title: How to Test and Treat Small Intestinal Bacterial Overgrowth: an Evidence-Based Approach.
abstract: 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).
authors.affiliation: GI Motility Program, Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, 8730 Alden Drive, Thalians Bldg, #E226, Los Angeles, CA, 90048, USA. Ali.Rezaie@cshs.org.|David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, USA. Ali.Rezaie@cshs.org.
authors.forename: Ali
authors.initials: A
authors.lastname: Rezaie
authors.affiliation: GI Motility Program, Division of Gastroenterology, Department of Medicine, Cedars-Sinai Medical Center, 8730 Alden Drive, Thalians Bldg, #E226, Los Angeles, CA, 90048, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Pimentel
authors.affiliation: Division of Gastroenterology/Hepatology, Medical College of Georgia, Augusta University, Augusta, GA, USA.
authors.forename: Satish S
authors.initials: SS
authors.lastname: Rao
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001431:Bacteriological Techniques / Q000379:methods; D001765:Blind Loop Syndrome / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*; D001944:Breath Tests / Q000379:methods; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D007421:Intestine, Small / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Elemental diet; Glucose breath test; Lactulose breath test; Promotility drugs; Small intestinal aspiration and culture; Small intestinal bacterial overgrowth (SIBO)