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Review
. 2025 Feb 17:62:e24107.
doi: 10.1590/S0004-2803.24612024-107. eCollection 2025.

DIAGNOSIS AND TREATMENT OF SMALL INTESTINAL BACTERIAL OVERGROWTH: AN OFFICIAL POSITION PAPER FROM THE BRAZILIAN FEDERATION OF GASTROENTEROLOGY

Bruno César da Silva  1 , Gabriela Piovezani Ramos  2 , Luisa Leite Barros  3 , Ana Flávia Passos Ramos  4 , Gerson Domingues  5 , Décio Chinzon  3 , Maria do Carmo Friche Passos  4
Affiliations
Review

DIAGNOSIS AND TREATMENT OF SMALL INTESTINAL BACTERIAL OVERGROWTH: AN OFFICIAL POSITION PAPER FROM THE BRAZILIAN FEDERATION OF GASTROENTEROLOGY

Bruno César da Silva et al. Arq Gastroenterol. .

Abstract
in English, Portuguese

Background: Small intestinal bacterial overgrowth (SIBO) is a condition characterized by an abnormal increase in bacterial population in the small intestine, leading to symptoms such as bloating, abdominal pain, distension, diarrhea, and eventually malabsorption. The diagnosis and management of SIBO remain challenging due to overlapping symptoms with other gastrointestinal disorders such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), and coeliac disease.

Objective: This article aims to review current evidence on the diagnosis and treatment of SIBO, with a focus on strategies suitable for the Brazilian healthcare system.

Methods: A comprehensive literature review was performed, focusing on clinical guidelines, randomized controlled trials, and cohort studies concerning SIBO. Diagnostic methods, including breath tests and direct aspiration techniques, were critically analyzed. Treatment approaches, including antibiotics, dietary modifications, and probiotics, were reviewed. The recommendations were formulated based on a panel of gastroenterologists, members of the Brazilian Federation of Gastroenterology (FBG), with approval from the majority of the members.

Results: Breath tests using glucose and lactulose remain the most commonly used non-invasive diagnostic tools, though they are subject to limitations such as false positives and false negatives. Treatment with rifaximin is effective in most cases of SIBO, while systemic antibiotics like metronidazole and ciprofloxacin are alternatives. Probiotics and dietary interventions, particularly low FODMAP diets, can complement antibiotic therapy. Long-term follow-up is essential due to the recurrence rate, which is common in SIBO patients.

Conclusion: Standardizing SIBO diagnosis and treatment in Brazil is essential to reduce diagnostic delays and optimize care, especially given the disparities and heterogeneity in clinical practice across the country. This article provides evidence-based recommendations to guide clinical practice. Further research is needed to refine diagnostic methods, explore novel treatment strategies, and better understand the specific characteristics of the Brazilian population.

Contexto:: O supercrescimento bacteriano no intestino delgado (SIBO) é uma condição caracterizada por um aumento anormal da população bacteriana no intestino delgado, levando a sintomas como dor e inchaço abdominal, diarreia e, eventualmente, má absorção. O diagnóstico e o manejo do SIBO permanecem desafiadores devido à sobreposição de sintomas com outros distúrbios gastrointestinais, como doença inflamatória intestinal (DII), síndrome do intestino irritável (SII) e doença celíaca.

Objetivo:: Este artigo tem como objetivo revisar as evidências atuais sobre o diagnóstico e o tratamento do SIBO, com foco em estratégias adequadas ao sistema de saúde brasileiro.

Métodos:: Foi realizada uma revisão abrangente da literatura, com ênfase em diretrizes clínicas, ensaios clínicos randomizados e estudos de coorte relacionados ao SIBO. Métodos diagnósticos, incluindo testes respiratórios e técnicas de aspiração direta, foram analisados criticamente. Abordagens terapêuticas, como antibióticos, modificações dietéticas e probióticos, foram revisadas. As recomendações foram formuladas com base em um painel de gastroenterologistas, membros da Federação Brasileira de Gastroenterologia (FBG), com aprovação da maioria dos membros.

Resultados:: Os testes respiratórios com glicose e lactulose continuam sendo as ferramentas diagnósticas não invasivas mais utilizadas, embora apresentem limitações como falsos positivos e falsos negativos. O tratamento com rifaximina é eficaz na maioria dos casos de SIBO, enquanto antibióticos sistêmicos como metronidazol e ciprofloxacino são alternativas. Probióticos e intervenções dietéticas, especialmente dietas com baixo teor de FODMAP, podem complementar a terapia antibiótica. O acompanhamento de longo prazo é essencial devido à alta taxa de recorrência, que é comum em pacientes com SIBO.

Conclusão:: Padronizar o diagnóstico e o tratamento do SIBO no Brasil é essencial para reduzir atrasos diagnósticos e otimizar os cuidados, especialmente considerando as disparidades e a heterogeneidade na prática clínica no país. Este artigo apresenta recomendações baseadas em evidências para orientar a prática clínica. Mais pesquisas são necessárias para aprimorar os métodos diagnósticos, explorar novas estratégias de tratamento e compreender melhor as características específicas da população brasileira.

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Conflict of interest statement

Declared conflict of interest of all authors: none

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