Clinical Pearls
Small Intestinal Bacterial Overgrowth: Updates and Clinical Implications


Christine Stubbe, ND, FABNOSmall intestinal bacterial overgrowth (SIBO) is a condition in which the small bowel is colonized by microbes normally found in the large intestine. This common gastrointestinal disorder can cause maldigestion and malabsorption of critical nutrients.

The gold standard for SIBO diagnosis is endoscopy with small bowel aspiration and culture. Because of the invasive nature of this procedure, assessing breath gases following a challenge drink is a widely accepted methodology to make the diagnosis. The American College of Gastroenterology recently collected a consensus of expert opinions to standardize breath testing, and to establish guidelines on how those results should be interpreted.

In this webinar presented November 15, 2017, Dr. Christine Stubbe reviews the new SIBO guidelines and discusses the latest options in breath testing at Genova Diagnostics.


Clinical Pearl 1 – When to Consider SIBO

Patients with SIBO present with a variety of symptoms. There are also many diseases that have a high prevalence of SIBO. With so many nuances, clinicians often overlook SIBO as an etiology and patients often go undiagnosed. Listen as Dr. Christine Stubbe outlines some of the most common signs and symptoms of SIBO, as well as predisposing risk factors, that may lead you to consider SIBO in your differential diagnosis.

Hallmark Symptoms
Play Video Clip - Hallmark Symptoms
Risk Factors
Play Video Clip - Risk Factors

Clinical Pearl 2 – How Does Breath Testing Diagnose SIBO?

The gold standard for the diagnosis of SIBO involves upper endoscopy with small bowel aspiration and culture. There are many disadvantages to this highly invasive procedure. With the increasing prevalence of SIBO, breath testing is now more commonly used. Dr. Christine Stubbe explains the physiology behind using breath sampling in the evaluation of common gastrointestinal problems.

How Does Breath Testing Diagnose SIBO?
Play Video Clip - The Small Intestine

Clinical Pearl 3 – Genova's SIBO Test

Genova Diagnostics now offers clinicians the option of selecting a 2- or 3-hour SIBO assessment. The 3-hour SIBO panel provides insight into gas levels over a longer period of time, which may be helpful in patients with slower transit. The report has also been upgraded to reflect the current state of scientific understanding related to SIBO and offers an easy to interpret graphic to highlight findings. Listen as Dr. Christine Stubbe outlines the report graphics for both tests.

Genova's SIBO Test
Play Video Clip - 2- or 3-Hour SIBO Assessment

Clinical Pearl 4 – Interpreting the Test

In March of 2017, the American Journal of Gastroenterology published a consensus paper summarizing gastroenterology expert opinions on SIBO. The goal of the consensus was to standardize the indications, preparation, performance and interpretation of breath testing in clinical practice. Using these consensus findings, Genova not only upgraded the SIBO Profile but also adjusted the test interpretation to remain in line with the most current literature. Here, Dr. Christine Stubbe outlines the North American Consensus guidelines and shows how to apply them in clinical practice, using the Genova SIBO breath test.

Evaluation for Hydrogen
Play Video Clip - Evaluation for Hydrogen
Evaluation for Methane
Play Video Clip - Evaluation for Methane

Clinical Pearl 5 – Case Study: SIBO

Listen as Dr. Christine Stubbe walks through a clinical case study outlining a SIBO patient's clinical presentation, breath-testing results and interpretation. In the context of the case, she also offers some treatment and follow up testing recommendations.

Case Study
Play Video Clip - Case Study

Updated Guidelines for Assessing and Treating SIBO

In this webinar, presented November 15, 2017, Dr. Stubbe reviewed the new SIBO guidelines and discussed the latest option of a 2- and 3-hour breath test offered at Genova Diagnostics. In addition, interventions involving diet, digestive support, probiotics, and antimicrobials were discussed.

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