Why Does SIBO Keep Coming Back After Treatment? — Why the standard model predicts what actually happens

The standard SIBO treatment model rests on a specific causal claim. The disease is the microbial overgrowth. The lesion is in the small intestine. The cure is microbial reduction. If this account is correct, antimicrobial treatment should produce durable remission, and recurrence should be the exception rather than the rule. The data do not support this prediction. Recurrence is the rule. The model that produces a prediction inconsistent with the data is the model that needs to be re-examined. The dysbiosis-first paradigm has had decades and tens of thousands of treated patients to validate itself. It has not. This is not a failure of clinical competence. It is a failure of the framework. Clinicians applying the dysbiosis-first model are not making mistakes in execution. They are working from a model that misidentifies the lesion. Better execution of the wrong model produces the same result faster. The Host Capacity Model offers a different account. It begins from a different unit of analysis, makes different predictions, and points to a different set of interventions.