Small Intestinal Bacterial Overgrowth
A feeling that something is stuck in your throat, frequent throat clearing, a hoarse voice. If an examination of the nose and throat shows no clear cause, the problem may be coming up from the gut. At Yonsei DANA ENT Clinic, we look at the larynx and the condition of the gut together in one place.
SIBO (small intestinal bacterial overgrowth) is a condition in which bacteria that should mainly live in the large intestine increase excessively in the small intestine. When gas produced in the small intestine pushes up on the stomach, reflux can occur, and as a result throat symptoms may be noticed before abdominal symptoms.
The diagnosis is made by considering the hydrogen breath test together with the consultation; it is not decided by a single test value.
If you have these symptoms together
Not all of the symptoms below mean SIBO. However, if throat symptoms and digestive symptoms occur together and persist, that is a reason to check the condition of your gut as well.
Symptoms felt in the throat
A lump-in-the-throat feeling, frequent throat clearing, a hoarse voice, a sore or stuffy throat on waking — when a nose and throat examination shows no clear cause.
Reflux-related symptoms
Heartburn, sour or bitter fluid coming up, chest tightness that worsens after meals or when lying down, frequent burping.
Symptoms felt in the belly
Bloating after meals, gas, gurgling sounds, alternating diarrhea and constipation, symptoms that worsen after certain foods.
Changes felt throughout the body
Tiring easily, a foggy head, difficulty concentrating. These can be related to nutrient absorption or inflammation, so we check them as well.
Background factors
Conditions that slow gut motility, long-term use of acid-reducing medication, a history of abdominal surgery, and underlying conditions such as diabetes or thyroid disease.
What you have been through
You have been tested at several hospitals without finding a clear cause, or your throat symptoms remain even while taking reflux medication.
About the hydrogen breath test
After drinking a set solution, you breathe into a device at regular intervals so we can measure how the hydrogen concentration in your breath changes. It is a needle-free test; you only breathe out.
Before testing
- Preparation depends on your meals and current medications before the test
- If you take antibiotics, probiotics, or medications that affect gut motility, please tell us in advance
- Please do not stop your medications on your own
- Preparation and time required are explained when you book.
Limits in reading the results
- The breath test is supporting information.
- False positives and false negatives are both possible
- Gut transit time, recent meals, and medications can affect the result
- We interpret it not by a single number but together with your symptoms .
How your care proceeds
We listen closely to how your symptoms developed
Since when, how they relate to meals, and whether throat or belly symptoms came first. We also review the tests you have had so far and your current medications.
We examine the throat and nose first
With an ENT examination, we check for rhinitis or postnasal drip, mucosal changes from reflux, and the condition of the vocal cords. If a cause is found here, we address it first.
We recommend tests when needed
Along with the hydrogen breath test, we recommend functional medicine tests such as nutritional status or inflammation markers when needed. The tests depend on your symptoms and previous results.
We explain the results in relation to your symptoms
We look at how well the test values explain your current symptoms and whether there are other causes. Whether and how to treat is decided at this stage.
We treat and follow your progress
When needed, we combine eradication treatment with dietary adjustment and also look at background factors such as gut motility, stomach acid, and underlying conditions. We then adjust according to how your symptoms change.
Treatment and care in five steps
We apply the 5R framework used in functional medicine for gut problems, with the order adjusted to fit the characteristics of SIBO. Reducing bacteria alone is not the end. If we don't also look at why they increased, the overgrowth can come back.
RemoveRemove — reduce the overgrowth and irritating factors
When the consultation indicates it is needed, we carry out eradication treatment and temporarily adjust foods that worsen symptoms. The medication and duration are decided by the doctor after the consultation, and because side effects can occur, we proceed while monitoring your progress.
ReplaceReplace — supply what digestion needs
If stomach acid, digestive enzymes, or bile flow are insufficient, food is not broken down properly, creating an environment where bacteria can increase more easily. When needed, we discuss supplementation after evaluation.
RepairRepair — support recovery of the intestinal lining
We check nutritional factors involved in mucosal recovery, such as zinc, glutamine, and vitamins, and supplement what is lacking. In SIBO, we place this step before reintroducing bacteria.
ReinoculateReinoculate — start when the timing is right
Unlike the standard 5R, in SIBO using probiotics too early can make symptoms worse. We decide the timing and type after the lining has recovered to some extent and symptoms have settled, and stop if they don't suit you.
RebalanceRebalance — look at the background so it doesn't return
We look at reduced gut motility, long-term use of acid-reducing medication, a history of abdominal surgery, underlying conditions, meal spacing, sleep, and stress. Because recurrence is not uncommon, we keep following your progress even after symptoms improve.
Frequently asked questions
Isn't SIBO just a condition where gas builds up in the belly?
Bloating and gas are common symptoms, but they are not the only ones. When gas produced in the small intestine pushes up on the stomach, reflux can occur, and as a result some people notice symptoms in the throat first, such as a lump-in-the-throat feeling, frequent throat clearing, or a hoarse voice. That is why people whose belly feels fine but whose throat keeps bothering them come to an ENT clinic.
How is the hydrogen breath test done?
After drinking a set solution, you breathe into a device at regular intervals so we can measure changes in the hydrogen concentration in your breath. It is a needle-free test; you only breathe out. Preparation depends on your meals and current medications before the test, so we explain how to prepare when you book. Please do not stop your medications on your own.
If the test is positive, does treatment start right away?
No. The breath test is supporting information, and both false positives and false negatives are possible. We decide whether and how to treat at the consultation by looking at your symptom pattern, the relationship with meals, previous test results, and your medications together. Treatment is not decided by a single number.
Once treated, will it not come back?
SIBO recurs fairly often. It can return if underlying causes remain, such as reduced gut motility, low stomach acid, surgical or anatomical factors, or other medical conditions. That is why, even after symptoms improve, we continue to look at the causes, adjust diet and lifestyle, and follow your progress. Treatment results vary from person to person.
Do I have to stay on a low-FODMAP diet?
A low-FODMAP diet is a temporary method to reduce symptoms, not a diet to follow for life. After a restriction period, foods are reintroduced one at a time to find the range that suits you. Restricting for a long time on your own can lead to nutritional deficiencies, so we adjust it together at your visits.
We have put together a separate low-FODMAP diet guide
A specialist guide from Yonsei DANA ENT Clinic for people who need dietary management after a SIBO diagnosis. What to reduce and how to reintroduce foods is collected on a separate site (in Korean).
See the diet guide on fodmap.kr (Korean) ↗A low-FODMAP diet is a temporary method to reduce symptoms, not a diet to follow for life. Restricting for a long time on your own can lead to nutritional deficiencies, so the range and duration of restriction are adjusted together at your visits.
Throat symptoms and belly symptoms —
we look at them together in one place
Bringing the test results you have had so far and your current medications helps the visit.
- Phone
- 0507-1384-5075
- Address
- Rooms 322–323, 3F Lemeilleur Jongno Town, 19 Jongno, Jongno-gu, Seoul (Jonggak Stn Exit 1 · Gwanghwamun Stn Exit 4)
- Diet guide
- fodmap.kr — low-FODMAP diet guide (Korean) ↗