SIBO and intestinal health: clinical implications of an altered microbiota
DOI:
https://doi.org/10.56294/shp2025201Keywords:
bacteria, diagnosis, symptoms, treatment, testAbstract
Small intestinal bacterial overgrowth (SIBO) was described as a condition characterised by an abnormal increase of bacteria in the small intestine, frequently associated with non-specific gastrointestinal symptoms. Over the years, its study has been deepened thanks to advances in diagnostic techniques and in the knowledge of its pathophysiology. Predisposing factors such as hypochlorhydria and anatomical or motility alterations were identified. In diagnosis, although jejunal aspirate culture remained the reference method, breath tests were widely used because of their accessibility, despite their limitations. The interpretation of these results was complex and the need to standardise criteria to avoid diagnostic errors and unnecessary treatments was emphasised. Continuous medical training and a comprehensive clinical approach were fundamental for the adequate management of SIBO.
References
1. Baker JR, Chey WD, Watts L, Armstrong M, Collins K, Lee AA, et al. How the North American Consensus Protocol Affects the Performance of Glucose Breath Testing for Bacterial Overgrowth Versus a Traditional Method. Am J Gastroenterol. 2021 Apr;116(4):780–7. doi: 10.14309/ajg.0000000000001110. PMID: 33982948.
2. Bures J, Cyrany J, Kohoutova D, Förstl M, Rejchrt S, Kvetina J, et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010 Jun 28;16(24):2978–90. doi: 10.3748/wjg.v16.i24.2978. PMID: 20572300; PMCID: PMC2890937.
3. Bushyhead D, Quigley EM. Small Intestinal Bacterial Overgrowth. Gastroenterol Clin North Am. 2021 Jun;50(2):463–74. doi: 10.1016/j.gtc.2021.02.008. PMID: 34024452.
4. Bushyhead D, Quigley EMM. Small Intestinal Bacterial Overgrowth-Pathophysiology and Its Implications for Definition and Management. Gastroenterology. 2022 Sep;163(3):593–607. doi: 10.1053/j.gastro.2022.04.002. PMID: 35398346.
5. Chatterjee S, Park S, Low K, Kong Y, Pimentel M. The degree of breath methane production in IBS correlates with the severity of constipation. Am J Gastroenterol. 2007 Apr;102(4):837–41. doi: 10.1111/j.1572-0241.2007.01072.x. PMID: 17397408.
6. Gabrielli M, D'Angelo G, Di Rienzo T, Scarpellini E, Ojetti V. Diagnosis of small intestinal bacterial overgrowth in the clinical practice. Eur Rev Med Pharmacol Sci. 2013;17 Suppl 2:30–5. PMID: 24443065.
7. Gasbarrini A, Corazza GR, Gasbarrini G, Montalto M, Di Stefano M, Basilisco G, et al.; 1st Rome H2-Breath Testing Consensus Conference Working Group. Methodology and indications of H2-breath testing in gastrointestinal diseases: the Rome Consensus Conference. Aliment Pharmacol Ther. 2009 Mar 30;29 Suppl 1:1–49. doi: 10.1111/j.1365-2036.2009.03951.x. Erratum in: Aliment Pharmacol Ther. 2010 Jan;31(1):166. Satta PU [corrected to Usai-Satta P]. PMID: 19344474.
8. Ghoshal UC, Nehra A, Mathur A, Rai S. A meta-analysis on small intestinal bacterial overgrowth in patients with different subtypes of irritable bowel syndrome. J Gastroenterol Hepatol. 2020 Jun;35(6):922–31. doi: 10.1111/jgh.14938. PMID: 31750966.
9. Khoshini R, Dai SC, Lezcano S, Pimentel M. A systematic review of diagnostic tests for small intestinal bacterial overgrowth. Dig Dis Sci. 2008 Jun;53(6):1443–54. doi: 10.1007/s10620-007-0065-1. PMID: 17990113.
10. Leite G, Rezaie A, Mathur R, Barlow GM, Rashid M, Hosseini A, et al.; REIMAGINE Study Group. Defining Small Intestinal Bacterial Overgrowth by Culture and High Throughput Sequencing. Clin Gastroenterol Hepatol. 2024 Feb;22(2):259–70. doi: 10.1016/j.cgh.2023.06.001. PMID: 37315761.
11. Losurdo G, Leandro G, Ierardi E, Perri F, Barone M, Principi M, et al. Breath Tests for the Non-invasive Diagnosis of Small Intestinal Bacterial Overgrowth: A Systematic Review With Meta-analysis. J Neurogastroenterol Motil. 2020 Jan 30;26(1):16–28. doi: 10.5056/jnm19113. PMID: 31743632.
12. Magge S, Lembo A. Low-FODMAP Diet for Treatment of Irritable Bowel Syndrome. Gastroenterol Hepatol (N Y). 2012 Nov;8(11):739–45. PMID: 24672410; PMCID: PMC3966170.
13. Martín Domínguez V, Malagelada C, Santander C. Small intestinal bacterial overgrowth. A position paper of ASENEM-SEPD. Rev Esp Enferm Dig. 2023 Dec;115(12):679–81. doi: 10.17235/reed.2023.10027/2023. PMID: 37982553.
14. Quigley EMM. The Spectrum of Small Intestinal Bacterial Overgrowth (SIBO). Curr Gastroenterol Rep. 2019 Jan 15;21(1):3. doi: 10.1007/s11894-019-0671-z. PMID: 30645678.
15. Quigley EMM, Murray JA, Pimentel M. AGA Clinical Practice Update on Small Intestinal Bacterial Overgrowth: Expert Review. Gastroenterology. 2020 Oct;159(4):1526–32. doi: 10.1053/j.gastro.2020.06.090. PMID: 32679220.
16. Rao SSC, Bhagatwala J. Small Intestinal Bacterial Overgrowth: Clinical Features and Therapeutic Management. Clin Transl Gastroenterol. 2019 Oct;10(10):e00078. doi: 10.14309/ctg.0000000000000078. PMID: 31584459; PMCID: PMC6884350.
17. Ruscio M. Is SIBO A Real Condition? Altern Ther Health Med. 2019 Sep;25(5):30–8. PMID: 31550680.
18. Suárez Terán J, Guarner Aguilar F. Small Intestinal Bacterial Overgrowth (SIBO), a clinically overdiagnosed entity? Gastroenterol Hepatol. 2024 May 6:S0210-5705(24)00148-1. doi: 10.1016/j.gastrohep.2024.502190. PMID: 38719183.
19. Codoceo Alquinta R, Muñoz Codoceo C, Ariza Astolfi MJ, Muñoz Codoceo RA. Test del hidrógeno (H) espirado: Metodología e indicaciones [Internet]. Seghnp.org. [citado el 16 de octubre de 2024]. Disponible en: https://www.seghnp.org/sites/default/files/2020-02/Test%20hidrogeno%20espirado_2.pdf.
Published
Issue
Section
License
Copyright (c) 2025 Michelle Jésica Saín, Diego Balcarce (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
The article is distributed under the Creative Commons Attribution 4.0 License. Unless otherwise stated, associated published material is distributed under the same licence.
