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Review
. 2020 Jun 27;12(6):e8860.
doi: 10.7759/cureus.8860.

Small Intestinal Bacterial Overgrowth: Comprehensive Review of Diagnosis, Prevention, and Treatment Methods

Ted George O Achufusi  1 , Anuj Sharma  2 , Ernesto A Zamora  1 , Divey Manocha  2
Affiliations
Review

Small Intestinal Bacterial Overgrowth: Comprehensive Review of Diagnosis, Prevention, and Treatment Methods

Ted George O Achufusi et al. Cureus. .

Erratum in

Abstract

Small intestinal bacterial overgrowth (SIBO) is a commonly diagnosed gastrointestinal disorder affecting millions of individuals throughout the United States. It refers to a condition in which there is an excess and imbalance of small intestinal bacteria. Despite its prevalence, it remains underdiagnosed due to the invasive nature of diagnostic testing. Symptoms observed in SIBO, including abdominal distension, bloating, diarrhea, and gas formation, are nonspecific and can overlap with other gastrointestinal disorders. Frequently cited predisposing factors include gastric acid suppression, dysmotility, gastric bypass, and opioids. The diagnostic gold standard remains small bowel aspirate and culture. However, due to its invasive nature, it remains an unpopular method among patients and clinicians alike. Glucose and lactulose breath testing have become the go-to diagnostic method in clinical practice due to its noninvasive nature and low cost. Treatment is guided towards the eradication of bacteria in the small bowel and usually consists of a prolonged course of oral antibiotics. Due to recent advances in our understanding of the human microbiome, we are surely poised for a transformation in our approach to diagnosing and treating this condition.

Keywords: diarrhea; dysmotility; hydrogen breath testing; inflammatory bowel disease; malabsorption; microbiome; rifaxamin; small intestinal bacterial overgrowth.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Breath test preparation
IV: intravenous
Figure 2
Figure 2. SIBO management algorithm
FODSMAPS: fermentable oligosaccharides, disaccharides, monosaccharides, and polyols; SIBO: small intestinal bacterial overgrowth
See this image and copyright information in PMC

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