Stasis

Our colon contains billions of bacteria. Ideally, the small intestine inhabits "Gram-positive" bacteria (such as Blautia, Rumminococcaceae, etc.),  that we live with in peace, and even enjoy their beneficial effect on our health.

In a state of imbalance, a proliferation of "Gram-negative" bacteria (such as Enterobacteriaceae, escherichia coli, klebsiella, etc.) begins in the small intestine, as well as "Gram-positive" bacteria that should not be inhabited (such as the Enterococous species, Staphylococcus Streptococcus, etc.).

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Some of these bacteria are naturally found in the colon as well as in our mouth, but their presence in the small intestine can certainly be detrimental to our health.

This unwanted bacteria usually finds its way from the colon and mouth to the small intestine due to stasis (intestinal immobility), a condition in which there's no normal and smooth movement of food from the small intestine to the large intestine, which naturally raises the level of bacteria in the small intestine.

This also causes the migration of bacteria from the large intestine to the small one. 

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Stasis can be caused by several conditions:

• Gastroparesis - a disease in which there is a slow gastric emptying process.

• Celiac disease (wheat allergy)

• High levels of LPS - which are toxins that secrete Gram-negative bacteria. These toxins penetrate the brain and impair intestinal motility through the secretion of TNF alpha pro-inflammatory protein. 

Hypochlorideria

Every day trillions of bacteria flow from the mouth into the stomach through ingestion of food and saliva, but most of them are eliminated by the hydrochloric acid secreted in the stomach.

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Stomach acid plays a crucial role in digestion and in controlling bacterial populations by killing or inhibiting the growth of ingested microorganisms. When stomach acid is low (hypochlorhydria), this protective barrier is weakened, allowing more bacteria to survive and potentially colonize the small intestine.

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Low stomach acid impairs the breakdown of food and the activation of digestive enzymes. This incomplete digestion can leave more nutrients available in the small intestine, providing fuel for bacteria to multiply abnormally, which is the hallmark of Sibo.

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​Hypochlorhydria can be caused by the use of acid-suppressing medications such as proton pump inhibitors (PPIs) or chronic Helicobacter pylori infection. Both of these factors reduce stomach acid and are associated with an increased risk of SIBO.

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Other causes:

• Structural Abnormalities

Anatomical changes or abnormalities—like strictures, adhesions, small intestine diverticula, bowel obstructions, and surgically created blind loops (e.g., after gastric bypass or other abdominal surgeries)—create areas where bacteria can accumulate and overgrow

• Impaired Digestive Secretions

Pancreatic insufficiency (lack of digestive enzymes) and reduced bile flow both decrease the antibacterial effects in the small intestine, making it easier for bacteria to proliferate.

• Immune System Disorders

Immunodeficiency conditions (such as HIV, IgA deficiency, or other immune disorders) weaken the gut’s natural defenses against bacterial overgrowth

• Other Medical Conditions

Chronic pancreatitis, celiac disease, Crohn’s disease, cirrhosis, and other systemic illnesses can predispose individuals to SIBO by affecting motility, immunity, or the structure of the gut.

• Medications

Long-term use of certain medications, including opioids (which slow gut motility) and acid-suppressing drugs, can increase the risk of SIBO.

• Aging

Older adults are at greater risk due to naturally declining stomach acid and motility, as well as increased use of medications that affect these functions.

• Stress

Chronic stress can reduce stomach acid, slow gut motility, and weaken the immune system, all of which contribute to SIBO risk