Historically, most human studies of the gut microbiome have been based on fecal studies that provide valuable information on the large intestine microbiome, but they fall short in answering key questions regarding bacteria inhabiting the small intestine. However, one can say we are still at the infancy stages, as much has to be learned about the microbiome outside of the colon. The current understanding of the human microbiome has progressed rapidly over recent years. Gaining a better understanding of the small intestinal microbiome has proven to be key in unraveling SIBO, as it helps clinicians determine the validity of any diagnostic method used to screen for this condition. In this comprehensive review, we will provide a current and up-to-date review of small intestinal bacterial overgrowth, including prevalence, symptomology, predisposing risk factors, the evolution of diagnostic testing, and the latest in available treatment options while focusing on their interface with diet and nutrition.
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Previously used jejunal aspirates and duodenal fluid analyses have been replaced by breath tests, while newly published guidelines provide a clearer picture of how to interpret diagnostic data, such as breath testing. However, much has changed recently in our understanding of SIBO and how to approach treatment.
Much of the controversy surrounding the diagnosis stems from the wide-ranging clinical presentations and substantial overlap with other heterogeneous diagnoses, with irritable bowel syndrome (IBS) being the most cited example. The ambiguity surrounding SIBO is compounded by the lack of consensus when it comes to diagnosing and treating the condition. However, it has recently gained traction as a viable explanation for a wide variety of gastrointestinal manifestations. Historically, SIBO was widely considered a controversial and contested diagnosis. Small intestinal bacterial overgrowth (SIBO) is a well-recognized cause of maldigestion and malabsorption worldwide. Glucose and lactulose breath testing have become the go-to diagnostic method in clinical practice due to its noninvasive nature and low cost. Treatment is guided towards the eradication of bacteria in the small bowel and usually consists of a prolonged course of oral antibiotics. Due to recent advances in our understanding of the human microbiome, we are surely poised for a transformation in our approach to diagnosing and treating this condition. However, due to its invasive nature, it remains an unpopular method among patients and clinicians alike. Symptoms observed in SIBO, including abdominal distension, bloating, diarrhea, and gas formation, are nonspecific and can overlap with other gastrointestinal disorders. Frequently cited predisposing factors include gastric acid suppression, dysmotility, gastric bypass, and opioids. The diagnostic gold standard remains small bowel aspirate and culture. It refers to a condition in which there is an excess and imbalance of small intestinal bacteria. Despite its prevalence, it remains underdiagnosed due to the invasive nature of diagnostic testing.
Small intestinal bacterial overgrowth (SIBO) is a commonly diagnosed gastrointestinal disorder affecting millions of individuals throughout the United States.
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