SIBO: When your digestion becomes a ticking time bomb

 SIBO: When your digestion becomes a ticking time bomb

What is SIBO, this intestinal disorder that can poison your life?
Digestion disrupted by an excess of bacteria

SIBO, an acronym for Small Intestinal Bacterial Overgrowth, is defined as an abnormal proliferation of bacteria in the small intestine, causing a multitude of digestive disorders. This syndrome is now being taken seriously, with the publication of the first official French recommendations at the end of March 2025 by the French Neuro-Gastroenterology Group, during the Francophone Days of Hepato-Gastroenterology and Digestive Oncology.

As indicated Actu.fr on April 6, 2025, SIBO manifests itself by a constellation of digestive symptoms: "diarrhea, abdominal pain and/or abdominal discomfort, bloating, abdominal distension, flatulence". In addition, there may be biological abnormalities such as vitamin B12 deficiency or steatorrhea (fatty stools).

Multiple and insidious causes

Contrary to what some still uninformed practitioners might think, irritable bowel syndrome is rarely the cause of SIBO. The most rigorous studies, as Actu.fr points out, estimate this causality at less than 4%. Worse, the tests associated with these hypotheses are often considered unreliable.

The real triggers are well identified: digestive surgery (in particular gastric bypass), slowing down of intestinal motility (e.g. diabetic neuropathy), structural abnormalities (diverticula, stenosis), prolonged use of certain medications (opioids), gastric acid deficiency, weakened immune system or physiological ageing of the digestive system.

Digestion and diagnosis: between imperfect tests and discussed practices

The reference test, as recalled in the clinical recommendation of the American College of Gastroenterology (Am J Gastroenterol, February 2020), remains the analysis of duodenal fluid. But this method, complex and invasive, is not available in France.

In practice, health professionals fall back on the glucose breath test, which measures the production of exhaled hydrogen. A rise of more than 20 ppm signals excessive fermentation — and therefore a potential SIBO. Except that this method, which is easy to disrupt, offers a disputed reliability.

The latest fad, the home self-test, is strongly discouraged: "No reliability of this test is guaranteed, assure the experts who strongly advise against them", according to Actu.fr.

Treatment: the end of miracle solutions

If you were hoping to solve your digestion problems with a simple diet or probiotics bought in the pharmacy, you've missed it. As a recent Spanish study conducted on 179 patients, relayed by Ma Clinique on April 7, 2025, states bluntly, one-dimensional approaches are largely insufficient.

The study shows that only 41.3% of patients return to normal breath tests after treatment. However, 72.6% of them report a clear improvement in their quality of life — proof that the symptoms do not always follow the clinical logic. This dissonance between biological data and the patient's experience is pushing us to rethink the therapeutic strategy.

According to the same study, the effective management of SIBO requires a multidimensional approach, adapted to microbial phenotypes (H2, CH4 or mixed): targeted antibiotic therapy (rifaximin, neomycin), modification of the intestinal flora, nutritional support, consideration of co-morbidities, and even psychological support. All of this is medically supervised, with personalized follow-up.