How to Test and Treat Small Intestinal Bacterial Overgrowth: an Evidence-Based Approach

Ali Rezaie, Mark Pimentel, Satish S. Rao

Research output: Contribution to journalReview article

47 Citations (Scopus)

Abstract

Small intestinal bacterial overgrowth (SIBO) is characterized by an excessive amount of bacteria in the small intestine and a constellation of symptoms that include bloating, pain, gas, and diarrhea. Although known for many decades, there is a lack of consensus and clarity regarding the natural history and methods for its diagnosis. Several tests have been proposed, including the glucose breath test, lactulose breath test, small intestinal aspiration and culture, and others. However, there is a lack of standardization of these tests and their interpretation. Treatment of SIBO remains empirical; generally, broad spectrum antibiotics are recommended for 2 weeks (amoxicillin, rifaximin, ciprofloxacin, etc.) but evidence for their use is fair. Clearly, there is a strong need to develop a systematic approach for the management of SIBO and to perform multicenter clinical trials for the treatment of SIBO. In this review, we will discuss the current evidence for the diagnosis and treatment of SIBO, which includes (1) elimination/modification of the underlying causes, (2) induction of remission (antibiotics and elemental diet), and (3) maintenance of remission (promotility drugs, dietary modifications, repeat or cyclical antibiotics).

Original languageEnglish (US)
Article number8
Pages (from-to)1-11
Number of pages11
JournalCurrent Gastroenterology Reports
Volume18
Issue number2
DOIs
StatePublished - Jan 1 2016

Fingerprint

Breath Tests
Anti-Bacterial Agents
rifaximin
Diet Therapy
Lactulose
Formulated Food
Remission Induction
Amoxicillin
Ciprofloxacin
Natural History
Multicenter Studies
Small Intestine
Diarrhea
Consensus
Therapeutics
Gases
Maintenance
Clinical Trials
Bacteria
Glucose

Keywords

  • Antibiotics
  • Elemental diet
  • Glucose breath test
  • Lactulose breath test
  • Promotility drugs
  • Small intestinal aspiration and culture
  • Small intestinal bacterial overgrowth (SIBO)

ASJC Scopus subject areas

  • Gastroenterology

Cite this

How to Test and Treat Small Intestinal Bacterial Overgrowth : an Evidence-Based Approach. / Rezaie, Ali; Pimentel, Mark; Rao, Satish S.

In: Current Gastroenterology Reports, Vol. 18, No. 2, 8, 01.01.2016, p. 1-11.

Research output: Contribution to journalReview article

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