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Predictive risk of Small Intestinal Bacterial Overgrowth (SIBO) in large cohort retrospective study

Predictive risk of Small Intestinal Bacterial Overgrowth (SIBO) in large cohort retrospective study . A total of 1809 patients who tested positive for SIBO using a Lactulose Hydrogen Breath test (Brechmann, Sperlbaum, & Schmeigel, 2017). The study looked at which pathophysiological exposures had the most predictive risk of SIBO.

They used a statistic called odds ratio (OR) . An odds ratio (OR) is a measure of association between an exposure and an outcome. The OR represents the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure. For example you can see that being exposed to proton pump therapy makes you 1.4 times more likely than those non-exposed to proton pump therapy to develop SIBO.  This is a great study in that addresses the mechanisms that would lead to impaired clearance of bacteria from the small intestine and the subsequent development of SIBO. 

Surprisingly that being exposed to levothyroxine (a common thyroid medication) made subjects 3.0 times more likely to test positive for SIBO. Some of the other findings are highly explainable but I believe thyroid disorder which is being diagnosed more frequently is often overlooked as risk factor for SIBO. Makes sense because gut motility is influenced by thyroid metabolism.

Pathophysiologic Exposure
Odds Ratio of Positive Lactulose Hydrogen Breath Test
Impaired gastric barrier

Gastrectomy
3.5
Proton Pump Therapy
1.4
Impairments of Intestinal Clearance

Resecting gastric surgery
2.4
Colonic resection
1.9
Stenosis
3.4
Gastroparesis
3.4
Neuropathy
2.2
Immune suppression

Drug induced immunosuppression
1.8
Thyroid Gland Metabolism and Endocrine Disorders

Hypothyroidism
2.6
Levothyroxine therapy
3.0
Diabetes mellitus
1.9

Chart adapted from: (Brechmann, Sperlbaum, & Schmeigel, 2017)

This is a useful study in that it points out some more mechanisms on how to find SIBO, how to treat it, and how to prevent it from coming back. Also I am fairly confident that its the thyroid disorder and not the levothyroxine that is making SIBO more likely in hypothyroid patients. However it would be interesting if a different medication like Armour Thyroid would be more effective in clearing SIBO in the hypothyroid patient.

All of the above impairments are valid approaches to consider in treating SIBO and preventing recurrence. Including improving gut lining, improving gut clearance, improving immune function, improving endocrine function.  If you have SIBO or are dealing with another functional motility disorder like IBS a well rounded assessment  and treatment approach can be employed stabilize your digestion.

Adam Rinde, ND is a licensed Naturopathic Physician seeing patients in Kirkland, Washington in the Seattle Puget Sound region. He can be reached at www.soundintegrative.com 

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