Do you ever experience bloating, particularly after consuming carbohydrates, and wonder if you might have gluten intolerance? Or perhaps you’ve experienced abdominal discomfort, excessive belching, and flatulence, along with symptoms resembling indigestion.

These symptoms are often initially treated with proton pump inhibitors (PPIs) for reflux. However, you may have noticed that your symptoms either persist or even worsen despite this treatment.

You might be dealing with a condition known as Small Intestine Bacterial Overgrowth (SIBO).

What is SIBO?

SIBO is a condition where an abnormal amount of microorganisms colonise the small intestine. This overgrowth can lead to a range of gastrointestinal symptoms, and interestingly, it’s often mistaken for other conditions, including gluten intolerance.

The connection to reflux

SIBO is frequently associated with laryngopharyngeal reflux (LPR) symptoms, which can include a sore throat, post-nasal drip, throat clearing, a sensation of a lump in the throat (globus) and voice problems.

One of the mechanisms behind these symptoms is the belching of an aerosol of stomach contents up into the oesophagus and throat. This aerosol may contain hydrochloric acid and the powerful stomach enzyme pepsin, which can exacerbate these symptoms.

Moreover, other classic reflux symptoms like regurgitation, heartburn, and even respiratory symptoms can be linked to intestinal dysbiosis. Research has also shown that constipation may increase the frequency of transient lower oesophageal relaxations (TLOSRs), which are associated with reflux.

Thus, the use of laxatives can sometimes help reduce reflux symptoms. Since SIBO is associated with constipation, this may be another way in which intestinal dysbiosis causes reflux symptoms.

The research on SIBO and reflux

A 2021 study published in the Surgical Endoscopy journal found that intestinal dysbiosis, including SIBO, is prevalent in patients with gastroesophageal reflux disease (GERD). These patients are more likely to report gas-related symptoms before undergoing anti-reflux surgery. Surprisingly, patients undergoing anti-reflux surgery are not routinely screened for SIBO, even though many of them experience gas-related symptoms after the procedure.

The study examined data from consecutive patients referred to a specialty reflux centre, the Functional Gut Clinic.

These patients underwent a diagnostic workup for GERD, including various tests and assessments. Intestinal dysbiosis was determined through hydrogen and methane breath testing, with positive results indicating SIBO or intestinal methanogen overgrowth (IMO).

The results showed that a significant percentage of patients had intestinal dysbiosis, with SIBO and IMO being common. These patients were more likely to report symptoms such as bloating and belching. Interestingly, their acid exposure time and the number of reflux episodes were similar to those without dysbiosis. However, patients with dysbiosis were more likely to have a positive reflux-symptom association, particularly for regurgitation.

The importance of early reflux diagnosis

The connection between SIBO and reflux highlights the significance of early reflux diagnosis. Identifying and addressing SIBO can not only alleviate gastrointestinal symptoms but also potentially improve reflux symptoms.

Therefore, if you’re experiencing persistent or worsening reflux symptoms, especially in conjunction with gas-related symptoms, it’s essential to consider the possibility of SIBO and seek proper evaluation and diagnosis.

Early diagnosis by using Peptest can lead to targeted treatment that can make a significant difference in your journey toward better digestive health.

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