Small Intestine Bacterial Overgrowth (SIBO) is caused by bacterial overgrowth in small intestines resulting in a number of uncomfortable symptoms including bloating, extreme abdominal pain (some describe as if stomach may explode!), nausea, vomiting, and diarrhea. In extreme case, it also causes fear of eating as episodes follow eating (often rich in carbohydrates).
The bloating is caused by gas (either hydrogen or methane) which can be detected by tests. While many antibiotics can be used to to treat SIBO, rifaximin (poorly absorbed antibiotic) has best evidence for treating SIBO. However, rifaximin does not have 100% success rate. There are studies that show that herbal therapy is equivalent to rifaximin. (Chedid V, Dhalla S, Clarke JO, Roland BC, Dunbar KB, Koh J, Justino E, Rn ET, Mullin GE. Herbal therapy is equivalent to rifaximin for the treatment of small intestinal bacterial overgrowth. Global advances in health and medicine. 2014 May;3(3):16-24.)
For my patients, I recommend food based approach to healing. There are two main approaches - 1. Ketogenic diet with no added sugar 2. Elemental diet. Of the two approaches, elemental diet shows up to 85% success rate.
Below is an excellent article on SIBO: