Treatment

Whenever possible, doctors treat SIBO by dealing with the underlying problem — for example, by surgically repairing a postoperative loop, stricture or fistula. But a loop can't always be reversed. In that case, treatment focuses on correcting nutritional deficiencies and eliminating bacterial overgrowth.

Antibiotic therapy

For most people, the initial way to treat bacterial overgrowth is with antibiotics. Doctors may start this treatment if your symptoms and medical history strongly suggest this is the cause, even when test results are inconclusive or without any testing at all. Testing may be performed if antibiotic treatment is not effective.

A short course of antibiotics often significantly reduces the number of abnormal bacteria. But bacteria can return when the antibiotic is discontinued, so treatment may need to be long term. Some people with a loop in their small intestine may go for long periods without needing antibiotics, while others may need them regularly.

Doctors may also switch among different antibiotics to help prevent bacterial resistance. Antibiotics wipe out most intestinal bacteria, both normal and abnormal. As a result, antibiotics can cause some of the very problems they're trying to cure, including diarrhea. Switching among different drugs can help avoid this problem.

Nutritional support

Correcting nutritional deficiencies is a crucial part of treating SIBO, particularly in people with severe weight loss. Malnutrition can be treated, but the damage it causes can't always be reversed.

These treatments may improve vitamin deficiencies, reduce intestinal distress and help with weight gain:

• Nutritional supplements. People with SIBO may need intramuscular injections of vitamin B-12, as well as oral vitamins, calcium and iron supplements.

• Lactose-free diet. Damage to the small intestine may cause you to lose the ability to digest milk sugar (lactose). In that case, it's important to avoid most lactose-containing products, or use lactase preparations that help digest milk sugar.

  Some affected people may tolerate yogurt because the bacteria used in the culturing process naturally break down lactose.