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SIBO: Small Intestinal Bacterial Overgrowth

Intestinal Adhesions and SIBO

SIBO (small intestinal bacterial overgrowth) is a frequently undiagnosed but serious condition affecting many people with gastrointestinal disease. Patients with IBS (irritable bowel syndrome), Crohn’s disease, other gastrointestinal disorders, and those with adhesions from endometriosis or former surgery are at increased risk of developing SIBO.

an inside look at how adhesions cause bowel blockage and exacerbate small intestinal bacterial overgrowth

Adhesions can form in the bowel as the first step in healing from an infection, surgery or trauma. After antibiotic/medical treatment, bacteria can remain in the intestine, trapped by the adhesions – thus, SIBO can recur.

While SIBO refers to an elevated number of bacteria in the small intestine, the treatment of SIBO becomes more difficult in patients with abdominal adhesions, internal scars that can form from any healing event in the intestine: i.e. surgery, infection, inflammation, trauma, endometriosis or radiation therapy. The body has no way to naturally remove adhesions; once formed, they tend to remain in the body for life – a permanent straight-jacket that slows movement of food through your body.

While medications can treat SIBO, the treated bacteria must exit the intestine in a timely manner, or SIBO can recur. Bowel adhesions can slow or stop the bacteria from leaving the intestine. Thus, even with the best medications, SIBO and symptoms can return unless the adhesions are first removed.

We are experts in clearing adhesions in the intestines, and throughout the abdomen. This can be vitally important for people with recurring or unresolved SIBO when adhesions prevent treated bacteria from exiting the body. Many SIBO physicians feel the best medical treatment is stymied by the bowel adhesions. As we clear adhesions, medications can work better, and intestinal mobility, motility and absorption can improve – significantly. Thus, many physicians treating SIBO suggest we clear the intestines of adhesions before they treat, to increase the effectiveness of their treatment.


Our History With SIBO

We have treated intestinal adhesions in hundreds of patients over many years. Before treating adhesions in SIBO patients, we developed methods and expertise treating recurring small bowel obstructions (SBO) – intestines blocked by adhesions. This condition can quickly become life-threatening because food cannot pass through the digestive tract.

a diagram of an adhesion related bowel stricture preventing the treatment of SIBO

Adhesions can squeeze the intestine from the outside, creating a build-up of SIBO bacteria above the adhered site. As in the prior image, the adhesions need to be cleared in order to allow the bacteria to leave the body.

Most of our SIBO patients had undergone surgery before therapy. While one or more surgeries may have saved theirlives, adhesions are the near-inevitable by-product of surgery – and the primary cause of bowel obstruction. Our patients were concerned about having more obstructions and surgeries. They felt trapped in a terrible cycle of adhesions-obstruction-surgery – with no end in sight. Our work helped most of them break the cycle, and get their lives back.

In 2014, Dr. Allison Siebecker, a nationally regarded SIBO specialist contacted us. She had noticed surprisingly positive results in SIBO patients who saw us. We conferred and discussed our various fields of expertise. She was an expert in SIBO; we were experts in decreasing bowel adhesions. We discussed areas where our work overlapped, and how we could help patients with SIBO.

In 2015, Dr. Steven Sandberg-Lewis, another nationally regarded SIBO expert, came to our Florida Headquarters for further consultation. Together, we sharpened our protocols for treating these patients. It became apparent that we were helping many people with recurring SIBO because we cleared adhesions that prevented bacteria from leaving the body after antibiotic use. Dr. Sandberg-Lewis asked us to address the Second Annual SIBO Symposium in Portland, Oregon, later that year. We did that; the doctors at the Symposium were very receptive to our work – and to working together to help their patients attain normal lives.

Many of these doctors and SIBO experts were concerned that, unless adhesions could first be cleared without surgery, they would never cure their patients’ gut issues. We were joined on the podium by several leaders of SIBO research, including:

  • Dr. Mark Pimentel, Director of the GI Motility Program at UCLA’s Cedars Sinai Medical Center (Los Angeles)
  • Dr. Gerard Mullin, Director of Integrative GI Nutrition Services, Johns Hopkins Hospital (Baltimore)
  • Dr. Leonard Weinstock, President of Specialists in Gastroenterology and the Advanced Endoscopy Center, Associate Professor of Clinical Medicine and Surgery at Washington University School of Medicine (St. Louis) (http://www.gidoctor.net/)
  • Dr. Allison Siebecker, Conference Director, and Medical Director of the SIBO Center for Digestive Health at the National College of Natural Medicine (NCNM; Portland, OR)
  • Dr. Steven Sandberg-Lewis, professor of gastroenterology, pathology and psychophysiology at the SIBO Center for Digestive Health (NCNM; Portland, OR)

Like Clear Passage, these dedicated physicians and others are working to help improve quality of life and eliminate SIBO for many patients.

click to view sibo diet guide by dr. siebecker

SIBO Treatment at Clear Passage

Bowel adhesions generally form as the first step in healing from surgery, infection, inflammation, trauma, endometriosis or radiation. SIBO can cause severe inflammation over time; that in itself can cause adhesions. If you have a history of any of these and are struggling with resolving your symptoms, you may have adhesions. During a phone consultation, we can help walk you through the process to determine whether that is the case.

If you have been diagnosed with SIBO or if your physician suspects you have this condition, we encourage you to contact us. It is important to work with a team that is familiar with both adhesions and SIBO. We are glad to work with you and your physician as a team, to help you determine whether you have adhesions and the best protocol to help you achieve your goals, so you can get back to an active life.

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Cautions and Contraindications

During our discussions with SIBO physicians, we expressed our need to screen patients for contraindications. In addition to treating the bowels, our work also treats the interstitial spaces of the body — the areas between organs and other structures. We find that if a person comes to us with an underlying condition, infection, severe active inflammation or a heightened inflammatory tendency, therapy can induce negative side-effects. We don’t want that to happen, so we regularly screen for infections and uncontrolled inflammatory conditions before accepting applicants for therapy.

We screen by looking at your systemic profile a bit differently than other medical specialists – because we treat the whole body. By requesting certain screening tests, we can measure your degree of inflammation and your tendency towards inflammatory responses – to get you the best results possible.

It is important to remember that Clear Passage treatment is different from any other type of medical intervention; the outcome predictors we use are unique to our treatment. While the SIBO bacteria is a local overgrowth and Xifaxan (Rifaximin) is typically focused in the bowel, patients can experience systemic side effects from bacterial “die off” and treatment itself. Therefore, we screen each patient to achieve the best results – without significant negative side-effects.

Our Digestive Health Guides

Digestive needs and dietary recommendations for patients with SIBO are very different from those with recurring bowel obstructions. You can find one of Dr. Siebecker’s SIBO diets by clicking the button above or via this link: http://dev.clearpassage.com/site-resources/sibo-specific-diet-food-guide.pdf.

Note: Any dietary guide we offer contains information we gathered and consolidated from licensed diet professionals. These resources should never replace the guidance of your physician.


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