![]() In this comprehensive review, we will provide a current and up-to-date review of small intestinal bacterial overgrowth, including prevalence, symptomology, predisposing risk factors, the evolution of diagnostic testing, and the latest in available treatment options while focusing on their interface with diet and nutrition. Previously used jejunal aspirates and duodenal fluid analyses have been replaced by breath tests, while newly published guidelines provide a clearer picture of how to interpret diagnostic data, such as breath testing. However, much has changed recently in our understanding of SIBO and how to approach treatment. Much of the controversy surrounding the diagnosis stems from the wide-ranging clinical presentations and substantial overlap with other heterogeneous diagnoses, with irritable bowel syndrome (IBS) being the most cited example. The ambiguity surrounding SIBO is compounded by the lack of consensus when it comes to diagnosing and treating the condition. However, it has recently gained traction as a viable explanation for a wide variety of gastrointestinal manifestations. ![]() Historically, SIBO was widely considered a controversial and contested diagnosis. ![]() Small intestinal bacterial overgrowth (SIBO) is a well-recognized cause of maldigestion and malabsorption worldwide. 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. However, due to its invasive nature, it remains an unpopular method among patients and clinicians alike. 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. 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. Pregnant x.Small intestinal bacterial overgrowth (SIBO) is a commonly diagnosed gastrointestinal disorder affecting millions of individuals throughout the United States. Contraindication for upper endoscopy for any reason viii. Use of probiotics in the past 30 days vii. Use of antibiotics in the past 30 days vi. Use of colon cleansing prep in the past 1 month v. Gastric surgery with vagotomy (Bilroth I, Bilroth II, vagotomy/pyloroplasty) or gastric bypass iv. Surgery with decreased gastric acid exposure for small bowel a.Small bowel blind limb, diverticulum or fistula.Resection of ileocecal valve for any reason.Connective tissue disorder (scleroderma, polymyositis, mixed connective tissue disease, or systemic lupus.Established risk factors for SIBO (ANY of the following) ![]() Patients who are undergoing double balloon enteroscopy or upper enteroscopy for another medical reason.Įxclusion Criteria i. Unable to give own informed consentĢ Control Subjects Inclusion Criteria i. Contraindication for upper endoscopy for any reason v. Use of probiotics in the past 30 days iv. Treatment with antibiotics in the past 30 days (antibiotics are allowable for patients undergoing clinical indicated repeat aspiration to determine bacteria clearance) iii. Use of colon cleansing prep in the past 1 month ii. All patients who are undergoing small bowel aspiration for suspected SIBO regardless etiology.Įxclusion Criteria i. Why Should I Register and Submit Results?ġ.Study Subjects Inclusion Criteria i.
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