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Essential Medical Disorders of the Stomach and Small Intestine pp 417–436Cite as

Small Intestinal Bacterial Overgrowth

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Abstract

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.

Keywords

  • Small intestinal bacterial overgrowth
  • Microbiota
  • Breath hydrogen test
  • Jejunal aspiration
  • Irritable bowel syndrome
  • Rifaximin

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Essential Readings

  • 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 detail

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  • Gatta L, Scarpignato C. Systematic review with meta-analysis: rifaximin is effective and safe for the treatment of small intestine bacterial overgrowth. Aliment Pharmacol Ther. 2017;45:604–16. A detailed assessment of the impact of rifaximin in SIBO

    CrossRef  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Gastroenterology, Houston Methodist Hospital, Houston, TX, USA

    Eamonn M. M. Quigley

Authors
  1. Eamonn M. M. Quigley
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Corresponding author

Correspondence to Eamonn M. M. Quigley .

Editor information

Editors and Affiliations

  1. Mayo Clinic, Jacksonville, FL, USA

    MD Brian E. Lacy

  2. Mayo Clinic, Scottsdale, AZ, USA

    MD John K. DiBaise

  3. Cedars-Sinai Medical Center, Los Angeles, CA, USA

    MD Mark Pimentel

  4. Leeds Teaching Hospitals NHS Trust, Leeds Gastroenterology Institute, Leeds, UK

    Dr. Alexander C. Ford

Self-Test

Self-Test

  • Question 1. SIBO may be complicated by which one of the following?

    1. A.

      Vitamin B12 deficiency.

    2. B.

      Folate deficiency.

    3. C.

      Small intestinal lymphoma.

    4. D.

      Elevated levels of vitamin B12 in serum.

  • Question 2. Which one of the following is regarded as diagnostic of SIBO?

    1. A.

      >103 CFU/mL of Gram-positive organisms in a jejunal aspirate.

    2. B.

      A rise in breath hydrogen of more than 10 ppm within 120 min of lactulose ingestion.

    3. C.

      The detection of any hydrogen or methane in the basal breath sample, before either lactulose or glucose is administered.

    4. D.

      > 105 CFU/mL of bacteria in a jejunal aspirate.

  • Question 3. Regarding the use of rifaximin in SIBO, which one of the following is correct?

    1. A.

      Systemic side effects are a long-term issue because of the rapid absorption of the drug.

    2. B.

      It can only be used for one 2-week course as efficacy is lost at that stage.

    3. C.

      Eradication rates in excess of 60% are to be expected.

    4. D.

      Clostridium difficile-associated disease (CDAD) is a common side effect.

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Quigley, E.M.M. (2019). Small Intestinal Bacterial Overgrowth. In: Lacy, B., DiBaise, J., Pimentel, M., Ford, A. (eds) Essential Medical Disorders of the Stomach and Small Intestine. Springer, Cham. https://doi.org/10.1007/978-3-030-01117-8_20

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  • DOI: https://doi.org/10.1007/978-3-030-01117-8_20

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-01116-1

  • Online ISBN: 978-3-030-01117-8

  • eBook Packages: MedicineMedicine (R0)

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