Why Does My SIBO Keep Coming Back?

Why Does My SIBO Keep Coming Back?

Why does my SIBO (Small Intestinal Bacterial Overgrowth) keep coming back?

This is one of the most common questions I get when patients call for a consultation.  People who were diagnosed with SIBO and have gone through treatment sometimes find their symptoms have returned in a few months or that they are not responding to treatments very well.

Here are three common causes of SIBO recurrence:  

Inadequate Treatment

Treatment for SIBO is determined based on the presenting symptoms—especially whether it’s predominantly diarrhea or constipation. The duration of treatment is estimated based on the severity of gas in the breath test result. Presence of biofilm can further complicate the situation. 

You can think of biofilm as a nest or fortress that some bacteria like to build around themselves.  These fortresses harbor a whole community of yeast, bacteria and viruses.  The biofilm can serve as a protective barrier for the integrity of the GI lining cells, but it can also protect bacterial overgrowth and promote local inflammation. 

If you don’t use the right tools to treat bacteria and biofilm or if you don’t treat the bacteria long enough, you will not get the results you hope for. 

Sometimes patients respond to some treatment better than the others, so it’s important to find an experienced practitioner who is familiar with all treatment options and can provide you with the right treatment—and alternatives when one doesn’t work out.


The overgrowth in the small intestine may be a result of the overgrowth of other organisms. It is quite common that people with SIBO also have yeast growth. 

Yeast can slow down the motility of the small intestine and cause recurrences of symptoms.  Yeast overgrowth can also cause symptoms similar to SIBO, such as bloating, abdominal pain, heartburn and constipation.

There is currently no test for testing fungal overgrowth in the small intestine, but testing for antibodies of candida albicans, checking presence of yeast in the stools or yeast metabolites in the urine can provide us some clues.

Some SIBO antibiotics or herbs don’t treat yeast, and some antibiotics even promote yeast overgrowth, so once again finding an experienced practitioner will help investigate your symptoms thoroughly and pick up the right tools for treatment

Besides yeast, other potential overgrowth are mold, lyme and parasites. Mold and lyme are particularly challenging to treat, so you will need to find a specialist, but once they are treated, SIBO doesn’t come back.  

Incurable underlying causes

Unfortunately, there are some underlying causes of SIBO which cannot be cured.  For example, post-infectious IBS is an autoimmune condition in which your body develops antibodies that attack the migrating motor complex that regulates the motility of the small intestine.  Given the nature of autoimmune disease, it’s not curable. 

Although it sounds depressing, it doesn’t mean that you are doomed for life.  It just means that you need a maintenance protocol to keep you in remission.  Patients can still have a good quality of life when they follow the protocol.  

If you have recurrent SIBO, I hope this article helps answer some of your questions. 

If you have other questions regarding how I treat SIBO, you can find my other blogs or schedule a complimentary 10 min consultation with me.

Dr. Sherry Su
Naturopathic Doctor San Jose


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