Eradication of small intestinal bacterial overgrowth in irritable bowel syndrome using herbal therapy: A case report

Abstract

Small intestinal bacterial overgrowth (SIBO) is a common pathology in irritable bowel syndrome (IBS). Symptoms include bloating, excessive belching, flatulence, epigastric and abdominal pain, nausea, early satiety, fatigue and altered bowel habits. Given the high incidence of IBS globally, SIBO needs to be investigated in IBS using hydrogen and methane breath testing. Adherence to the North American Consensus 2017 or the updated guidelines from the Association of Gastrointestinal Physiology (AGIP) committee of the British Society of Gastroenterology 2019 is necessary to ensure that testing and diagnosis are standardised. The treatment of SIBO with antibiotics, most commonly rifaximin, may restore gastrointestinal function and reduce the symptoms of IBS. A number of herbal and nutraceutical supplements are known to exert antimicrobial effects. There is increasing awareness amongst the public regarding these herbal and nutraceutical supplements, and there is an increased demand for their use. The present study describes the case of a patient with severe IBS symptoms, scoring in the extreme category on a quality of life questionnaire validated for IBS and functional digestive disorders. The patient tested positive for SIBO, which was then eradicated using a herbal formulation containing garlic, berberine, oregano, grapefruit seed extract and caprylic acid, while following a diet low in fermentable oligo‑, di‑, mono‑saccharides and polyols (FODMAP). The patient's quality of life assessment markedly improved following treatment and the remaining symptoms improved at the 3‑month follow‑up performed by verbal confirmation.