At 39 years old, Kristin Gibbons is no stranger to gut issues. Off and on for most of her adult life, she has lived with bloating, gas, feeling full after only a few bites of food, bowel movement problems and general pain. She cycled through doctors, finding temporary relief but never a real solution.

Four years ago Kristin sought out Dr. Maria Johnson, a gastroenterologist with Connecticut GI and Hartford HealthCare, who in turn referred her to a naturopathic doctor, Dr. Megan Lester.

Drs. Lester and Johnson have been working together to help Kristin get fully well.

“I can’t say enough about her,” Kristin said of Johnson. “She is so clinically thorough, she actually listens to me, and asks me what I think, and she is so responsive. I have never worked with a doctor like her before. I’m hopeful.”

What is Small Intestinal Bacterial Overgrowth (SIBO)?

SIBO is a condition in which the small intestine is colonized with microorganisms that normally live in the large intestine. You have more than 100 trillion microbes in your body. Most coexist peacefully in your system. They stimulate the immune system, help digest food and synthesize vitamins like vitamins K and B.

Different internal and external factors can upset the peace among these microbes, however, including giving birth, changes in your environmental exposures, stress, medications and  supplements. In Kristin’s case, surgery on her colon to remove a growth about two years ago caused a major flare-up of SIBO that she has been struggling with since.

Some risk factors for SIBO include abnormal motility disorders of the digestive tract, prolonged antibiotic use, low acid levels in the stomach, anatomic abnormalities, chronic pancreatitis, and an abnormal immune system. SIBO is mostly commonly diagnosed with a carbohydrate breath test in patients who present with typical symptoms of SIBO such as bloating, excess flatulence, abdominal pain and a change in bowel habits.

Typically, SIBO can be treated with a combination of antibiotics and diet changes. Herbal therapy also can be helpful.

SIBO is Common and Treatable

“I am seeing so many patients with SIBO,” Johnson said. “Many of the patients I am seeing are coming to me for a second opinion after they have been diagnosed with Irritable Bowel Syndrome (IBS). The symptoms overlap so when they come to me I commonly test them for SIBO. This is not a new disorder, there’s just heightened awareness.”

Johnson said one of the possible contributing factors for developing SIBO can be excessive use of antibiotics earlier in life. For example, severe acne can be treated with a class of antibiotics called tetracyclines (including doxycycline and minocycline) that can affect the digestive system’s bacteria.

Kristin’s case is probably one of the most severe that Johnson has seen.

“She’s a great patient. She has tried everything including food eliminations, a low FODMAP diet, herbal remedies, antibiotics and even two weeks of an elemental diet,” Johnson said.

Long-Term Treatment for SIBO

Johnson frequently collaborates with Lester, who has expertise in managing SIBO, and they are working together on Kristin’s health. This time, it is a longer duration treatment plan.

Kristen is on a two-week regimen of xifaxan and neomycin, which will be followed by a year of low-dose erythromycin (three weeks on/one week off per month). She is also taking partially hydrolyzed guar gum (PHGG), a water-soluble dietary fiber that will hopefully “bring all the bacteria that’s in there out of hiding” so the antibiotics can kill them, Gibbons said.

Gibbons said she has learned to live with her symptoms (like so many patients tell Dr. Johnson at their first visit with her) but is looking forward to feeling better.

“I don’t like to complain,” Gibbons said. “I work full time, I have a full social life. I refuse to let this alter my life. But it’s always in the back of mind, and when I go out to dinner, I am always wondering if it will flare up.”