SIBO Prevention

Small intestinal bacterial overgrowth arises when the mechanisms that keep the small bowel relatively sterile fail: the migrating motor complex, gastric acid, the ileocaecal valve, bile and pancreatic secretions, and immune surveillance. Recurrence rates after antibiotic treatment are high — often over 40% within a year — precisely because the predisposing factor persists. Common drivers include post-infectious IBS, diabetic or scleroderma-related gastroparesis, adhesions, chronic opioid use and long-term PPI therapy. Breath testing is imperfect and frequently over-interpreted, so treat symptoms and context, not a test result alone.

1) Identify and address the underlying cause — motility disorder, adhesions, structural abnormality, or medication effect — since recurrence is otherwise near-inevitable. 2) Space meals 4-5 hours apart to let the migrating motor complex sweep the small bowel; constant snacking suppresses it. 3) Avoid unnecessary long-term PPI use, which removes the gastric acid barrier. 4) Discuss a prokinetic with your clinician for post-treatment maintenance, which has the best recurrence-prevention evidence. 5) Reduce opioid use where possible, as it directly impairs motility. 6) Treat constipation, which promotes bacterial migration and stasis. 7) Use dietary modification such as low FODMAP for symptom control short term only, not as a permanent regime — prolonged restriction harms microbiome diversity. 8) Herbal antimicrobials have small comparative-trial support but are not a substitute for fixing the cause.

• •Spacing meals 4-5 hours apart
• •Avoiding unnecessary PPI use
• •Treating constipation
• •Reducing opioid use
• •Regular physical activity
• •Stress management for gut-brain signalling
• •Time-limited dietary modification