Review article: small intestinal bacterial overgrowth – prevalence, clinical features, current and developing diagnostic tests, and treatment

• Published in: Alimentary pharmacology & therapeutics Vol. 38; no. 7; pp. 674 - 688
• Main Authors: Grace, E., Shaw, C., Whelan, K., Andreyev, H. J. N.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell 01.10.2013
• Subjects: Animals; Anti-Bacterial Agents - therapeutic use; Bacteria; Bacterial diseases; Bacterial Infections - diagnosis; Bacterial Infections - epidemiology; Bacterial Infections - therapy; Biological and medical sciences; Diagnostic Tests, Routine - methods; Human bacterial diseases; Humans; Infectious diseases; Intestine, Small - microbiology; Medical sciences; Miscellaneous; Prevalence; Human; Prevalence; Digestive system; Gut; Clinical form; Review; Epidemiology; Infection; Overgrowth syndrome; Treatment; Bacteriosis; Bacteria; Diagnosis; Bibliographic review
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.12456

Summary Background The symptoms and signs of small intestinal bacterial overgrowth (SIBO) are often identical to a variety of diseases and can lead to diagnostic confusion. Aims To review the diagnostic options for SIBO and present new investigative options for the condition. Methods A literature search was performed on MEDLINE, EMBASE and Web of Science for English articles and s. Search terms included free text words and combinations of the following terms ‘small intestinal bacterial overgrowth’, ‘small bowel bacterial overgrowth’, ‘diagnostic tests’, ‘treatment’, ‘antibiotics’, ‘probiotics’, ‘metabonomics’, ‘proton nuclear magnetic resonance spectroscopy’, ‘electronic nose’ and ‘field asymmetric ion mobility spectrometry’. Results All of the available methods to test for SIBO have inherent limitations and no ‘gold‐standard’ diagnostic test for the condition exists. Accurate diagnosis of SIBO requires identification of bacterial species growing inappropriately within the small intestine and symptom response to antibiotics. Proton nuclear magnetic resonance spectroscopy, electronic nose technology and/or field asymmetric ion mobility spectrometry may represent better investigative options for the condition. Conclusions Novel diagnostic options are needed to supplement or replace available tests.