SIBO Treatment in Katy, TX
Testing and treatment for small intestinal bacterial overgrowth, with a plan that looks for the reason it developed, which can help lower the chance it comes back.
Understanding SIBO
Small intestinal bacterial overgrowth (SIBO) happens when too many bacteria, or the wrong types of bacteria, grow in the small intestine. Most of the bacteria in your gut normally live in the large intestine (the colon). When they build up in the small intestine, they ferment food before it can be properly absorbed, producing gas and interfering with digestion.
SIBO is not a disease on its own so much as a sign that something has changed in how the small intestine works. It usually develops because food and bacteria are not moving through normally, because the body’s natural defenses against bacteria are weakened, or because the shape of the bowel has changed after surgery or illness. Finding that underlying cause is a key part of treatment.
Symptoms of SIBO
- Bloating and a visibly swollen belly, often worse after meals
- Excess gas and belching
- Abdominal pain or discomfort
- Diarrhea, or constipation (which is more often linked to methane overgrowth, see below)
- Nausea
- Feeling full quickly
When SIBO is more severe or lasts a long time, it can interfere with absorption and cause weight loss, fatty or greasy stools, and low levels of vitamin B12, iron, or vitamins A, D and E. These signs need prompt medical attention.
Hydrogen, methane and IMO
Microbes in the gut produce gases that can be measured on a breath test. Overgrowth that produces mainly hydrogen is more often linked to diarrhea. Overgrowth of microbes that produce methane (archaea, not bacteria) is called intestinal methanogen overgrowth (IMO). It is considered separate from SIBO, can involve the colon as well as the small intestine, and is more often linked to constipation. The difference matters, because the two are treated differently.
What causes SIBO?
SIBO usually develops when one or more of the body’s protections against bacterial overgrowth are disrupted. Common risk factors include:
- Slow movement of the bowel, for example from diabetes, scleroderma, Parkinson’s disease, gastroparesis or long-term use of opioid pain medicines
- Previous abdominal surgery, especially bowel resections, removal of the valve between the small and large intestine, or gastric bypass
- Structural changes, such as strictures from Crohn’s disease, adhesions, or small pouches in the small intestine (diverticula)
- Reduced stomach acid, which normally helps keep bacteria in check, including from long-term use of acid-reducing medicines
- Other conditions, such as chronic pancreatitis, celiac disease, cirrhosis and immune deficiencies
- Older age
SIBO is also found more often in people with irritable bowel syndrome. The two conditions share many symptoms, and researchers are still working out how they are connected.
When to see a gastroenterologist
See a specialist if bloating, gas, abdominal discomfort or a change in bowel habits has lasted more than a few weeks or keeps coming back. Bloating has many possible causes, and SIBO is only one of them, so a proper evaluation helps you avoid unnecessary diets and treatments. See a doctor promptly for weight loss you cannot explain, blood in the stool, vomiting that keeps returning, or symptoms that wake you at night.
Our approach to SIBO
SIBO is easy to over-diagnose and easy to under-treat. Our gastroenterologists confirm the diagnosis properly, treat the overgrowth with evidence-based therapy, and then look for the reason it happened, to reduce the chance you need repeated courses of antibiotics.
Getting the diagnosis right
- A careful history and exam, including past surgeries, medicines and conditions that slow the bowel, because these point to both the likelihood of SIBO and its cause.
- A breath test. After an overnight fast and a special diet the day before, you drink a sugar solution (glucose or lactulose) and breathe into collection tubes at set times. A rise in hydrogen or methane suggests overgrowth. Our office arranges the test and explains the preparation, which matters for accurate results.
- Blood tests for anemia, vitamin B12, iron and other nutrients, and for conditions that can cause similar symptoms, such as celiac disease.
- An upper endoscopy or other tests when needed, to look for causes such as strictures or to rule out other conditions. In some cases, a sample of fluid from the small intestine can be taken during the procedure and cultured.
Breath tests are useful but not perfect. They can give false results, especially if the preparation is not followed, so we interpret them together with your symptoms and history.
Treatment
- Antibiotics. SIBO is treated with a course of antibiotics, usually for one to two weeks. Rifaximin, an antibiotic that stays mostly in the gut, is often used. It is FDA approved for IBS with diarrhea but not specifically for SIBO. Other antibiotics are options depending on your situation, and methane-predominant overgrowth (IMO) may need a different approach.
- Treating the underlying cause. This may mean better control of diabetes or a thyroid condition, reviewing medicines that slow the bowel or reduce stomach acid, treating a stricture, or managing a motility disorder.
- Diet support. Our registered dietitians can guide a short-term diet such as a low FODMAP plan, which may ease symptoms in some people during and after treatment, and help correct any nutrient deficiencies. Diet changes can relieve symptoms, but they are not a substitute for treating the overgrowth.
- Preventing a return. SIBO comes back in a significant number of people, especially when the underlying cause continues. Some patients may benefit from medicine that helps the small intestine move more effectively, although evidence for this is limited. We also agree on a plan for re-testing and retreatment if symptoms return.
We do not recommend long, unsupervised courses of herbal antimicrobials or restrictive diets. The evidence for these approaches is limited, and they can delay finding the real cause of your symptoms.
SIBO is rarely the whole story. Clearing the bacteria brings relief, but asking why they built up in the first place gives patients the best chance of staying well.
Dr. Vivian Asamoah, MD
Board-Certified Gastroenterologist, Integrative Medicine
Key Facts
What you need to know
Everything you need to know before your appointment.
Who should consider this
Anyone with ongoing bloating, gas and bowel changes, or SIBO that keeps coming back.
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What to expect
A detailed first visit, the right test with clear preparation instructions, and a plan based on the results.
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Recovery and results
Many people feel better within a few weeks of treatment, with a plan in place in case symptoms return.
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Why our team
Gastroenterologists and registered dietitians who treat SIBO and look for the reason behind it.
Learn moreWhat Our Patients Say
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Dr. Asamoah is a wonderful doctor with an excellent bedside manner who cares about what you're going through and leaves no stone unturned I highly recommend.
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From the moment of entering the Surgical Center, I felt like I was an individual and my needs were of concern. The actual procedure experience was great. Dr. Asamoah has a way of making you feel at ease. She's gathered a staff of people who do the same thing. Highly recommend.
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I was very impressed with both doctors' expression of authentic interest in and concern with my health concerns. A rare experience.
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Highly recommend. The office staff and Dr. Asamoah were helpful, friendly and very accommodating! We left feeling like we have answers and are hopeful.
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First time visit. Impressed by the clean and nice environment. Friendly staff. Doctor takes her time to hear you and answer any questions you have. Great experience.
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Wow!!! Absolutely amazed by the facility and doctor! Dr. Vivian Asamoah is extremely educational, professional, and so sweet! I went in feeling extremely anxious because of my health issues, and she put me at ease by explaining every detail! Xiomara, her MA, was so helpful and thorough. Honestly, she is by far one of the best doctors I've seen. God bless this office and everyone in it! I most definitely recommend her!
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I went in to check on issues I was having with my colon. I was in a panic and was not feeling my best. Dr. Asamoah was kind and very understanding, with great patient-relationship skills. She is genuine and truly professional. Her staff is great and wonderful. I will recommend my family and friends.
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Had a great experience. The doctors are very understanding and comforting. They listen to all of your needs. Loved their music. Very relaxing.
Individual results vary.
Ready to talk with a specialist about your bloating and SIBO?
Schedule a consultation with our team. We are here to help you find lasting relief.
Expert GI. Whole-person care. All under one roof.Common questions about SIBO
SIBO stands for small intestinal bacterial overgrowth. It means there are too many bacteria, or the wrong types, in the small intestine. They ferment food early, causing bloating, gas, abdominal discomfort and changes in bowel habits.
Common symptoms are bloating, excess gas, abdominal discomfort, diarrhea or constipation, nausea and feeling full quickly. Longer-lasting or severe SIBO can cause weight loss and low levels of vitamin B12, iron and other nutrients.
SIBO usually develops when the small intestine does not move food along normally, after abdominal surgery, with structural problems such as strictures, or when stomach acid is reduced. Diabetes, scleroderma, opioid medicines and older age are common risk factors.
SIBO is usually diagnosed with a breath test. You drink a sugar solution and breathe into tubes over two to three hours, and a rise in hydrogen or methane suggests overgrowth. In some cases, a fluid sample from the small intestine is taken during an upper endoscopy.
They are useful but not perfect. Results can be affected by the preparation, recent antibiotics, laxatives and how quickly food moves through your gut. That is why a gastroenterologist should interpret the result together with your symptoms and history.
SIBO usually refers to overgrowth of bacteria that produce hydrogen, often linked to diarrhea. IMO, intestinal methanogen overgrowth, is overgrowth of organisms that produce methane and is more often linked to constipation. Both are detected on a breath test and may be treated differently.
SIBO is treated with a course of antibiotics, often rifaximin, usually for one to two weeks. Treating the underlying cause matters most for lowering the chance it comes back. Correcting nutrient deficiencies and short-term diet support can help with recovery and symptoms.
Yes. SIBO returns in a significant number of people, especially when the cause, such as slow bowel movement or previous surgery, is still present. Addressing the cause, where possible, can help lower the chance of repeat episodes.
There is no single proven SIBO diet. A short-term low FODMAP diet may reduce bloating and gas for some people while they are being treated, ideally with guidance from a registered dietitian. Long-term restrictive diets are not recommended, because they can cause nutrient gaps without treating the cause.
No, but they overlap. SIBO is found more often in people with IBS, and the two share symptoms such as bloating and changes in bowel habits. Testing helps decide whether SIBO is contributing to your symptoms and whether treating it is likely to help.
Houston Gastro Institute tests for and treats SIBO and other causes of bloating at our clinic on Kingsland Boulevard in Katy, TX. Patients come to us from across west Houston, including Cinco Ranch, Fulshear, Richmond, Brookshire, Sugar Land and Cypress. Upper endoscopies are performed at Zazen Surgery Center in the same building.