Sibo Diagnosis

[Feeneyja]

My 8yo daughter is just finishing up her gluten challenge and has blood work scheduled for next week, endoscopy scheduled for April 8th. Her breath test results just came back and she is positive for small intestine bacterial overgrowth. She will start antibiotics. The doctor has said that if she responds to the antibiotics we can cancel the endoscopy. I don't want to put her through more than necessary, but I don't think we should cancel the endoscopy. As I understand it, SIBO is a result of the intestines not working properly and is not a disease so much as a symptom. She clearly responded positively to a gluten free diet prior to seeing the doctor. And she got very sick when we reintroduced gluten for the challenge.

Did anyone else have a positive SIBO prior to celiac testing?

What do others think? Insist on the endoscopy no matter what?

[jddh]

SIBO is a disease, but can also be symptomatic of/caused by other issues, including celiac disease. A difficulty of separating the two pathologically is that SIBO often presents with the same changes in the small intestine (inflammation, villous atrophy). So if the endoscopy results report inflammation and villous atrophy, this could be indicative of SIBO, celiac disease, or indeed both.

 

On the other hand, most people with celiac disease have clear blood indicators (TTG, EMA) that ought to be abnormal after a gluten challenge. 

 

Conversely, there is some disagreement as to which breath tests can be considered reliable for SIBO. Do you know what catalyst they used (lactulose, lactose, glychocolic acid)?

 

IMO, I would be inclined to have all the tests done so you have the most information to work with. Your description certainly sounds like your daughter has a reaction to gluten, SIBO or not. One empirical way to proceed after her tests would be to put her back on a gluten free diet, but hold off on the antibiotics, to see how she responds. If her symptoms continue despite the diet, perhaps she needs to be treated for SIBO too. People are most often tested for SIBO in the context of celiac disease if they don't first respond to a gluten-free diet.

 

The difficulty of treating celiac disease (gluten-free diet) and SIBO (antibiotics) simultaneously is that if things get better, you don't know what was successfully treated. Regardless, if your daughter's symptoms resolve on either treatment, it's important to arrange a follow-up workup (bloodwork, endoscopy) to make sure her intestines are healing. This is usually done 6-12 months later.

 

Your doctor probably knows best, but lots of people on this forum have benefitted from pushing for getting all the tests possible done.