SIBO - Symptoms post anti-reflux surgery?
Small Intestinal Bacterial Overgrowth
Can cause gas-bloat syndrome and dysphagia post antireflux surgery.
– Inability to belch, postprandial bloating, flatulence
Symptoms: Diarrhoea, postprandial bloating and flatulence (increased gas production in the small bowel, bacterial fermentation)
Cause: PPI use changes gut microbiota towards the oral microbiome and by reducing acid levels, allows the colonisation of microorganisms in the proximal gut.
Diagnosis: Presence of bacteria in SB >103 CFU/ml. Duodenal aspirates is difficult. Hydrogen and Methane brath testing (HMBT) is widely accepted.
Treatment: wide spectrum antibiotics to cover aerobes and anaerobes (Augmentin, Metronidazole, Co-trimoxazole, Ciprofloxacin) for 1-2 weeks. Check levels of B12, iron, niacin, thiamine.