Still bloated after SIBO treatment?

I was treated for SIBO and got better… but not completely

If you took antibiotics, followed the diet, felt somewhat better and are still bloated, it doesn't mean there's no solution. It usually means a piece is missing. Here are the ones I find most often in my practice.

"My digestive system has always been my weak spot." "On stressful days, I'd feel it in my stomach." "A few years ago, everything got worse." "I had a test, they gave me antibiotics and a diet, and I got better. But never completely."

I hear this story almost every day in my practice, in different words but nearly always in this order. If it sounds familiar, this article is for you.

Getting partly better is information too

The fact that treatment helped a little doesn't mean it failed, or that your case can't be solved. It means it dealt with one part of the problem.

Bloating, gas or changes in bowel habits rarely have a single cause. An imbalance in the gut microbiota, a more sensitive gut, a way of eating that makes you swallow a lot of air, a period of stress that never quite ends and a diet that keeps getting smaller can all exist at the same time. If only one of those pieces is addressed, what you'd expect is exactly what happened to you: you get better, but not completely.

What a breath test can tell you (and what it can't)

The breath test is a useful tool, and I use it. But it helps to know what it measures: the gases bacteria produce when they ferment a sugar you drink during the test. It's an indirect measurement, and the result depends on how you prepared for the test, how fast your gut transit is and how the result is interpreted.

That's why its accuracy is limited, and a borderline result ("a bit of hydrogen") on its own neither confirms nor rules out very much. The Spanish societies of neurogastroenterology and digestive pathology have warned about common mistakes in how it's interpreted.

My approach is simple: the test is one piece, not the whole diagnosis. I review it alongside your symptoms, your history and the rest of your tests. If you'd like to understand what SIBO is, I explain it in this article.

The pieces the test can't see

These are the ones I find most often when a patient comes to me after a treatment that only partly worked.

1. What happened when everything got worse

It's one of my first questions. Behind "a few years ago it got worse" I find all sorts of things: a period of very restrictive dieting, a difficult relationship with food, a loss, a trip, a time of heavy pressure.

It isn't a minor detail. The gut and the nervous system are in constant communication through the gut–brain axis, and the system that regulates your stress response can change how sensitive your gut is and its rhythm. Understanding what set off the symptoms tells me what needs working on.

2. How you eat

Eating fast, chewing little or talking while you eat are linked to swallowing more air. That air doesn't show up on any test, but you notice it: in burping, in feeling full, and it can add to bloating.

3. How you breathe and how you sit

Breathing through your mouth, breathing high up in your chest or spending many hours hunched over are patterns I see very often in patients with bloating. The evidence on this link is still limited, so I'll call it what it is: a clinical observation I always take into account when building your plan.

4. How your abdomen responds to gas

Many people with distension notice that their belly "grows" over the day and is back to normal by the morning. Studies show that in many of these cases there isn't much more gas than normal: what changes is the body's response. Instead of relaxing, the diaphragm pushes down, and the abdominal wall relaxes outwards.

It's called abdominophrenic dyssynergia, and much of what we know about it was researched in Barcelona hospitals. The important part is that it can be treated: in clinical trials, guided training of breathing and the abdominal muscles reduced distension.

5. What you've cut out of your diet

Every diet that doesn't fully work tends to leave some food out for good. So many patients come to me eating fewer and fewer things, afraid of food, and with the problem still unsolved.

That's why I don't do restrictive diets. When a tool like a low-FODMAP diet makes sense, I use it temporarily and with reintroduction, because the goal is to widen your diet, not narrow it.

Before repeating treatment, I look for the main driver

One of the questions I'm asked most is: "Do I need to take antibiotics again?" Sometimes another treatment is indicated, and when it is, I prescribe it. But first I identify the main driver to work on in your case: it may be stress, the way you eat and breathe, posture, the microbiota, gut transit… or several at once.

And above all, I explain it to you. When you understand what's happening in your body, the changes make sense and they're much easier to keep up.

A profile I see often

A patient arrives with a near-normal breath test, with a bit of hydrogen. She has already been treated. As we talk, something else comes up: she eats very fast, breathes through her mouth and spends the day hunched over.

In a case like this, the plan doesn't start with another antibiotic or with cutting out foods. It starts with explaining what's happening and working on how she eats, how she breathes and her posture, with support from other professionals when needed (physiotherapy or ENT, for example).

Composite profile based on what I see in my practice. It doesn't correspond to any specific patient.

When not to wait

Some symptoms should never be put down to a functional problem without being investigated. If you have any of these, see whichever doctor you can get to first, as soon as possible:

• Weight loss you weren't trying for.

• Blood in your stool.

• Anaemia.

• Fever.

• Abdominal pain that wakes you up at night.

What your first visit with me is like

The first visit is long and thorough. It isn't a consultation to give you another diet: it's to understand what's happening to you, why and since when.

• Your symptoms and your story: when it all started and what was going on in your life at the time.

• Your tests: breath tests, blood tests, gastroscopies, colonoscopies, ultrasounds, stool tests. If something important is missing, I'll guide you. I order what could change a decision, not tests for the sake of it.

• Your medication and supplements: I review what you take and how. Often it's about simplifying.

• Your real habits: your schedule, work, how you eat, how you breathe, how you sleep.

• A Traditional Chinese Medicine perspective: the pattern of your symptoms helps me choose foods, preparations and routines that suit you better.

Afterwards you receive a written plan made for your life, and I explain every recommendation and why it's there.

In person in Barcelona or online

I see patients in person in Barcelona and online, with the same level of detail. Listening to your story, reviewing your tests and building your plan work just as well remotely, so you can see me even if you live in another city or outside Spain.

Frequently asked questions

Do I need to repeat the breath test?

Not necessarily. First I review the one you already have: how it was done, what it showed and whether it fits your symptoms. I only order a new test if its result could change what we do.

Are you going to put me on another diet?

Not a restrictive one. Your plan starts from a varied diet adapted to what your gut tolerates right now. If I use any restriction, it's temporary and with reintroduction.

What should I bring to my first visit?

Everything you have: breath tests, blood tests, endoscopy or colonoscopy reports, ultrasounds, stool tests and a list of the medication and supplements you take or have taken. If your visit is online, send them to me beforehand.

Can I see you if I don't live in Barcelona?

Yes. The online first visit is as thorough as the in-person one, and I adapt the plan to your country, your schedule and the foods available where you live.

Does this story sound familiar?

Book your first visit and bring your tests. We'll look at them together and put the pieces in order.

Book your first visit · in person in Barcelona or online

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Dr. Sonia Ojeda · Physician trained in gastroenterology, with residency in Argentina and experience in Barcelona hospitals. Integrative digestive medicine. More about me