Does Celiac Disease Cause SIBO and IBS?
Celiac disease, a digestive disorder, is caused by an immune response to eating gluten found in barley, wheat, and rye. When you are diagnosed with the disease, you may think that following a gluten-free diet plan will solve the digestive issue.
Research studies, however, show that it is not always easy to overcome the symptoms of celiac disease. There are many potential reasons for the persistent digestive symptoms, which can occur along with the celiac disease. These include irritable bowel syndrome (or IBS), inflammatory bowel disease (or IBD), and gastrointestinal reflux disease (or GERD).
Table of Contents
- 1 What is SIBO
- 2 What is IBS
- 3 What are the Causes of SIBO
- 4 Celiac Disease and SIBO/IBS: How are They Connected
- 5 Can Celiac Disease and SIBO Coexist
- 6 Why does Celiac Disease Lead to SIBO/IBS
- 7 What are the Treatment Options
- 8 Conclusion
Non-digestive conditions, including thyroid disease, can also lead to digestive symptoms. However, one of the most common explanations for the ongoing symptoms is small intestinal bacterial overgrowth or SIBO.
According to a study, SIBO affects patients with celiac disease with continuing GI symptoms like abdominal pain, diarrhea, bloating, excessive gas, and nausea 1. Do they sound familiar? First of all, let us find out everything about SIBO.
What is SIBO
Your digestive system comprises millions of bacteria, most of which live in the large intestine. These bacteria help you to digest the food you eat and produce vitamins, including biotin and Vitamin K.
The small intestine, on the other hand, contains different varieties of bacteria and in smaller amounts as compared to your large intestine. Small intestinal bacterial overgrowth refers to the condition in which bacteria from the large intestine travels to your small intestine and flourish 2.
When these bacteria multiply where they are not supposed to, they cause all sorts of digestive problems, and in severe cases, SIBO leads to deficiencies of nutrients and vitamins. Proper diagnosis of SIBO is difficult, and the symptoms do not always improve with treatment.
- Learn more about SIBO: Everything About SIBO – Causes, Symptoms and More
What is IBS
Irritable bowel syndrome or IBS, also known as irritable colon and spastic colon, is an intestinal disorder that causes stomach pain, constipation, wind, and diarrhea. Its diagnosis is made after evaluating the symptoms.
Some patients with IBS can improve their symptoms by managing stress, diet, and lifestyle. Others, however, require medication and counseling.
- Learn more about IBS, Anxiety, and Stress
What are the Causes of SIBO
Excess bacteria residing in the small intestine make it harder for your gut to digest and absorb the nutrients. These bacteria can also cause a fair amount of damage to the lining of your intestine. Here, we explore some of the conditions that cause bacterial overgrowth in your small intestine.
- Short bowel syndrome because of surgical removal of your small intestine
- Immunoglobulin deficiency or AIDS
- Diseases like scleroderma and diabetes that cause movement issues in your small intestine
- A surgical procedure that produces a loop in your small intestine, facilitating the growth of excess bacteria
- Large sacs may occur in the lining of your intestine if you have small bowel diverticulosis. The sacs allow hundreds and thousands of bacteria to grow
Celiac Disease and SIBO/IBS: How are They Connected
Celiac disease, as it is mentioned above, occurs when the body’s immune system erroneously responds to gluten, which is found in rye, barley, and wheat. When a person with celiac disease consumes gluten, the white blood cells target the lining of his small intestine, destroying the intestinal villi and causing villous atrophy. Although the celiac disease is a digestive disorder, it affects the entire body with symptoms occurring not just in your digestive tract but also on your skin and brain 3.
The symptoms of SIBO are almost similar to that of the celiac disease. Some of the similar digestive symptoms include diarrhea, gas, bloating, heartburn, and abdominal pain. However, severe forms of small intestinal bacterial overgrowth can lead to weight loss and fatigue.
These symptoms can also occur as a result of celiac disease that is left undiagnosed and untreated, which causes your body’s immune system to destroy the lining of your small intestine. As a matter of fact, small intestinal bacterial overgrowth can actually cause villous atrophy, which is the same kind of small intestinal damage observed in people with celiac disease.
Diagnosis of celiac disease involves blood tests to find out specific markers that point out toward your body’s immune reaction to gluten. These blood tests, along with a medical procedure known as endoscopy, allows your healthcare professional to look at the lining of your small intestine, helping in identifying the celiac disease.
Whereas a breath test is used for the diagnosis of SIBO, doctors can also use endoscopies. Things could get a bit complicated when people have celiac disease, as the breath test for SIBO does not work well in them.
Can Celiac Disease and SIBO Coexist
Yes, it is possible to get affected by both celiac and SIBO simultaneously, which is the reason why it becomes difficult to tell their symptoms apart.
As a matter of fact, some studies indicate that celiac disease leads to SIBO and IBS, and it commonly occurs in people whose symptoms do not improve even after following the gluten-free diet. A review of medical literature on celiac and SIBO has indicated that about one-fifth of those who had celiac are also affected by SIBO 4.
The review highlighted the fact that 28% of the celiacs who had persistent symptoms despite having a gluten-free diet also had SIBO. Surprisingly, only 10% of the celiacs whose symptoms improved after following the gluten-free diet tested positive for SIBO.
Why does Celiac Disease Lead to SIBO/IBS
Although researchers have found that people with celiac disease have a higher risk of being affected by SIBO, the reason is not clear. A possible explanation is the intestinal motility or the speed with which the food moves through the digestive tract.
Those who have celiac disease may have either slower-than-normal or faster-than-normal motility. They can also have faster-than-normal motility in one part (such as the colon) combined with slower-than-normal motility in another part (such as the stomach). Intestinal motility issues can facilitate bacteria to thrive in places where they are not supposed to grow.
What are the Treatment Options
The objective is to treat the cause by using any of the following:
- Medicines that increase the speed of intestinal movement
- Nutrition that is given through the patient’s vein
- Intravenous fluids
- Dietary changes such as a lactose-free diet
Your doctor probably will prescribe an antibiotic called rifaximin. The antibiotic, also used for treating traveler’s diarrhea, is not absorbed well by your body. It means that the antibiotic works exclusively in the digestive tract.
Remember that SIBO is not exclusively treated with rifaximin, and it does not work well in every patient. A study has shown that people having celiac disease and SIBO were given rifaximin, but they did not show any reduction of digestive symptoms.
As you know, there is no specific treatment available for SIBO, and practitioners may use different methods to keep bacterial overgrowth in check. Aside from taking the medicines prescribed by your doctor, you should try every possible way to improve the symptoms.
Make sure to space meals about 4-5 hours apart, as it allows your body’s electromechanical activity to work properly, cleansing your gut with intestinal juices and washing away harmful bacteria. Finally, incorporate moderate exercises into your routine and take 6-8 cups of fluid every day to help normalize bowel patterns.