Preventing SIBO Recurrence - How to Avoid Bacterial Recolonization

SIBO Bacterial Recurrence

Often, after successful treatment of bacterial overgrowth, a relapse occurs, i.e., the reappearance of bacteria in areas of the small intestine that should be free of microorganisms. For the patient, this usually means a recurrence of symptoms.

In most cases, this recurrence is facilitated by pre-existing conditions and/or previously untreated underlying causes of bacterial overgrowth.

The most common causes of relapse and the need for repeat treatment are disorders of small bowel motility (migrating motor complex dysfunction) or anatomical causes (e.g. previous surgery, adhesions, ileocecal valve defects or resection, increased intestinal elasticity due to collagen synthesis disorders such as Ehlers-Danlos syndrome).

Because of the frequency of such relapses (up to 60%), various strategies are used to prevent them:

  • "Meal spacing" as described above - with an interval of 4-5 hours between meals without "snacking", the intestine has enough time to switch from digestive to cleansing mode. A (functioning) MMC then ensures that bacteria and food residues are flushed out with "cleaning waves".

  • Adherence to a specific SIBO diet, especially in the first weeks after treatment with carbohydrate reduction.

    Discontinuation (tapering!) of stomach acid inhibitors (PPIs) such as pantoprazole, omeprazole, esomeprazole, and antacids, as these worsen digestion and facilitate bacterial colonization of the small intestine.

  • Treatment of possible underlying neurological or rheumatologic conditions

  • Visceral (osteopathic) therapy for anatomical problems, pre-surgery or problems with the ileocecal valve.

  • Support digestive function by providing bittering agents, apple cider vinegar, dextrorotatory lactic acid, or even betaine HCL (for gastric acid deficiency).

  • Treatment with prokinetics: Some therapists use prokinetics as a standard after antibacterial treatment is completed to prevent recurrence.These include herbs such as ginger or combinations of herbs such as iberogast, as well as more potent classical medications such as prucalopride (Resolor), low-dose naltrexone, or low-dose erythromycin. They are usually taken at bedtime to take advantage of the fasting period during the night to stimulate the MMC and support the body's own "cleansing waves". The correct choice and dosage depends on the preferences and experience of the patient and therapist and should be determined on an individual basis.

SIBO Breath Test


Probably the safest way to detect SIBO as root cause for your symptoms

  • Home Test Kit

  • Free delivery, Testresult within 24 hours

  • Money Back Guarentee

Healthcare professionals agree that the Breath Test is one of the best available options for testing for SIBO.