TY - JOUR
T1 - Small Intestinal Fungal Overgrowth
AU - Erdogan, Askin
AU - Rao, Satish Sanku Chander
PY - 2015/4/1
Y1 - 2015/4/1
N2 - Small intestinal fungal overgrowth (SIFO) is characterized by the presence of excessive number of fungal organisms in the small intestine associated with gastrointestinal (GI) symptoms. Candidiasis is known to cause GI symptoms particularly in immunocompromised patients or those receiving steroids or antibiotics. However, only recently, there is emerging literature that an overgrowth of fungus in the small intestine of non-immunocompromised subjects may cause unexplained GI symptoms. Two recent studies showed that 26 % (24/94) and 25.3 % (38/150) of a series of patients with unexplained GI symptoms had SIFO. The most common symptoms observed in these patients were belching, bloating, indigestion, nausea, diarrhea, and gas. The underlying mechanism(s) that predisposes to SIFO is unclear but small intestinal dysmotility and use of proton pump inhibitors has been implicated. However, further studies are needed; both to confirm these observations and to examine the clinical relevance of fungal overgrowth, both in healthy subjects and in patients with otherwise unexplained GI symptoms. Importantly, whether eradication or its treatment leads to resolution of symptoms remains unclear; at present, a 2–3-week course of antifungal therapy is recommended and may be effective in improving symptoms, but evidence for eradication is lacking.
AB - Small intestinal fungal overgrowth (SIFO) is characterized by the presence of excessive number of fungal organisms in the small intestine associated with gastrointestinal (GI) symptoms. Candidiasis is known to cause GI symptoms particularly in immunocompromised patients or those receiving steroids or antibiotics. However, only recently, there is emerging literature that an overgrowth of fungus in the small intestine of non-immunocompromised subjects may cause unexplained GI symptoms. Two recent studies showed that 26 % (24/94) and 25.3 % (38/150) of a series of patients with unexplained GI symptoms had SIFO. The most common symptoms observed in these patients were belching, bloating, indigestion, nausea, diarrhea, and gas. The underlying mechanism(s) that predisposes to SIFO is unclear but small intestinal dysmotility and use of proton pump inhibitors has been implicated. However, further studies are needed; both to confirm these observations and to examine the clinical relevance of fungal overgrowth, both in healthy subjects and in patients with otherwise unexplained GI symptoms. Importantly, whether eradication or its treatment leads to resolution of symptoms remains unclear; at present, a 2–3-week course of antifungal therapy is recommended and may be effective in improving symptoms, but evidence for eradication is lacking.
KW - Diagnosis
KW - Duodenal culture
KW - Fungal overgrowth
KW - Review
KW - Small intestine
KW - Symptoms
KW - Treatment
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U2 - 10.1007/s11894-015-0436-2
DO - 10.1007/s11894-015-0436-2
M3 - Review article
C2 - 25786900
AN - SCOPUS:84925950099
SN - 1522-8037
VL - 17
JO - Current Gastroenterology Reports
JF - Current Gastroenterology Reports
IS - 4
ER -