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Neurogastroenterol Motil. 2018 Nov;30(11):e13494. doi: 10.1111/nmo.13494.

The diagnosis of small intestinal bacterial overgrowth: Two steps forward, one step backwards?

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First Department of Internal Medicine, IRCCS S. Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
Lynda K and David M Underwood Center for Digestive Disorders, Division of Gastroenterology and Hepatology, Houston Methodist Hospital and Weill Cornell Medical College, Houston, Texas.


Small intestinal bacterial overgrowth (SIBO) was originally described decades ago as a cause of malabsorption among individuals with abnormal intestinal anatomy and/or impaired gastric acid secretion and intestinal motor functions. More recently, the concept of SIBO has been expanded to explain symptoms among a much broader patient population-a move that brings the definition of SIBO into much sharper focus. For largely logistical reasons, breath tests and, especially, those based on the excretion of hydrogen consequent on the fermentation of unabsorbed carbohydrate substrates, have almost entirely replaced jejunal aspirates in the diagnosis of SIBO. Ever bedeviled by concerns regarding their reliability, hydrogen breath tests have now come under even more critical scrutiny with the study from Sundin and colleagues in this issue suggesting that their sole function is to detect carbohydrate malabsorption and that they are incapable of defining SIBO.


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