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

Authors


  • This uncommissioned review article was subject to full peer-review.

Correspondence to:

Dr H. J. N. Andreyev, The GI Unit, Department of Medicine, The Royal Marsden NHS Foundation Trust, London, UK.

E-mail: j@andreyev.demon.co.uk

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 abstracts. 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.

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