TY - JOUR
T1 - How to Test and Treat Small Intestinal Bacterial Overgrowth
T2 - an Evidence-Based Approach
AU - Rezaie, Ali
AU - Pimentel, Mark
AU - Rao, Satish S.
N1 - Publisher Copyright:
© 2016, Springer Science+Business Media New York.
Copyright:
Copyright 2016 Elsevier B.V., All rights reserved.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - 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).
AB - 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).
KW - Antibiotics
KW - Elemental diet
KW - Glucose breath test
KW - Lactulose breath test
KW - Promotility drugs
KW - Small intestinal aspiration and culture
KW - Small intestinal bacterial overgrowth (SIBO)
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U2 - 10.1007/s11894-015-0482-9
DO - 10.1007/s11894-015-0482-9
M3 - Review article
C2 - 26780631
AN - SCOPUS:84958245306
SN - 1522-8037
VL - 18
SP - 1
EP - 11
JO - Current Gastroenterology Reports
JF - Current Gastroenterology Reports
IS - 2
M1 - 8
ER -