Get up-to-date information about SIBO and the 2018 NUNM SIBO Symposium
Written by Dr. Steven Sandberg-Lewis
April 20, 2018
The theme of the NUNM 2018 SIBO Symposium is Underlying Causes of SIBO. My experience is that if I treat any or all of the treatable causes, relapse is much less likely and the patient’s outcome will be improved. The following is a list of questions I ask every new patient to look for underlying issues.
Tell me about your history of:
- Gastroenteritis, food poisoning or traveler’s diarrhea I use all three terms, just in case they relate or remember it better by a different name.
- Traumatic brain or spinal injury, whiplash/flexion-extension injury. The key here is a “shaken brain”. It could be football injury, heading the ball in soccer, “I fell but didn’t hit my head” such as horseback riding or bike accident, or a shock wave such as an explosion whether or not anything struck the head.
- Ehlers-Danlos syndrome/ other collagen issues I use the Beighton score as a screening test.
- Scleroderma – thickening of the intestinal wall alters motility
- Hypothyroidism – especially if undertreated
- Metabolic syndrome, prediabetes or diabetes – can cause vagal autonomic neuropathy
- Endometriosis – a major source of relapsing SIBO
- Pelvic inflammatory disease, – pelvic or abdominal surgery or radiation treatment All of these can cause thickening of the bowel or adhesions which alter motility.
- Perforated hollow viscus (perforated appendix), another common cause of adhesions.
- Internal hemorrhage such as ruptured ovarian cyst – another adhesion cause.
- Blind loops, diverticuli, and other anatomical abnormalities – These are good places for bacteria to hide and not be flushed out by the migrating motor complex.
- Superior mesenteric artery syndrome – a rare but important cause of partial duodenal obstruction.
- Cesarean vs. vaginal birth and breast fed status – I like to know if they received Lactobacillus and Bifidobacter at this key window of time.
Tell me about your exposure to:
- antispasmodics (specify dicyclomine/bentyl, hyosyamine/levsin, cimetropium)
- tricyclic antidepressants (specify amitriptyline, other)
- alosetron (lotronex)
- lomotil (diphenoxaylate/atropine)
- imodium (loperamide)
- proton pump inhibitors
- cholestyramine (cholestipol, questran)
- OTC fiber supplements other than methylcellulose
The symposium will discuss assessment, treatment and management of some of the more common underlying causes. This will allow you to apply Tolle Causam – treat the cause.