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:

  • antibiotics
  • alcohol
  • opiates/narcotics
  • 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.


Learn more about the NUNM SIBO Symposium