Date:
Patient:
Reason for Visit:
Initial evaluation for suspected SIBO
Follow-up for diagnosed SIBO
Assessment of treatment response or recurrence
Management plan discussion
History:
Presenting Illness: (For initial evaluation)
Onset and duration of symptoms (abdominal pain, bloating, diarrhea, constipation, nausea)
Risk factors for SIBO (e.g., prior abdominal surgery, motility disorders, anatomical abnormalities)
Dietary habits (high-carbohydrate diet may worsen symptoms)
Previous treatments for SIBO (if applicable)
Past Medical History (PMH):
Underlying medical conditions that may contribute to SIBO (e.g., irritable bowel syndrome, celiac disease, scleroderma)
Previous surgeries or procedures involving the intestines
Social History:
Medications (some medications can worsen SIBO)
Physical Exam:
General: Assess vital signs (temperature, blood pressure) and overall health.
Abdominal: Evaluate for abdominal distention, tenderness, and abnormal bowel sounds.
Diagnostic Tests (may be ordered depending on clinical suspicion):
Breath tests (most common diagnostic test):
Hydrogen or methane breath test – measures the rise in hydrogen or methane gas after ingesting a specific sugar (e.g., lactulose or glucose). Abnormal rise suggests bacterial overgrowth.
Small bowel aspirate and culture (less common): Direct sampling of fluid from the small intestine to identify bacterial overgrowth.
Imaging studies (not routinely used for diagnosis, but may be helpful in some cases):
Abdominal X-ray or CT scan – to rule out other causes of symptoms.
Assessment:
Clinical suspicion of SIBO: Based on history, physical exam findings, and risk factors.
Confirmation of SIBO: Relies on breath testing results or small bowel aspirate culture.
Severity of SIBO: Correlated with symptom severity and impact on quality of life.
Plan:
Treatment approach:
Dietary modifications:
Low FODMAP diet (eliminates fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) to reduce substrate availability for bacteria.
Smaller, more frequent meals may improve symptoms.
Antibiotics:
Rifaximin (Xifaxan) – the most commonly used antibiotic for SIBO.
Other antibiotics (e.g., neomycin) may be considered in some cases.
Discuss potential side effects of antibiotics with the patient.
Probiotics: May be helpful in some patients, but research is ongoing.
Follow-up:
Re-assessment after treatment to evaluate symptom improvement.
Repeat breath testing (if needed) to confirm eradication of SIBO.
Long-term management plan to address underlying conditions and prevent recurrence.
Patient education: Provide information about SIBO, its causes, treatment options, and dietary modifications.
Explain the importance of dietary changes in managing SIBO.
Discuss potential triggers and identify strategies to avoid them.
Encourage open communication about any questions or concerns.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of small intestinal bacterial overgrowth.