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Small Intestinal Bacterial Overgrowth (SIBO) – An Update

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Small intestinal bacterial overgrowth (SIBO) is a common disorder, yet poorly recognized even within the conventional gastroenterology community. There is growing awareness of SIBO in North America since the 2006 publication of Pimentel’s book “A New IBS Solution: Bacteria – The Missing Link in Treating Irritable Bowel Syndrome.” SIBO tends to recur after initial treatment and successful ongoing management requires an understanding of risk factors, appropriate testing and test result interpretation, and treatment strategies. The purpose of this presentation is to provide a current evidence-based review of various aspects of SIBO, predisposing factors, diagnostic tests, therapies and clinical management.

Learning Objectives

By the end of this lecture, the clinician will be able to:

Understand the accepted criteria for positive SIBO testing and interpretation of various breath test results.

Appreciate the significance of considering hydrogen sulfide producing bacteria.

Understand the pros and cons of various antimicrobials in the treatment of SIBO.

Appreciate the significance of considering bile acids and their effects on gut microbiota.

Consider the possibility of exocrine pancreatic insufficiency in patients with SIBO who have persistent diarrhea.

Understand the evidence supporting fecal microbiota transplantation for patients with SIBO.

CE Credits

CONO: Category A General – 0.75 credit; Pharmacology – 0.25 credit
British Columbia: Category C General – 1.0 credit
AANP: General – 0.75 credit; Pharmacy – 0.25 credit
OANP/OBNM: For Oregon attendees seeking OBNM approved CE credits, please note that this event has not been submitted for approval to the OBNM. CE certificate will be issued upon individual request.

Dr Michael Traub, ND, DHANP, CCH, FABNO

Dr Michael Traub obtained his undergraduate degree in biological sciences from the University of California, Irvine in 1976 where he conducted neurobiology research of learning and memory for Professor James L. McGaugh. He graduated from the National College of Naturopathic Medicine in 1981 and completed a residency there in Family Practice and Homeopathy.

He became board certified in homeopathic medicine by the Homeopathic Academy of Naturopathic Physicians in 1989. Dr Traub was recognized for his many years of service to the American Association of Naturopathic Physicians, including President from 2001-2003, when he was honored with the 2006 Physician of the Year Award. His father was a dermatologist, and this inspired Dr Traub to undertake extra study in this subject. He has taught dermatology at five of the seven accredited naturopathic medical schools in North America and is the author of “Essentials of Dermatologic Diagnosis and Integrative Therapeutics.”

He is a recognized authority in the naturopathic profession on dermatology. He serves on the scientific advisory boards of several natural product companies, and has been actively engaged in clinical research for most of his career. Dr Traub has been medical director of Lokahi Health Center in Kailua Kona, Hawaii for the past 37 years. He is also board certified in naturopathic oncology by the American Board of Naturopathic Oncology.