Our entire intestinal tract is filled with bacteria - good bacteria and not so good. My doctor explained my SIBO was caused by good bacteria in the lower intestines migrating to the upper small intestines to feed. That is due to not digesting food well in the small intestine to move it to the lower where these bacteria feed and causing problems like gas and acid reflux. I took prebiotics and probiotics for a period of time. When my symptoms subsided, I went off the prebiotic and continued with the probiotics. During this time I also made changes to my diet - omitted sugar (substituting stevia for tea and coffee) and sugar laden desserts, reduced alcohol, limited fruits to berries, and vegetables low in sugar. Bacteria like to feed on the sugars. So the goal was to get the lower intestinal bacteria back to the lower intestine by improving digestion in the upper small intestine. I also took 10 minutes before meals 2 pumps of bitters with water to get the digestive juices going, followed by a digestive enzyme after several bites of food.
Prior to all this, I took Rifaxamin for 6 weeks prescribed by a different doctor but once off it without the dietary changes, the symptoms returned.
I’m now symptom free which has benefited my heath in other ways as well.
In my humble opinion, a doctor should be open to both botanical, herbal supplements as well as a pharmaceuticals if that is the best way to treat and also test for vitamin and mineral levels to prescribe supplements to get the vitamins and minerals we may be low in that are critical to our well being.