Small Intestinal Bacterial Overgrowth
Small intestinal bacterial overgrowth (SIBO) was described many years ago as an important cause of maldigestion and malabsorption among individuals who had undergone upper gastrointestinal surgery or had some other major anatomical anomaly or motility disorder of the small intestine. More recently the definition of SIBO has been extended to a much larger patient population – individuals who would otherwise be classified as a functional gastrointestinal disorder but who have tested positive for SIBO, usually on the basis of a breath test. This extension of the concept of SIBO is problematic as it assumes that the available tests to diagnose SIBO are accurate, which they are not. The challenges that the diagnosis and management of this disorder pose will be explored.
KeywordsSmall intestinal bacterial overgrowth Microbiota Breath hydrogen test Jejunal aspiration Irritable bowel syndrome Rifaximin
- 1.Quigley EMM. Small intestinal bacterial overgrowth. In: Feldman M, Friedman LS, Brandt LJ, editors. Sleisenger and Fordtran’s gastrointestinal and liver disease. 10th ed. New York: Elsevier; 2016. p. 1824–31.Google Scholar
- Rezaie A, Buresi M, Lembo A, Lin H, McCallum R, Rao S, Schmulson M, Valdovinos M, Zakko S, Pimentel M. Hydrogen and methane-based breath testing in gastrointestinal disorders: the North American consensus. Am J Gastroenterol. 2017;112:775–84. Though its recommendations are not without its critics, this recent consensus document discusses the current status of breath testing in some detailCrossRefGoogle Scholar