Is SIBO Chronic? Not Necessarily.

I often encounter patients who have read online that SIBO (small intestinal bacterial overgrowth) is a chronic condition that never fully goes away. In my clinical experience, this is not true. However, it can feel like a chronic issue when it’s either misdiagnosed or not treated thoroughly.

Why Accurate SIBO Diagnosis Matters

Let’s start with diagnosis. The most accurate, readily available, way to diagnose SIBO, is with a breath test. Sometimes patients tell me they were diagnosed using a specialty stool test. While certain stool markers might suggest the possibility of SIBO, they are not definitive or diagnostic.

I typically order at-home breath tests, which I have found to be very reliable. These tests are often easier for patients to complete than in-office ones, especially since I usually order the 3-hour tests, to make sure to catch cases in people who have slower digestive motility. These breath tests measure hydrogen and methane gas levels in the breath. (When methane is elevated, it is technically considered Intestinal Methanogen Overgrowth, or IMO.)

Why does this matter? Because an accurate diagnosis is the first step to an effective, complete treatment plan. Which gases are present, and how elevated the levels become, are key to guiding treatment strategies.

SIBO Treatment Plans Based on Breath Test Results

Knowing your gas levels helps tailor the treatment approach. As a naturopathic doctor, I offer an integrative treatment plan. This may include:

Prescription antibiotics
Herbal antimicrobials
Or a combination of both

I generally don’t recommend antibiotics without a confirmed diagnosis. But with a positive test, the treatment recommendations change depending on the type and amount of gases present.

Some patients choose to go the herbal route only, which is totally fine. While it may take longer to fully eradicate with herbals alone, it is definitely possible.

Preventing Chronic SIBO with Complete Treatment

So, how do we prevent SIBO from becoming chronic? We treat it until it has fully resolved. One of the most common mistakes I see is under-treatment. The only reliable way to confirm eradication is by repeating the breath test.

What to Do When SIBO Symptoms Don’t Improve

Sometimes, gas patterns change in ways that give clues about how to shift treatment strategies, and this is where repeat testing can be helpful. Adjustments made based on the results can make your treatment plan more precise and more effective.

The key is working with a provider who has the clinical insight and experience to guide you through the process until the SIBO is truly resolved.