Small Intestinal Bacterial Overgrowth: How to Diagnose and Treat (and Then Treat Again)

Gastroenterol Clin North Am. 2020 Sep;49(3):571-587. doi: 10.1016/j.gtc.2020.04.010. Epub 2020 Jun 14.

Abstract

Small intestinal bacterial overgrowth (SIBO) is a condition with presentation that can vary from asymptomatic to steatorrhea and malnutrition. Small bowel aspiration and culture is the current gold standard of diagnosis; however, this is invasive and is not without risk to the patient. Breath testing is a noninvasive and less expensive alternative method; however, it lacks diagnostic sensitivity and specificity. Novel diagnostic methods being studied include gas-sensing capsules. The mainstay of treatment is antibiotics; alternative therapies include herbal medications, dietary modifications, and prokinetic agents. Further investigation into less invasive and less harmful diagnostic methods and treatment options is warranted.

Keywords: Diagnosis; Pathophysiology; Review; SIBO; Treatment.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / administration & dosage
  • Diet Therapy / methods
  • Drugs, Chinese Herbal / administration & dosage
  • Dysbiosis / diagnosis*
  • Dysbiosis / microbiology*
  • Dysbiosis / therapy*
  • Humans
  • Intestinal Diseases / diagnosis*
  • Intestinal Diseases / microbiology*
  • Intestinal Diseases / therapy*
  • Intestine, Small / microbiology*
  • Kinetics

Substances

  • Anti-Bacterial Agents
  • Drugs, Chinese Herbal