The Spectrum of Small Intestinal Bacterial Overgrowth (SIBO)
Purpose of Review
To critically review recent (past 3 years) literature on the definition, diagnosis, and management of small intestinal bacterial overgrowth (SIBO).
While various series continue to illustrate the occurrence of SIBO in disease states where well-known risk factors for its occurrence are present (hypochlorhydria, disorders of intestinal structure or motor function, pancreatic insufficiency, and chronic liver disease, for example), the current challenge is in defining the limits of SIBO. Is SIBO truly common among those with “functional” gastrointestinal symptoms where there is no evidence of maldigestion or malabsorption; the original hallmarks of SIBO? Our attempts to address this question continue to be hampered by the limitations of our diagnostic tool kit. There is hope—the application of modern molecular techniques to the study of the small intestinal microbiome, together with some innovative sampling techniques, such as real-time intestinal gas sampling, may soon allow us to truly define the spectrum of SIBO.
SIBO, once removed from its original confines as a cause of malabsorption syndrome, has proven to be an elusive and moving target. Only the most rigorous studies employing validated methodologies will finally corral this mysterious entity.
KeywordsSmall intestinal bacterial overgrowth Microbiome Breath testing Hydrogen methane Rifaximin
This study is supported, in part, by a bequest from the Hughes-Sterling Foundation.
Compliance with Ethical Standards
Conflict of Interest
Eamonn M M Quigley reports consultancies with and/or research support from 4D Pharma, Alimentary Health, Allergan, Axon Pharma, Biocodex, Glycyx, Ironwood, Pharmasierra, Salix, Shire, Takeda, Vibrant, and Zeeland.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
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