Small Intestinal Bacterial Overgrowth: Clinical Features and Therapeutic Management

Satish S.C. Rao, Jigar Bhagatwala

Research output: Contribution to journalArticle

Abstract

Small intestinal bacterial overgrowth (SIBO) is a common, yet underrecognized, problem. Its prevalence is unknown because SIBO requires diagnostic testing. Although abdominal bloating, gas, distension, and diarrhea are common symptoms, they do not predict positive diagnosis. Predisposing factors include proton-pump inhibitors, opioids, gastric bypass, colectomy, and dysmotility. Small bowel aspirate/culture with growth of 10-10 cfu/mL is generally accepted as the "best diagnostic method," but it is invasive. Glucose or lactulose breath testing is noninvasive but an indirect method that requires further standardization and validation for SIBO. Treatment, usually with antibiotics, aims to provide symptom relief through eradication of bacteria in the small intestine. Limited numbers of controlled studies have shown systemic antibiotics (norfloxacin and metronidazole) to be efficacious. However, 15 studies have shown rifaximin, a nonsystemic antibiotic, to be effective against SIBO and well tolerated. Through improved awareness and scientific rigor, the SIBO landscape is poised for transformation.

Original languageEnglish (US)
Pages (from-to)e00078
JournalClinical and translational gastroenterology
Volume10
Issue number10
DOIs
StatePublished - Oct 1 2019

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Anti-Bacterial Agents
rifaximin
Lactulose
Norfloxacin
Gastric Bypass
Colectomy
Proton Pump Inhibitors
Metronidazole
Causality
Opioid Analgesics
Small Intestine
Diarrhea
Therapeutics
Gases
Bacteria
Glucose
Growth

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Small Intestinal Bacterial Overgrowth : Clinical Features and Therapeutic Management. / Rao, Satish S.C.; Bhagatwala, Jigar.

In: Clinical and translational gastroenterology, Vol. 10, No. 10, 01.10.2019, p. e00078.

Research output: Contribution to journalArticle

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