the conditions we can say, “Well, we can give you an antibiotic for a week to treat it. If you get better after the one week of antibiotics then we know that this is what was going on.” That’s the other option. Formerly a breath test is most commonly used and the other one would be to do what we call an empiric treatment which is diagnostic and therapeutic at the same time.
How do you treat it, you mentioned antibiotics.
Dr. Hagan: Correct.
And then it’s lifestyle change, diet change, anything to prevent it from coming back?
Dr. Hagan: In terms of prevention, most often diet is not the culprit. Having said that, if you eat certain carbohydrates that don’t quite work with you then perhaps limit specifically certain sugars and maybe sugar alcohols then that could be addressed. But for the most part, the conditions tend to be things that are beyond your control. As I said, if you’ve had surgery that’s changed your anatomy, no amount of dietary change would make a difference. That being said, if you limit sugar which is what we use for our testing, you can perhaps address it that way.
How long is the antibiotic and just one treatment and that should take care of the problem or is this something that once you are prone to it, it might keep coming back.
Dr. Hagan: For some people we have various antibiotics that we use. The treatment is usually a seven day course. For some people one course is enough, others may have what we call recurrence or relapse and then they may require a second course of antibiotics. There are a few people who may have continuous recurrences. When that becomes the case, there are some people that we put on a regiment at the beginning of every month. For the first seven days they may be on a course of antibiotics on an ongoing basis. Those are rare cases but we do that in people who continue to have the issue.
What’s the danger or risk for people if they’re not diagnosed? Is it discomfort, could it lead to something more serious down the road?
Dr. Hagan: There are no major long term complications. I think the most severe would be if it got to the point of becoming malnourished. We would be most concerned about weight loss. With malnourishment, you can get things like osteoporosis just by virtue of not absorbing nutrients, and then complications that come along with malabsorption. But there’s no cancer or anything of that sort that you have to be concerned about, but yes.
Is there anything I didn’t ask you that you want to make sure that people know about SIBO?
Dr. Hagan: Essentially if you have your usual common symptoms like bloating, abdominal cramping and it’s just not going away I think the important thing is to discuss it with your doctor because there could be something that could be done about it. There’s really no way to know right off the bat if this is what’s going on but it’s something that should be discussed.
Is there any indication of how many people in the United States might be struggling with it, is it under-diagnosed?
Dr. Hagan: Potentially it could be just by virtue of presenting like so many other things. It is probably less common than irritable bowel, but there could be some underlying or there could be some coexisting cases as well.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Dan Collins
Public Relations
410-332-9714
Sign up for a free weekly e-mail on Medical Breakthroughs called
First to Know by clicking here.
